Oliguria or anuria in the postoperative period of a post-transplant patient must alert the transplant team for a possibility of vascular problem and requires high clinical suspicion for early diagnosis and prompt decision making.

We report a case of sudden anuria in a renal transplant recipient during the immediate post-operative period, wherein prompt decision to re-operate and explore identified an external iliac artery dissection compromising the perfusion to the renal allograft. The dissected segment was irreparable, hence, was resected and reconstructed using a non-autogenous graft, restoring the perfusion to the allograft and lower limb. The renal graft was explanted, re-perfused and subsequent end to side anastomosis of the allograft arteries to the vascular graft was done. The patient had improved diuresis and decreasing creatinine trend as well as absence of lower extremity ischemic symptoms during the postoperative period.

Polytetrafluoroethylene (PTFE) interposition is an essential salvage technique for restoring blood flow in cases of external iliac artery dissection during renal transplantation.

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

BACKGROUND: Yersinia pseudotuberculosis is known to cause fever, gastroenteritis, or acute kidney injury (AKI). There have been several Y. pseudotuberculosis infection outbreaks to date associated with ingestion of contaminated food or unsterile water. While this disease was considered to have practically been eradicated with the improvement in public health, we encountered several cases of AKI associated with Yersinia infection. METHODS: We retrospectively collected data from medical records of patients with suspected Y. pseudotuberculosis infection who visited Seoul National University Children’s Hospital in 2017. RESULTS: There were nine suspected cases of Yersinia infection (six males and three females; age range 2.99–12.18 years). Among them, five cases occurred in May, and seven patients were residing in the metropolitan Seoul area. Three patients had history of drinking mountain water. Every patient first presented with fever for a median of 13 days, followed by gastrointestinal symptoms and oliguria. Imaging studies revealed mesenteric lymphadenitis, terminal ileum wall thickening, and increased renal parenchymal echogenicity. Creatinine levels increased to 5.72 ± 2.18 mg/dL. Urinalysis revealed sterile pyuria, proteinuria, and glycosuria. Oliguria continued for 4 to 17 days, and two patients required dialysis; however, all of them recovered from AKI. Mucocutaneous manifestations developed later. In the diagnostic work-up, Yersinia was isolated from the stool culture in one patient. Anti-Yersinia immunoglobulin (Ig) A and IgG were positive in 6 patients. CONCLUSION: Y. pseudotuberculosis infection is an infrequent cause of interstitial nephritis presenting with AKI. When a patient presents with fever, gastroenteritis, and AKI not resolving despite hydration, the clinician should suspect Y. pseudotuberculosis infection.
Acute Kidney Injury ; Creatinine ; Dialysis ; Disease Outbreaks ; Drinking ; Eating ; Female ; Fever ; Gastroenteritis ; Glycosuria ; Humans ; Ileum ; Immunoglobulin G ; Immunoglobulins ; Male ; Medical Records ; Mesenteric Lymphadenitis ; Nephritis, Interstitial ; Oliguria ; Proteinuria ; Public Health ; Pyuria ; Retrospective Studies ; Seoul ; Urinalysis ; Water ; Yersinia Infections ; Yersinia pseudotuberculosis ; Yersinia

PURPOSE: This study aimed to investigate the incidence and clinical features of late-onset circulatory collapse (LCC) in preterm infants. METHODS: Medical records of 327 preterm infants (born before 32 gestational weeks) admitted to the neonatal intensive care unit of Seoul National University Bundang Hospital between January 2014 and December 2017 were reviewed. LCC was defined as sudden onset of refractory hypotension occurring after 7 days of life without obvious causes, which responded to glucocorticoid administration. Clinical characteristics and outcomes in infants with LCC were compared with those in infants with hypotension associated with identifiable causes, which developed after 7 days of life. RESULTS: Among 327 preterm infants who enrolled in this study, 65 infants developed hypotension with oliguria after 7 days of life. Among these 65 infants, 35 (53.8%) met the criteria for LCC and 30 (46.2%) were diagnosed with hypotension associated with other identifiable causes. No statistically significant differences were observed in the baseline pre- and perinatal characteristics between infants with LCC and those with hypotension associated with other causes. Infants with hypotension associated with other causes showed a higher mortality rate than those with LCC (33.3% vs. 5.7%, P=0.004). The mean gestational age and birth weight of infants with LCC were 27+5±2+1 weeks and 963±245 g, respectively. LCC occurred at a mean postnatal age of 18 days. The median body weight at the time of diagnosis of LCC was 1,200 g. No association was observed between LCC and gestational age. CONCLUSION: Among preterm infants born before 32 gestastional weeks who developed hypotension after 7 days of life, nearly 50% were diagnosed with LCC without apparent identifiable causes. Infants with LCC showed a lower mortality rate than those with hypotension associated with other causes.
Birth Weight ; Body Weight ; Diagnosis ; Gestational Age ; Humans ; Hydrocortisone ; Hypotension ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal ; Medical Records ; Mortality ; Oliguria ; Seoul ; Shock

