The infant (a girl aged 6 months) was admitted to the hospital because of oliguria and acute renal dysfunction. The laboratory examination results showed serious metabolic acidosis and increased blood urea nitrogen and serum creatinine levels. The patient continued to be anuric after 10 days of treatment with continuous renal replacement therapy (CRRT). she died a day later. The family history showed that the patient's sister died of acute renal failure 6 months after birth. The genomic sequencing results showed AGXT mutation in the patient and confirmed the diagnosis of primary hyperoxaluria type 1 (PH1). Her parents were heterozygous carriers. PH1 should be considered when the children have abnormal renal function or recurrent renal calculi or have a family history of these symptoms. AGXT gene analysis is an important method for PH1 diagnosis.
Acute Kidney Injury ; etiology ; Female ; Humans ; Hyperoxaluria, Primary ; complications ; Infant ; Mutation ; Oliguria ; etiology ; Transaminases ; genetics

OBJECTIVE: To explore the influence of intraoperative urine volume on postoperative acute kidney injury (AKI) and the independent risk factors of AKI. METHODS: This was a retrospective cohort study recruiting patients who received selective pulmonary resection under general anesthesia in Peking University First Hospital from July, 2017 to June, 2019. The patients were divided into the AKI group and the control group according to whether they developed postoperative AKI or not. Firstly, univariate analysis was used to analyze the relationship between perioperative variables and postoperative AKI. Secondly, receiver operating characteristic (ROC) curve was used to explore the predictive value of intraoperative urine output for postoperative AKI. The nearest four cutoff values [with the interval of 0.1 mL/(kg·h)] at maximum Youden index were used as cutoff values of oliguria. Then univariate analysis was used to explore the relationship between oliguria defined by these four cutoff values and the risk of AKI. And the cutoff value with maximum OR was chosen as the threshold of oliguria in this study. Lastly, the variables with P < 0.10 in the univariate analysis were selected for inclusion in a multivariate Logistic model to analyze the independent predictors of postoperative AKI. RESULTS: A total of 1 393 patients were enrolled in the study. The incidence of postoperative AKI was 2.2%. ROC curve analysis showed that the area under curve (AUC) of intraoperative urine volume used for predicting postoperative AKI was 0.636 (P=0.009), and the cutoff value of oliguria was 0.785 mL/(kg·h) when Youden index was maximum (Youden index =0.234, sensitivity =48.4%, specificity =75.0%). Furthermore, 0.7, 0.8, 0.9, 1.0 mL/(kg·h) and the traditional cutoff value of 0.5 mL/(kg·h) were used to analyze the influence of oliguria on postoperative AKI. Univariate analysis showed that, when 0.8 mL/(kg·h) was selected as the threshold of oliguria, the patients with oliguria had the most significantly increased risk of AKI (AKI group 48.4% vs. control group 25.3%, OR=2.774, 95%CI 1.357－5.671, P=0.004). Multivariate regression analysis showed that intraoperative urine output < 0.8 mL/(kg·h) was one of the independent risk factors of postoperative AKI (OR=2.698, 95%CI 1.260－5.778, P=0.011). The other two were preoperative hemoglobin ≤120.0 g/L (OR=3.605, 95%CI 1.545－8.412, P=0.003) and preoperative estimated glomerular filtration rate < 30 mL/(min·1.73 m²) (OR=11.009, 95%CI 1.813－66.843, P=0.009). CONCLUSION Oliguria is an independent risk fact or of postoperative AKI after pulmonary resection, and urine volume < 0.8 mL/(kg·h) is a possible screening criterium.
Acute Kidney Injury/etiology* ; Humans ; Lung ; Oliguria/etiology* ; Postoperative Complications/etiology* ; Postoperative Period ; Retrospective Studies ; Risk Factors

Gastrointestinal complications, especially duodenal complication after cardiopulmonary bypass are rare, but often fatal. We experienced 1 case of duodenal ulcer bleeding and 2 cases of duodenal ulcer perforation developing after cardiopulmonary bypass from August 1994 to April 1996. In the case of duodenal ulcer bleeding, palpitation, dizziness, tachycardia and melena were the clues leading to diagnosis, and in the cases of perforation, abdominal distension with pain, tachycardia, hypotension, oliguria were the clues. Duodenal perforations were diagnosed by abdominal paracentesis. The patient with duodenal bleeding was treated by H-2 receptor antagonist, antacids and transfusion. And emergency laparotomy was required for the patients with duodenal perforation. In addition to ulcer prophylaxis including H-2 receptor antagonist and antacids, a high index of suspicion and timely surgery are necessary for early diagnosis and appropriate treatment of duodenal complication developing after cardiopulmonary bypass.
Antacids ; Cardiopulmonary Bypass ; Diagnosis ; Dizziness ; Duodenal Ulcer ; Early Diagnosis ; Emergencies ; Heart* ; Hemorrhage ; Humans ; Hypotension ; Laparotomy ; Melena ; Oliguria ; Paracentesis ; Postoperative Complications ; Tachycardia ; Thoracic Surgery* ; Ulcer

