Urinary leak

The urinary fistula frequency ranges from 1% to 5%. It is the most common early complication, occurring during the first 2 weeks after transplantation. The majority of urinary leaks are attributed to ureteral ischemia. Maintaining ureteral blood supply by not... 

Fig. 3.6a-d. Urinary leak secondary to ureteral ischemia. Ultrasonography (a) shows a fluid collection between the lower pole of the transplant and the bladder, b On contrast-enhanced CT, fluid is noted around the graft and within the peritoneal cavity. The pelvic fluid collection ( ) has a water density at the early phase after contrast injection (c) but enhances at the late phase (d) due to the urinary leak of contrast medium... 

Fig. 3.7a,b. Urinary leak secondary to failure of ureterovesical anastomosis. Retrograde (a) and voiding cystography (b) show extravasation of contrast agent from the bladder... 

Kleinfeld (1980) reported a case of arsine poisoning in a 31-y-old man. The exposure to arsine occurred from a leaking canister thought to be empty. The exposure duration was estimated to be 1-2 min, but no actual or estimated arsine concentrations were available. The victim presented with hematuria. On hospital admission, no intact erythrocytes were present in the urine, hematocrit was 43%, and hemoglobin was 9.8 g/ dL. The hematocrit dropped to as low as 18%, the correction of which required one unit of packed cells. Based upon the exposure history and the subject s note of a "garlicky" odor, the diagnosis was arsine-induced hemolytic anemia. Urinary arsenic was 7.2 mg/L on admission and 0.1 mg/L 4 d later. The patient was subsequently discharged. 

Contraindications Primary or secondary hyperparathyroidism, including hypercalci-uria (renal calcium leak), hypomagnesemic states (serum magnesium less than 1.5 mg/dl), bone disease (osteoporosis, osteomalacia, osteitis), hypocalcemic states (e.g., hypoparathyroidism, intestinal malabsorption), normal or low intestinal absorption and renal excretion of calcium, enteric hyperoxaluria, and patients with high fasting urinary calcium or hypophosphatemia. 

Table V summarizes the results of analyses for 2,k,5-T in the 2U-hour urine samples. Urinary levels ranged from <0.01 ppm for an observer to IT ppm in urine collected from applicator it who was wearing the leaking backpack sprayer. Proper maintenance of equipment and better personal hygiene probably could have prevented the relatively high exposure experienced by this individual, estimated as a dose of about 0.2 mg/kg of body weight.

This multifactorial weakness in defence allows bacterial penetration of the ascitic fluid to be effected by (1.) transmural migration in portal hypertension with greater permeability of the intestinal wall, (2.) systemic bacteraemia in terms of haematogenic dispersion (particularly in urinary tract and bronchopulmonary infections), above all in the presence of intrahepatic and extrahepatic shunts (so-called portal vein bacteraemia), (3.) invasion of bacteria via the Fallopian tubes, and (4.) lymphatic flow into the ascitic fluid (e.g. via leaks in the lymph vessels or lymph nodes). 

In individuals v/ith damaged muscle cells, creatine leaks out of the damaged tissue and is rapidly cyclized, greatly increasing the quantity of circulating and urinary creatinine. 

Interleukin-2 (Aldesleukin, IL-2) Reversible syndrome of hypotension, oliguria, fluid retention, azotemia, and a very low urinary excretion of sodium Capillary leak syndrome Acute interstitial nephritis Steroids and plasma exchange... 

Major functions of the distal nephron include the regeneration of bicarbonate, the excretion of acid (hydrogen ion), the secretion of potassium, and the reabsorption of water. Damage to this portion of the nephron may present as significant acidemia and either hypo-or hyperkalemia, depending on the mechanism of injury. For example, amphotericin B produces small pores in the luminal membrane of distal tubular cells. These pores allow small molecules such as potassium to leak out the molecules are then wasted in the urine. Consequently, amphotericin B nephrotoxicity is characterized by hypokalemia secondary to renal potassium wasting. ATN is associated with urinary sediment characterized by the presence of tubular cells, coarse granular casts, and rarely, RBC casts. 

Roels et al. [38] points out that the analytical techniques identified in Table 1 are not easily available and are not well-suited for routine biomonitoring of occupational or environmental exposures. Instead, indirect biomarkers such as urinary enzymes are often used with success to evaluate mercury exposure and injury. Zalups [35] identifies numerous methods used to detect renal tubular injury induced by mercury. These methods monitor the urinary excretion of enzymes that leak from injured and necrotic proximal tubules, including lactate dehydrogenase (LDH), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and N-acetyl-P-D-glucosaminidase (NAG). Although advocated by Zalups (35) to detect renal tubular injury, Mason et al. (48) questions the practical utility of such biomarkers in occupational surveillance. According to Mason et al., small increases in NAG, leucine... 

Vandongen, R. and O Dwyer, J. (1984). Urinary 6-keto-PGFjjj and PGE2 in two kidney-one clip hypertension in the rat. Prostagl Leak. Med., 13, 289-293... 

Preservation of the upper urinary tract is the central goal in the treatment of neurogenic bladder in children with myelodysplasia. Predictive indicators for upper urinary-tract fate are detrusor sphincter dys-synergia, high bladder-filling pressure, poor bladder compliance, moderate to severe fibrosis of the detrusor (OzKAN et al. 2005), high leak-point pressure, and vesicoureteric reflux (Seki et al. 2004). 

Urological problems can be visualized by US in most situations. If requested, isotope studies, CT, or MRI may add valuable information. Severe bleeding around the transplant may be caused by anticoagulation for hemodialysis or a leak of the vessel anastomoses. Hydronephrosis caused by urinary tract obstruction may be the consequence of ureteral kinking, stenosis of ureteral implantation, ureteral necrosis, or large lymphoceles. It is important to note that children with acute renal failure caused by severe urinary obstruction may present with just minimal or moderate renal pelvic dilatation due to a diminished urinary flow (Fig. 21.5). In addition, these situations are painless as the transplant and the ureter have no nerves. Close follow-up is mandatory, especially in patients with bladder dysfunction or an augmented bladder. 

Fig.25.8a-c. Left renal fracture in an 11-year-old girl. No associated intra-abdominal or bone lesion was found by CT (a). Delayed scan (b) showed opacification oftheurinomaby the contrast medium. In spite of this severe leak, the urinary excretory system remained patent. Six months later, followup ultrasound showed the fracture between two normalsized segments (c). Excellent function of the left kidney was shown by nuclear medicine studies (not shown)... 

Fig. 25.14a,b. Bladder neck disruption in a young boy who underwent blunt abdominal trauma. Intravenous urography. Plain film (a) showed traumatic widening of the pubic symphysis, (b) As soon as 5 min, the faintly opacified urinary bladder (B) appears elevated by an infravesical leak (arrows)... 

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