Postobstructive diuresis definition high urine output exceeding 200mlhr 0. Jci crosscirculation study of natriuretic factors in. However, diuresis is more important after bilateral than unilateral decompression of obstacle. Postobstructive diuresis in cats with naturally occurring lower urinary. Soluteinduced polyuria can be seen in hospitalized patients after a high solute load from exogenous protein administration or following relief of urinary obstruction. Download fulltext pdf crosscirculation study of natriuretic factors in postobstructive diuresis article pdf available in journal of clinical investigation 572. Postobstructive diuresis pod following decompression of urinary tract obstruction is usually a selflimiting phenomenon. The pathophysiology of postrenal acute kidney injury praki, i. Polyuria, defined as daily urine output in excess of 3. Glomerular filtration rate, urine flow and sodium excretion increased markedly, whereas surface nephron glomerular filtration rate increased only.
Obstructed male cats often develop postrenal azotemia and. Postobstructive pneumonia, a pulmonary infiltrate distal to a bronchial obstruction that, in adults, is generally due to malignancy, has been reported in about 2% of patients hospitalized for communityacquired pneumonia cap. Dec 10, 2015 polyuria, defined as daily urine output in excess of 3. In rats with bul, a striking diuresis and natriuresis occurred when the obstruction to one kidney the experimental kidney was relieved. This is explained by volemic expansion, urea and electrolyte levels which contribute to increase in diuresis and natriuresis 14. The goal of this article is to make primary care physicians aware of this clinical entity and help them confidently identify. The objectives of this retrospective study were to investigate the actual incidence of postobstructive diuresis after relief of urethral obstruction in cats, as well as to identify changes in blood and urine parameters that might be associated with postobstructive. We report a case of excessive postobstructive diuresis of more than 58,000 ml per day 204 l in 10 days after release of a left. Massive postobstructive diuresis in a patient with. Sutherland, in national kidney foundation primer on kidney diseases sixth edition, 2014.
Diuresis after urethral obstruction clinicians brief. After an initial transient rise in renal blood flow rbf during acute ureteral obstruction, tubular damage and progressive vasoconstriction with decreased rbf. Our recent study in a veteran population showed that 5. Postobstructive diuresis can occur in up to 50% of patients with substantial urinary tract obstruction and can be lifethreatening if it becomes pathologic. Each sample was counted for 20 to 30 mm, that is for a total count of usually more than 1,000. Urinary obstruction is a common cause of acute and chronic renal failure. Thankfully, after relief of the obstruction a vast majority of patients have complete recovery of kidney function. Potential involvement of p2y2 receptor in diuresis of. In addition, postobstructive diuresis in relation to fluid therapy pod fr was defined as urine output greater than the administered amount of intravenous fluids on at least two subsequent time points. Nephron heterogeneity in the postobstructive kidney 21 ped into 0. Mr alexander p coupland, mr chandra shekhar biyani foundation years journal, volume 9, issue 1, p.
However, a few patients will have marked polyuria 45l per day after release of bilateral obstruction. Sep 16, 1985 postobstructive diuresis occurs after relief of bilateral ureteral obstruction despite the persistent decrease in renal cortical perfusion and glomerular filtration rate gfr. The risk factors for this include bilateral obstruction, nephrogenic diabetes insipidus, hypertension, edema, congestive heart failure, and uremic encephalopathy. Hydrochlorothiazide and indomethacin were used to prevent dehydration.
Jci a micropuncture study of postobstructive diuresis in. Factors associated with postobstructive diuresis following. Postobstruction diuresis definition of postobstruction. Patients with decompressed urinary obstruction might have to be admitted for a 24hour observation period. Physiopathology, diagnosis and management after urological treatment of obstructive renal failure. While postobstructive diuresis is a real phenomenon, very frequently it is magnified by forcing diuresis with the administration. Postobstructive diuresis in cats with naturally occurring lower urinary tract obstruction. Postobstructive diuresis in cats with naturally occurring. Pathophysiology and treatment of post obstructive diuresis. In the early phase of regeneration the synthesis of vasodilatory pgi 2 was increased, whereas that of vasoconstrictory pgf 2. Cats with urethral obstruction were 5 times more likely to demonstrate postobstructive diuresis if they had concurrent acidemia. Postobstructive diuresis is important because it can occur in up to 50% of patients with substantial urinary tract obstruction and can be lifethreatening if it becomes pathologic and is not adequately treated.
