Abnormal Renal Tubular Back-Diffusion Following Anuria

Abstract

A negative value for Tmp-aminobippurate was observed in a patient with sulfathiazole intoxication following 4 days of anuria and 5 days of marked oliguria. This negative Tmps is interpreted as indicating not only that the tubule cells had lost their ability to excrete PAH but that a portion of the PAH filtered by the glomeruli was escaping from the tubular urine by back-diffusion. It is the purpose of this paper to describe quantitatively the pattern of glomerular and tubular functional changes following the period of anuria to apparent functional recovery.On March 1, 1945 an 8-year-old white female developed sore throat and fever. There was no history of previous renal disease. She received approximately 3.0 grams of sulfathiazole in the form of chewing gum from March 3 to March 6. On March 6, vomiting occurred and continued for 10 days; March 7, anuria appeared and persisted for 4 days, followed by marked oliguria for 5 days. On the third day of anuria, a discrete, macular, erythematous rash appeared on all 4 extremities, and extended during the next 2 days to involve the face and become confluent on the upper extremities. On the fourth day of anuria, bilateral conjunctivitis appeared. The rash and conjunctivitis were present for 10 days. Systolic blood pressure ranged from 130 to 120 mm. and the diastolic from 96 to 80 mm. Hg from the fifth to the ninth day following onset of anuria. Three weeks later, the blood pressure was 11%4 mm. Blood non-protein nitrogen was 214 mgm. per cent 5 days following the onset of anuria and fell gradually to 21 mgm. per cent over a period of 3 weeks. Carbon dioxide combining power was 48 and 57 volumes per cent on the sixth and eighth days following the onset of anuria. Plasma chlorides rose from 71 milliequivalents to 104 in 3 weeks. The red blood cell count, hemoglobin and plasma proteins were normal. Four days following onset of anuria, the patient voided 15 ml. of urine in which a trace of protein was present, red and white cells were absent, and sulfathiazole crystals were seen; the plasma level of sulfathiazole at this time was 2 mgm. per cent. On the seventh and eighth days following onset of anuria, the urine contained moderate amounts of protein, 20 to 50 red blood cells per high power field, and innumerable white blood cells. In 3 weeks, the urine contained no protein or cellular elements.Spontaneous diuresis occurred on the tenth day following the onset of anuria and apparently was not related to any specific therapeutic measure.The patient was discharged from the hospital 39 days after the onset of anuria, and has been observed for a period of 92.5 weeks following the onset of anuria at the Nephritis and Hypertension Clinic, New York University Clinic. She has attended the clinic at regular intervals and has been symptom free; edema has been absent and the blood pressure has varied from 11%44 to 9%6 mm. Hg; proteinuria reappeared and has persisted, varying from a trace to 2 plus. Hematuria and pyuria have been absent. METHODSThe rate of glomerular filtration, the ef...

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Renal Distribution Volumes of Indocyanine Green, [51Cr]EDTA, and 24Na in Man during Acute Renal Failure after Shock. IMPLICATIONS FOR THE PATHOGENESIS OF ANURIA

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Plasma Renin Activity in Acute Renal Insufficiency

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