Renal cortical necrosis (RCN) is patchy or diffuse ischemic destruction of the renal cortex caused by significantly reduced renal arterial perfusion. It is a rare cause of acute kidney injury (AKI) and is associated with high mortality. Here, we review the case of RCN in a 15-year-old boy who developed AKI. A 15-year-old boy was referred to our hospital from a local hospital due to a sharp decrease in his renal function. He presented with acute flank pain, nausea with vomiting, and oliguria for the past two days. He had taken a single dose of antihistamine for nasal congestion. At our hospital, his peak blood pressure was 148/83 mmHg and he had a high body mass index of 32.9 kg/m². The laboratory data showed a blood urea nitrogen (BUN) of 28.4 mg/dL, a creatinine of 4.26 mg/dL, and a glomerular filtration rate estimated from the serum cystatin C of 20.2 mL/min/1.73m². Proteinuria (spot urine protein to creatinine ratio 1.66) with pyuria was observed. Kidney sonography showed parenchymal swelling and increased renal echogenicity. Due to rapidly progressing nephritis, steroid pulse therapy (750 mg/IV) was done on the second day of his admission and the patient showed complete recovery with normal renal function. However, the kidney biopsy findings revealed renal cortical hemorrhagic necrosis. Multifocal, relatively well-circumscribed, hemorrhagic necrotic areas (about 25%) were detected in the tubulointerstitium. Although RCN is an unusual cause of AKI, especially in children, pediatricians should consider the possibility of RCN when evaluating patients with rapidly decreasing renal function.
Acute Kidney Injury ; Adolescent ; Biopsy ; Blood Pressure ; Blood Urea Nitrogen ; Body Mass Index ; Child ; Creatinine ; Cystatin C ; Estrogens, Conjugated (USP) ; Flank Pain ; Glomerular Filtration Rate ; Humans ; Kidney ; Kidney Cortex Necrosis ; Male ; Mortality ; Nausea ; Necrosis ; Nephritis ; Obesity ; Oliguria ; Perfusion ; Proteinuria ; Pyuria ; Vomiting

Imperforate hymen is rare, with a low incidence of 1/16,000–30,000 in newborns. Most symptoms occur because of the accumulation of menstrual blood after puberty. In rare cases it can be found before puberty. Periodic abdominal pain, discomfort of the pelvic region, and the like are most commonly observed, and these symptoms increase at bowel movement. Usually a 13- to 15-year-old girl does not experience menarche. Continuous accumulation of menstrual blood leads to vaginal hematoma, or even to hysterovaginal, ovarian, or abdominal hematomas. Rarely, compression of the surrounding tissues can result in upper back pain, dysuria, frequent urination, or oliguria. We report on a rare case of imperforate hymen with urinary retention.
Abdominal Pain ; Adolescent ; Back Pain ; Dysuria ; Female ; Hematoma ; Humans ; Hymen* ; Incidence ; Infant, Newborn ; Menarche ; Oliguria ; Pelvis ; Puberty* ; Urinary Retention* ; Urination

