deamino-arginine-vasopressin and Urethral-Obstruction

Disequilibrium syndrome (DS) is a central nervous system disorder described in hemodialysis (HD) patients. The authors present 4 cases of elevated blood urea nitrogen (BUN); the first patient passed away from suspected DS, whereas the other 3 patients were identified as having a high risk of developing DS on the basis of their BUN. The authors tried to lower their BUN slowly and prevent rapid correction by different methods. This is the first study in which DS has been studied in patients who are not on HD, and methods are described to identify and prevent DS in such patients. They also review the existing literature on the pathogenesis of DS and highlight the importance of recognizing this syndrome in non-HD patients, while suggesting some innovative ways to prevent it.

Topics: Aged; Antidiuretic Agents; Blood Urea Nitrogen; Cerebellar Ataxia; Deamino Arginine Vasopressin; Disease Management; Female; Fluid Therapy; Humans; Hyperglycemic Hyperosmolar Nonketotic Coma; Intellectual Disability; Male; Middle Aged; Treatment Outcome; Urethral Obstruction; Urinary Catheterization; Water-Electrolyte Imbalance

Maximal renal concentrating capacity was determined with the aid of intranasal desaminocysteine-D-arginine vasopressin, a derivative of natural vasopressin, in 9 infants and 2 children with congenital or acquired pelvioureteral or vesicoureteral stenosis. Urinary tract infection was present in some but not all cases. Immediately postoperatively all 13 renal units displayed rather subnormal maximal renal concentration capacity (355 plus or minus 81 mosm. per kg. or mean plus or minus 1 standard deviation), which was corrected to some extent at the time of removal of the ureteral splint 5 to 10 days later (455 plus or minus 129 mosm. per kg.). Between 5 and 15 months postoperatively all but 1 renal unit displayed further significant increment in maximal renal concentration capacity. This single unit, operated on initially for vesicoureteral reflux secondary to neurogenic bladder, was found to be stenotic at the level of the ureterovesical junction. Routine determination of maximal renal concentration capacity at the time of operation could enable one to judge the kidney drainage postoperatively.

Topics: Arginine Vasopressin; Child; Deamino Arginine Vasopressin; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Kidney Concentrating Ability; Male; Postoperative Care; Prospective Studies; Time Factors; Ureteral Obstruction; Urethral Obstruction