Hepatitis A virus infection is the most common cause of acute hepatitis but is rarely reported during pregnancy. We report a case of acute hepatitis A in a 28-year old pregnant woman at 40 weeks of gestation. Her initial complaint was fever. Three days after, she developed spontaneous labor and delivered a healthy baby vaginally. Her laboratory examination showed thrombocytopenia, elevated D-dimer and decreased Fibrinogen level as well as markedly elevated liver enzymes. In addition, oliguria and pulmonary effusion were also noted. Hepatitis A infection during pregnancy may be associated with development of labor. And the differential diagnosis with preeclampsia and acute fatty liver of pregnancy is very important for the management.
Diagnosis, Differential ; Fatty Liver ; Female ; Fever ; Fibrin Fibrinogen Degradation Products ; Fibrinogen ; Hepatitis ; Hepatitis A ; Hepatitis A virus ; Humans ; Liver ; Oliguria ; Pre-Eclampsia ; Pregnancy ; Pregnancy Complications ; Pregnant Women ; Thrombocytopenia

INTRODUCTIONLymphoedema results from impaired lymphatic transport leading to the pathologic accumulation of protein-rich lymphatic fluid in the interstitial space, most commonly in the extremities. Primary lymphoedema, a developmental abnormality of the lymphatic system, may become evident later in life when a triggering event exceeds the capacity of normal lymphatic flow.

CLINICAL PICTUREWe present a 3-year-old nephrotic syndrome patient with an unusual localisation for primary lymphoedema.

TREATMENT AND OUTCOMEThe patient was treated with conservative approach and she was cured.

CONCLUSIONIn this particular case, lymphoedema developed at an unusual localisation, which has not been recorded before.

Albumins ; administration & dosage ; Child, Preschool ; Diuretics ; administration & dosage ; Female ; Furosemide ; administration & dosage ; Humans ; Infusions, Intravenous ; Lymphedema ; drug therapy ; etiology ; Nephrotic Syndrome ; complications ; Oliguria ; etiology

Ultrasound-guided cannulation of a large-bore catheter into the internal jugular vein was performed to provide temporary hemodialysis vascular access for uremia in a 65-yr-old woman with acute renal failure and sepsis superimposed on chronic renal failure. Despite the absence of any clinical evidence such as bleeding or hematoma during the procedure, a chest x-ray and computed tomographic angiogram of the neck showed that the catheter had inadvertently been inserted into the subclavian artery. Without immediately removing the catheter and applying manual external compression, the arterial misplacement of the hemodialysis catheter was successfully managed by open surgical repair. The present case suggests that attention needs to be paid to preventing iatrogenic arterial cannulation during central vein catheterization with a large-bore catheter and to the management of its potentially devastating complications, since central vein catheterization is frequently performed by nephrologists as a common clinical procedure to provide temporary hemodialysis vascular access.
Acidosis/complications ; Acute Disease ; Aged ; Catheterization, Central Venous/*adverse effects ; Female ; Hemorrhage/etiology ; Humans ; Kidney Failure, Chronic/*diagnosis ; Medical Errors/*prevention & control ; Oliguria/complications ; Renal Dialysis ; Sepsis/etiology ; Subclavian Artery/injuries/*radiography/surgery ; Tomography, X-Ray Computed ; Uremia/etiology

No abstract available.
Aged ; Colitis, Ischemic/complications/*diagnosis/therapy ; Cystitis/*diagnosis/etiology ; Dehydration/etiology ; Diarrhea/etiology ; Female ; Fluid Therapy ; Humans ; Hydronephrosis/*diagnosis/etiology ; Oliguria/etiology ; Predictive Value of Tests ; Radiation Injuries/*diagnosis/etiology ; Tomography, X-Ray Computed

From May, 1975 to August, 1986, we experienced 21 patients with ruptured aneurysm of the sinus of Valsalva. 1) Their ages ranged from 15 to 52 years with a mean age of 26.7 years, and 14 patients were male and 7 patients were female. Among 18 cases of which aneurysms occurred on the right sinus of Valsalva, 15 cases (83%) ruptured into the right ventricle, 1 case (6%) ruptured into the right atrium and 2 cases (11%) ruptured into the pulmonary artery. All 3 cases of which aneurysms occurred on the noncoronary sinus ruptured into the right atrium. 2) Clinical symptoms consisted of dyspnea (95%), palpitation (81%), chest pain (43%), orthopnea (33%), cough (14%), hemoptysis (5%), oliguria (5%), and fever (5%). In all patients continuous heart murmur was audible. Hepatomegaly (48%), pulmonary basal rale (14%), and pretibial pitting edema (19%) were also observed. 3) In all patients diagnosis was made with cardiac catheterization and angiography, and confirmed by operation excetpt one case. 4) Among 20 patients who had been performed corrective surgery, ventricular septal defect was observed in 16 patients (85%), aortic insufficiency in 5 patients (25%), pulmonary infundibular stenosis in 1 patient (5%), patent foramen ovale in 1 patient (5%), and tricuspid insufficiency in 1 patient (5%). Ventricular septal defect was observed in all 16 patients whose aneurysms of the right coronary sinus of Valsalva ruptured into the right ventricle and the pulmonary artery. 5) All patients survived operation, and no postoperative complication was found except 1 patient to whom reoperation was performed because of postoperative aortic insufficiency and detachment of the patch closure for ventricular septal defect. There was symptomatic improvement in all patients.
Aneurysm ; Aneurysm, Ruptured* ; Angiography ; Cardiac Catheterization ; Cardiac Catheters ; Chest Pain ; Coronary Sinus ; Cough ; Diagnosis ; Dyspnea ; Edema ; Female ; Fever ; Foramen Ovale, Patent ; Heart Atria ; Heart Murmurs ; Heart Septal Defects, Ventricular ; Heart Ventricles ; Hemoptysis ; Hepatomegaly ; Humans ; Male ; Oliguria ; Postoperative Complications ; Pulmonary Artery ; Pulmonary Subvalvular Stenosis ; Reoperation ; Respiratory Sounds ; Sinus of Valsalva*