Sarcoidosis presenting as bilateral hydronephrosis

We report an unusual case of sarcoidosis associated with bilateral hydronephrosis. The patient was a 53-year-old Japanese woman who presented with dysuria and urinary incontinence. Computed tomography of the abdomen showed bilateral hydronephrosis caused by a retroperitoneal mass, surrounded by enlarged retroperitoneal lymph nodes. Histological examination of the mass demonstrated noncaseating epithelioid cell granulomas involving the retroperitoneal lymph nodes. Corticosteroid therapy led to complete resolution of the retroperitoneal mass and hydronephrosis. This case emphasizes that sarcoidosis should be included in the differential diagnosis of a retroperitoneal mass.

Antihypertensive agents and renal protection: calcium channel blockers

This study defines the nature of the renal protective effects of calcium channel blockers (Ca blockers) and the effects of the Ca blocker, amlodipine, compared to those of the angiotensin-converting enzyme inhibitor (ACEI), enalapril, on the progression of renal injury in 5/6 nephrectomized spontaneously hypertensive rats (SHR) fed a high-salt diet. Furthermore, we studied the effects of various Ca blockers on the glomerular afferent and efferent arterioles using the isolated perfused hydronephrotic kidneys of six-week-old male Sprague-Dawley rats. In the first study, forty 6-week-old male SHRs which underwent 5/6 nephrectomy were equally divided into five groups. One group received no therapy. In two groups, therapy was started at four weeks post-nephrectomy, one with amlodipine and the other with enalapril. In the remaining two groups, amlodipine or enalapril therapy was started at eight weeks postnephrectomy. Amlodipine was more effective than enalapril in reducing proteinuria and glomerulosclerosis in the group that was started on drug therapy eight weeks after surgery. In the second study, at concentrations of 10(-6) to 10(-9) M, nifedipine, nicardipine and amlodipine dilated the afferent, but not the efferent, arteriole preconstricted with angiotensin II. On the other hand, efonidipine and manidipine clearly dilated angiotensin II-induced constriction of both the afferent and efferent arterioles. These results indicated that Ca blockers are effective at reducing renal injury in 5/6 nephrectomized SHR, and that they are more effective than ACEI in advanced stages of renal injury. The observation that only certain Ca blockers can dilate the efferent arteriole suggests that the renal protective effect of Ca blockers is not necessarily dependent on the dilation of the efferent arterioles.

[Left-sided hydronephrosis as the first sign of Crohn disease]

HISTORY AND CLINICAL FINDINGS

A previously well 29-year-old man was referred to the emergency department because of acute left lower abdominal pain without intestinal symptoms. Physical examination was unremarkable except for moderate suprapubic pain on pressure.

INVESTIGATIONS

There was evidence of a urinary infection. Erythrocyte sedimentation rate was increased (48 mm/h) and C-reactive protein elevated to 42 mg/l. There was mild leucocytosis (10000/microliter). Abdominal sonography revealed an enlarged left renal pelvis with hydroureter and possible prevesical stone, findings confirmed at excretion urography.

TREATMENT AND COURSE

He was discharged with the suspected diagnosis of ureteric stone and given co-trimoxazole, diclofenac and hyoscine butylbromide. After discontinuing medication the same symptoms developed two weeks later. Cystoscopy and retrograde pyelography were unremarkable and it was assumed the stone had been passed. The patient was again discharged on the above medication. When it was discontinued the same symptoms recurred and he was again admitted. Computed tomography, selective small-intestine radiology, coloscopy and biopsy indicated Crohn's disease with hydronephrosis as complication. Treatment trial with prednisone and mesalazine brought about only transient improvement so that an ileocaecal resection and ureterolysis were performed. The patient has since been free of symptoms.

CONCLUSION

If there are urological complications, chronic inflammatory intestinal disease should be included in the differential diagnosis even in the absence of any intestinal symptoms.

