Ureteric obstruction in pregnancy - diagnosis and management

Article Abstract:

Obstruction of the ureters (thin tubes that carry urine from the kidney to the bladder) during pregnancy is rare, and most cases result from pressure on the ureters by the pregnant uterus. The condition can lead to hydronephrosis (collection of urine in the renal pelvis, part of the kidney) or to serious kidney infection. One treatment is the insertion of a stent, a device to keep the ureter patent. The effects of this were studied in 10 pregnant women with painful obstruction of the ureter. All were treated during the second half of their pregnancies. Symptoms included severe pain on one side, nausea, and (in some cases) vomiting. One patient, who had undergone removal of one kidney two years earlier, had not urinated for four days: she received a stent on an emergency basis and urine flowed immediately. Eight of the 10 patients were in their first pregnancy. Insertion of the stent was followed by the immediate flow of urine in five cases, and pain disappeared after the procedure in six cases. Relief came to one patient one week later, and another felt only moderate relief. One continued to have pain and other symptoms; it was felt the stent was too long in her case. All pregnancies progressed normally. The stents were removed between four and six weeks after delivery. This was without complications in eight cases, but in one case, the stent had moved up the ureter and was removed under general anesthesia. In the 10th case, the stent was left in place because the patient had other kidney disease; the kidney was removed one year later. Accurate diagnosis of ureteric obstruction in pregnancy is necessary to avoid serious complications. It should be suspected in women with over-distended uteri, such as may occur in multiple pregnancy or polyhydramnios (excess amniotic fluid). Stenting is often an effective solution. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Evaluation, Causes of, Pregnancy, Complications of, Pregnancy complications, Stent (Surgery), Stents, Urination disorders, Ureters, Ureteral obstruction

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Severe nephropathy in three adolescents with cystic fibrosis

Article Abstract:

Cystic fibrosis is an inherited disease that mainly affects the pancreas, lungs, and intestines. It begins in infancy and has a poor prognosis. In the past it was believed that the kidneys were spared from damage during this disease, but the results of recent studies indicate that the kidneys may be affected. This article describes the case reports of three patients with cystic fibrosis who survived through childhood without any symptoms of kidney damage. The patients developed mild proteinuria (the presence of protein in the urine) at ages 12, 15, and 18. In two of the cases, the proteinuria become worse during the following year. Kidney biopsies were performed and these patients were diagnosed as having renal amyloidosis (a metabolic disorder that causes starch to be deposited in the kidneys). The third patient had kidney disease related to high blood levels of immunoglobulin A (IgA nephropathy). One of the patients with renal amyloidosis experienced kidney failure and required dialysis, the other two patients maintained normal kidney function until they died. All three patients died from heart failure (approximate ages were 15, 17, and 19). These case reports serve to illustrate that cystic fibrosis can be accompanied by the development of kidney disease during adolescence and that this condition has a fatal outcome. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Complications and side effects, Development and progression, Amyloidosis, Cystic fibrosis, Kidney diseases

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