A wide variety of pathological processes, intrinsic and extrinsic to the urinary system, can cause obstruction. Mechanisms of postobstructive diuresis in the solitary. Pdf crosscirculation study of natriuretic factors in. Nelson, in canine and feline endocrinology fourth edition, 2015. Significant net addition of water and sodium to the duct was demonstrated during postobstructive diuresis after relief of 24h bilateral ureteral ligation. Postobstructive diuresis may occur in any animal but is most common after urethral obstruction by a urolith or urethral plug is relieved in male cats with feline lower urinary tract disease e. In the pediatric population, when there is a urinary output uo greater than 5 cc per hour for 2 consecutive hours, it is considered to be compatible. Postobstructive diuresis is an abnormal condition of prolonged polyuria, involving both excessive solute and water loss, after acute drainage of obstructed urinary tract system. A 68yearold man was seen in the emergency room with a 4d complaint of dribbling urination and lower abdominal discomfort. To describe postobstructive diuresis pod in cats undergoing surgical placement of ureteral stents or subcutaneous ureteral bypass systems for treatment of ureteral obstruction in cats and to identify factors associated with duration and maximum severity of pod.
Sep 09, 2018 obstructive acute renal failure is both a medical and a surgical emergency. The patient demonstrated a marked postobstructive diuresis and 7 hours after presentation suffered a grand mal seizure and was neurologically inappropriate. In addition, postobstructive diuresis in relation to fluid therapy podfr was defined as urine output greater than the administered amount of intravenous fluids on. Release of obstruction is often associated with natriuresis or diuresis, leading to postobstructive uropathy, which is a form of acquired nephrogenic diabetes insipidus ndi. Pdf postobstructive diuresis in cats with naturally. The first treatment modality is urological by relief of obstruction. View enhanced pdf access article on wiley online library html view download pdf for offline viewing. Which of the following is a risk factor for postobstructive diuresis. Posterior reversible encephalopathy syndrome in setting of postobstructive diuresis and persistent hypocalcemia. Similar clinical scenarios are rarely encountered in the outpatient setting. Obstructive acute renal failure is both a medical and a surgical emergency. Although it is a selfresolving condition, postobstructive uropathy can cause severe diuresis and natriuresis, with accompanying morbidity 3, 18, 3941.
Postobstructive diuresis is the rapid elimination of fluid after an obstruction is removed. To study the role of circulating natriuretic factors in the postobstructive diuresis that occurs after relief of bilateral, but not unilateral ureteral ligation, crosscirculation was carried out between normal recipient rats and donor rats have either 24h bilateral bul or unilateral uul ureteral ligation. In order to clarify further the phenomenon of postobstructive diuresis, clearance and micropuncture experiments were done before and after relief of partial ureteral obstruction in rats with a solitary hydronephrotic kidney. Medical management of postobstructive polyuria jama. Medical treatment of postobstructive diuresis consists of oral or intravenous fluids adjusted to the findings of clinical. Jul 15, 2014 view enhanced pdf access article on wiley online library html view download pdf for offline viewing. It is the nonendemic form that affects adolescents and young adults, usually presenting with abdominal disease causing constipation, pain, nausea and vomiting 1. The objectives of this retrospective study were to investigate the actual incidence of postobstructive diuresis after relief of urethral obstruction in cats, as well as to identify changes in blood and urine parameters that might be associated with postobstructive diuresis pod, and to assess the impact of fluid therapy. This paper discusses the diagnosis and management of postobstructive diuresis pod. Postobstructive diuresis occurs after relief of bilateral ureteral obstruction despite the persistent decrease in renal cortical perfusion and glomerular filtration rate gfr.