Aortocaval fistula (ACF) occurs in < 1% of all abdominal aortic aneurysms (AAAs), and in 3% to 7% of all ruptured AAAs. The triad of clinical findings of AAA with ACF are abdominal pain, abdominal machinery bruit, and a pulsating abdominal mass. Other findings include pelvic venous hypertension (hematuria, oliguria, scrotal edema), lower-limb edema with or without arterial insufficiency or venous thrombus, shock, congestive heart failure, and cardiac arrest. Surgery is the main treatment modality. We report successful surgical treatment in a patient with a ruptured AAA with ACF who presented with cardiogenic shock.
Abdominal Pain ; Aortic Aneurysm, Abdominal ; Arteriovenous Fistula ; Edema ; Fistula* ; Heart Arrest ; Heart Failure ; Humans ; Hypertension ; Oliguria ; Shock ; Shock, Cardiogenic* ; Thrombosis

Urinary examination has formed part of patient assessment since the earliest days of medicine. Current definitions of oliguria are essentially arbitrary, but duration and intensity of oliguria have been associated with an increased risk of mortality, and this risk is not completely attributable to the development of concomitant acute kidney injury (AKI) as defined by changes in serum creatinine concentration. The increased risk of death associated with the development of AKI itself may be modified by directly or indirectly by progressive fluid accumulation, due to reduced elimination and increased fluid administration. None of the currently extant major illness severity scoring systems or outcome prediction models use modern definitions of AKI or oliguria, or any values representative of fluid volumes variables. Even if a direct relationship with mortality is not observed, then it is possible that fluid balance or fluid volume variables mediate the relationship between illness severity and mortality in the renal and respiratory physiological domains. Fluid administration and fluid balance may then be an important, easily modifiable therapeutic target for future investigation. These relationships require exploration in large datasets before being prospectively validated in groups of critically ill patients from differing jurisdictions to improve prognostication and mortality prediction.
Acute Kidney Injury ; Creatinine ; Critical Illness ; Dataset ; Humans ; Mortality ; Oliguria* ; Prospective Studies ; Water-Electrolyte Balance

The metal chromium is widely used in industry. Hexavalent chromium is a strong oxidizing agent, and exposure to some hexavalent compounds can cause serious problems, such as skin ulcers, acute gastroenteritis, acute tubular necrosis with renal failure, and hepatic necrosis. We report a case of acute kidney injury following skin exposure to hexavalent chromium, which burned a relatively small percentage of the total body surface area (TBSA). A 49-year-old man developed oliguria and acute kidney injury 3 days after burning about 5% of his TBSA with chromic acid solution, causing second-to third-degree chemical burns. His creatinine level increased to 12.5 mg/dL. The patient underwent hemodialysis with supportive care. His renal function improved and the dialysis was discontinued. The serum and urine chromium concentrations also decreased.
Acute Kidney Injury* ; Body Surface Area ; Burns ; Burns, Chemical* ; Chromium* ; Creatinine ; Dialysis ; Gastroenteritis ; Humans ; Middle Aged ; Necrosis ; Oliguria ; Renal Dialysis ; Renal Insufficiency ; Skin ; Skin Ulcer

Acute renal failure can be the result of acute renal cortical necrosis (RCN), which commonly occurs from complications occurring during pregnancy. RCN is rarely caused by medications, although tranexamic acid, which is used in patients with acute bleeding for its antifibrinolytic effects, reportedly causes acute RCN in rare cases. An 82-year-old woman experienced gastrointestinal bleeding after endoscopic papillectomy of an ampullary adenoma. The bleeding was controlled with tranexamic acid administration; however, 4 days later, her urine volume decreased and she developed pulmonary edema and dyspnea. Serum creatinine levels increased from 0.8 to 3.9 mg/dL and dialysis was performed. Abdominal pelvic computed tomography with contrast enhancement revealed bilateral RCN with no renal cortex enhancement. Renal dysfunction and oliguria persisted and hemodialysis was continued. Clinicians must be aware that acute RCN can occur after tranexamic acid administration to control bleeding.
Acute Kidney Injury ; Adenoma ; Aged, 80 and over ; Creatinine ; Dialysis ; Dyspnea ; Female ; Hemorrhage* ; Humans ; Kidney Cortex Necrosis* ; Oliguria ; Pregnancy ; Pulmonary Edema ; Renal Dialysis ; Tranexamic Acid