Late evaluation of the relationship between morphological and functional renal changes and hypertension after non-operative treatment of high-grade renal injuries
| Autor: | José Ivan de Andrade, Marcus Vinicius Simões, Valdair Francisco Muglia, Fernando Nobre, Antonio Carlos dos Santos, Mery Kato, Gerson Alves Pereira Júnior, Cecília Hissae Miyake |
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| Rok vydání: | 2012 |
| Předmět: |
Dimercaptosuccinic acid
Pathology medicine.medical_specialty Ambulatory blood pressure Radionuclide imaging Population lcsh:Surgery Urology Renal function urologic and male genital diseases Renal artery stenosis Asymptomatic Magnetic resonance angiography Follow-up imaging chemistry.chemical_compound medicine HIPERTENSÃO (COMPLICAÇÕES) Renal injury education Computed tomography education.field_of_study Creatinine medicine.diagnostic_test business.industry lcsh:Medical emergencies. Critical care. Intensive care. First aid lcsh:RD1-811 lcsh:RC86-88.9 medicine.disease chemistry Emergency Medicine Conservative management Surgery medicine.symptom business Renal hypertension Research Article medicine.drug |
| Zdroj: | World Journal of Emergency Surgery : WJES World Journal of Emergency Surgery, Vol 7, Iss 1, p 26 (2012) Repositório Institucional da USP (Biblioteca Digital da Produção Intelectual) Universidade de São Paulo (USP) instacron:USP |
| ISSN: | 1749-7922 |
| DOI: | 10.1186/1749-7922-7-26 |
| Popis: | Objective To evaluate the anatomical and functional renal alterations and the association with post-traumatic arterial hypertension. Methods The studied population included patients who sustained high grades renal injury (grades III to V) successfully non-operative management after staging by computed tomography over a 16-year period. Beyond the review of medical records, these patients were invited to the following protocol: clinical and laboratory evaluation, abdominal computed tomography, magnetic resonance angiography, DMSA renal scintigraphy, and ambulatory blood pressure monitoring. The hypertensive patients also were submitted to dynamic renal scintigraphy (99mTc EC), using captopril stimulation to verify renal vascular etiology. Results Of the 31 patients, there were thirteen grade III, sixteen grade IV (nine lacerations, and seven vascular lesions), and two grade V injuries. All the patients were asymptomatic and an average follow up post-injury of 6.4 years. None had abnormal BUN or seric creatinine. The percentage of renal volume reduction correlates with the severity as defined by OIS. There was no evidence of renal artery stenosis in Magnetic Resonance angiography (MRA). DMSA scanning demonstrated a decline in percentage of total renal function corresponding to injury severity (42.2 ± 5.5% for grade III, 35.3 ± 12.8% for grade IV, 13.5 ± 19.1 for grade V). Six patients (19.4%) had severe compromised function (< 30%). There was statistically significant difference in the decrease in renal function between parenchymal and vascular causes for grade IV injuries (p Conclusions Late results of renal function after conservative treatment of high grades renal injuries are favorable, except for patients with grades IV with vascular injuries and grade V renal injuries. Moreover, arterial hypertension does not correlate with the grade of renal injury or reduction of renal function. |
| Databáze: | OpenAIRE |
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