[Nonobstructive urinary tract dilatation due to diabetes insipidus in a patient with craniopharyngioma]

A 46-year-old man who had a history of hypogonadism, bilateral hydronephrosis and huge residual urine volume during the past ten years was admitted complaining of fever and flank pain. Polyuria which was more than 4 liters per day and inability of urine concentration suggested diabetes insipidus. Magnetic resonance imaging (MRI) demonstrated a tumor which was compatible with craniopharyngioma. Tumor resection and administration of desmopressin improved polyuria and urinary tract dilatation with marked reduction of residual urine volume from 400 ml to 20 ml.

Non-traumatic rupture of kidney in pregnancy--case report and review

During pregnancy, dilatation of the urinary collecting system is very common. Acute hydronephrosis is one of the most common causes of severe flank pain in pregnancy. Severe complications of hydronephrosis of pregnancy, such as pain, renal failure or a ruptured collecting system, occur very occasionally. A rare case of spontaneous rupture treated conservatively is presented.

Body growth in urinary tract malformations

Body height and height velocity were analysed in 54 children with obstructive urinary tract malformations over a mean period of 8.7 years, using new auxological methods. At the time of diagnosis, 9% of patients had a height of more than 2 standard deviations below the normal mean. Mean relative height changed significantly from the first to the last observation, the standard deviation score (SDS) increasing from -0.16 to +0.36 in patients with hydronephrosis compared with normal children (P < 0.05) and from -0.63 to +0.02 SDS in those without hydronephrosis (P < 0.005). The pathogenesis of the described growth disturbance is not clear. Stepwise multiple regression analysis pointed to a possible link between the duration of antibiotic treatment and the recovery of growth capacity, but improved growth could not clearly be attributed to any medical or surgical treatment. The synchronized average growth velocity curve was similar to that of healthy children and showed a normal pubertal spurt. Final height and target height calculated from parents' height differed only slightly from that of the normal population.

[Dopaminergic effect of anisodamine on the microcirculation of the hydronephrotic kidney of rats]

Anisodamine is an alkaloid extracted from the Tibetan plant "Anisodus tanguticus". Since 1965 it has been used in China for the treatment of shock but the mechanisms of its action are not fully known. The present study was performed to determine the effect of anisodamine on the renal microcirculation and to examine the underlying mechanism of its actions. The addition of anisodamine (10(-8) M to 10(-3) M) to the kidney bath resulted in a significant and dose dependent dilation of all preglomerular vessels. The maximal dilation (about 30% dilation) was found in the proximal interlobular artery. In contrast to preglomerular vessels anisodamine caused constriction of postglomerular vessels. The glomerular blood flow increased by about 50% at anisodamine concentration of 10(-3) M. Haloperidol, a dopamine receptor antagonist could abolish the renal vascular effect of anisodamine. It is suggested that anisodamine could improve renal function by the dilation of preglomerular vessels in combination with the constriction of postglomerular vessels, and the effect of anisodamine may be mediated by activation of the dopaminergic system.

A thromboxane A2 synthase inhibitor, DP-1904, prevents rat renal injury

The effects of DP-1904, a thromboxane (TX) A2 synthase inhibitor, on renal function were investigated by analysis of prostanoid metabolism in hydronephrotic and ischemic rat kidney models, and in isolated perfused normal and hydronephrotic rat kidneys. The increase in production of TXB2 in hydronephrotic or ischemic kidneys was significantly suppressed by intraperitoneal DP-1904 (10 mg/kg), with the 6-keto-prostaglandin F1 alpha to TXB2 ratio being significant increased. Urine volume, glomerular filtration rate and renal plasma flow were all improved. DP-1904 (0.3 micrograms/min) blocked the effects of infused arachidonic acid on isolated perfused normal rat kidneys thus reducing TXB2 levels and perfusion pressure but the pressor response to norepinephrine or angiotensin II remained unchanged. In isolated perfused hydronephrotic rat kidneys, DP-1904 suppressed the increase in perfusion pressure and TXB2 production caused by platelet-activating factor. These findings suggested that DP-1904 improved renal failure by specifically inhibiting TXA2 production.

