[Use of urokinase in the occlusion of the vascular access routes in chronic hemodialysis. 7 years' experience]. / Uso dell'urochinasi nell'occlusione di accessi vascolari per emodialisi cronica. Sette anni di esperienza.

Pharmacological treatment with urokinase in obstructions of vascular accesses due to chronic dialysis is a tried and tested technique. Retrospective investigation of a group of 111 cases treated with urokinase makes it possible to calculate the actuarial survival curve of vascular access in the period subsequent to fibrinolytic treatment. Mathematical analysis provides a precise indication to the use of the drug in thromboses of a-v fistulas and anatomically unimpaired vascular prothesies. In the presence of stenosis of a-v anastomosis, pharmacological thrombolysis permits restoration of a blood flow suitable to the conduction of haemodialytic treatment for a period useful to surgical correction. Infusion of urokinase is useless in cases of vascular prosthesis thrombosis complicated by the presence of stenosis of the lumen.

Acute renal failure in preeclampsia-eclampsia.

Acute renal failure (ARF) is regarded as relatively uncommon in preeclampsia-eclampsia (PE-E) and, in any event, of moderate degree or reversible. Cortical necrosis is reported as rare, even in fatal cases. Little light has as yet been shed on the mechanisms responsible for ARF in PE-E. This paper describes 17 cases observed over the last 15 years, in which cortical necrosis (3 histological and 2 clinical diagnoses) was relatively frequent (29.4%). The severity of renal impairment did not appear to be related to chronological age, parity, period of pregnancy in which PE-E commenced and its duration prior to delivery, presence of frank eclamptic crises or the concomitance of earlier vascular or renal disease (p greater than 0.05). The superimposition of abruptio placentae (AP) was the only clinical factor significantly correlated with cortical necrosis (p greater than 0.05). The association PE-E + AP seems to be a particularly unfavorable prognostic sign for the kidney owing to the contribution of additional damage mechanisms (vasospasm, disseminated intravascular coagulation, hemorrhagic shock) furnished by AP, while PE-E itself prepares the ground for AP. The fact that PE-E is difficult to diagnose when AP is the onset symptom may be responsible for the underestimation of its contribution towards the induction of severe renal damage.