Pharmacological enhancement of recovery in experimental hydronephrosis

The effects of mannitol, methylprednisolone, furosemide, inosine, indomethacin and captopril on the recovery from hydronephrosis were examined in rat kidneys. After 1 week of ureteral obstruction, left ureterocystostomy was performed in order to release the obstruction. Following ureteral release, mannitol, methylprednisolone, inosine, furosemide, captopril and indomethacin were given intravenously or orally. A saline group and non-treated control rats were also examined for comparison. 4 weeks after ureterocystostomy, 0.5 microCi of 203Hg-labelled chlormerodrin was given intravenously and the animals were sacrificed 48 h later. The left kidneys were significantly heavier in the mannitol-, methylprednisolone-, and inosine-treated groups than those of the control groups. The chlormerodrin uptake ratios of the left kidneys were significantly higher in the mannitol-, methylprednisolone-, captopril- and indomethacin-treated groups than in the control groups. These results suggest that the release of obstruction solely is not complete treatment for hydronephrosis, but that appropriate medical treatment may enhance the recovery from hydronephrosis.

[Regression of a massive hydronephrosis in familial central diabetes insipidus treated with Adiuretin]

A ten year old boy with hereditary pituitary diabetes insipidus presented with massive bilateral hydronephrosis, hydroureters and an extremely large bladder. Radiological investigations excluded a mechanical obstruction or vesicoureteral reflux. Treatment with the adiuretin analog DDAVP resulted in regression of the urinary tract changes after 5 months and an almost complete disappearance after 3 1/2 years. The urinary tract dilatation probably results from the large urine flows which exceed the capacity of the urinary tract causing a functional obstruction and residual urine.

The use of progesterone for ureteral stones: a preliminary report

Two ureteral stone patients were given injections of a progesterone derivative, resulting in prompt passage of the stones. The case reports are presented as well as a discussion of hydronephrosis of pregnancy and hormonal influences on the ureter.

Observations on the effect of metoclopramide (Primperan) on the human ureter. A preliminary communication

Metoclopramide, a procainamide derivative with a documented effect on the gastro-intestinal motility, was given to four patients with hydroureter. It induced strong peristalsis in the ureter, manifested clinically as relief of pain and fluoroscopically as emptying of the ureter and the renal pelvis.

Regression of prostatic cancer metastasis by high doses of diethylstilbestrol diphosphate

Diethylstilbestrol diphosphate (DES-P) has shown effective symptomatic relief in patients with metastatic carcinoma of the prostate. Although there is little known about its role in soft tissue metastasis, our experience in 3 patients with advanced carcinoma of the prostate infiltrating the trigone and ureterovesical junction revealed significant improvement of hydronephrosis. All patients failed to respond to conventional doses of stilbestrol. Diethylstilbestrol diphosphate is recommended in the treatment of advanced carcinoma of the prostate with soft tissue metastasis. It is safe and effective, and the tumor responses outweigh the side effects of the drug. The mechanism of action of this compound is discussed.

[Experience with amoxicillin therapy in urological field (author's transl)]

Amoxicillin (AMPC), an oral preparation of broad spectrum synthetic penicillin, was used for treatment of 10 cases with urological infection, and the following results were obtained. 1. AMPC at a daily dose of 750 approximately 1,500 mg was administered for 7 approximately 49 days to 5 cases of acute cystitis, 2 cases of acute epididymitis and one case each of calculous hydronephrosis, chronic prostatitis and postoperative cystitis. As the result, AMPC was found remarkably effective in 2 cases, effective in 7 cases and ineffective in one case; that is, the effective rate was 9/10 (90.0%). 2. Total 8 strains of bacteria, comprising 5 strains of Escherichia coli and one strain each of Klebsiella, Staphylococcus epidermidis and Pseudomonas, were isolated from the urine. These bacteria were relatively responsive to AMPC as well as to ABPC. 3. The side effect possibly due to AMPC was slight gastro-intestinal disorder only in 2 of 10 cases. No other side effect was observed.