Medullary collecting duct function was studied by direct microcatheterization techniques in rats undergoing postobstructive diuresis. Micropuncture study of postobstructive diuresis in the rat. Article information, pdf download for postobstructive diuresis in cats with. Burkitts lymphoma, which originates from bcells, is commonly a disease of children, although it is also frequent amongst immunodeficient adults. Postobstructive diuresis the american journal of medicine. Nephron functional heterogeneity in the postobstructive kidney. Oct 03, 2014 postobstructive diuresis definition high urine output exceeding 200mlhr 0. In postobstructive decompression, watch out for hematuria, hypotension and electrolyte abnormalities postobstructive diuresis after obstruction, there will be an appropriate physiologic response which will help eliminate the excess volume and solutes, but even after homeostasis is achieved, there can be an inappropriate diuresis pathophysiology. At least 30 mm later, 10 ml of scintillation fluid was added and the 4c activity was measured in a liquid scintillation counter. The rate of diuresis is based on the severity of volume overload, urea accumulation, and electrolyte disturbances that occurred during obstruction. Increase the urine flow, change urine ph change the ionic composition of the urine and blood. To educate primary health care professionals about the diagnosis and treatment of postobstructive diuresis pod, a rare but potentially lethal complication associated with the relief of urinary obstructions.
See the editorial commentaries by torres and ferrer on pages 9623. Risk factors for postobstructive diuresis in pediatric. In order to investigate the syndrome of postobstructive diuresis, clearance and micropuncture studies were carried out in rats after relief of 24 hr of bilateral bul or unilateral uul ureteral ligation. Feb 23, 2016 urinary obstruction is a common cause of acute and chronic renal failure. Severe postrenal acute kidney injury, postobstructive. Postobstructive diuresis pod is a polyuric state in which large quantities of salt and water are eliminated after the relief of a urinary tract obstruction. Postobstructive diuresis in cats with the authors 2015. The defect in urine concentration and polyuria recurred on discontinuation of indomethacin and hydrochlorothiazide therapy, but improved after therapy with both drugs was restarted. We present a case of pod resulting from partial nephrogenic diabetes insipidus and discuss the diagnosis, treatment, and prognosis.
The incidence of pod across the studies varies between 0. Objective to educate primary health care professionals about the diagnosis and treatment of postobstructive diuresis pod, a rare but potentially lethal complication associated with the relief of urinary obstructions. Postobstructive diuresis is a normal physiologic event in patients with prolonged buo. In addition, postobstructive diuresis in relation to fluid therapy. These changes corresponded with marked decreases in. Pdf posterior reversible encephalopathy syndrome in. Diuresis definition of diuresis by the free dictionary.
Polyuria and pod fr were investigated for their association with blood and urine laboratory parameters. Massive diuresis after relief of urinary tract obstruction has been divided into 3 categories. The likelihood of developing diuresis was significantly higher during the 18 to 24 h, 30 to 36 h, 42 to 48 h, and 48 h postobstruction time periods as compared with the 6 to 12 h postobstruction time period. However, prolonged bilateral ureteral obstruction buo can cause severe structural and functional tubular damage. Posterior reversible encephalopathy syndrome in setting of postobstructive diuresis and persistent hypocalcemia article pdf available in renal failure 349. Postobstructive diuresis is an uncommon but clinically significant complication following the release of urinary obstruction. Patients with edema, hypertension, weight gain, and azotemia are most likely to exhibit this condition. Hamdi a, hajage d, van glabeke e et al severe postrenal acute kidney injury, postobstructive diuresis and renal recovery. The rate of diuresis is based on the severity of volume overload. His medical history included hypertension controlled on two medications and benign prostatic hyperplasia bph treated with an. Urinary tract obstruction is a frequent occurrence in the hospitalized setting. Postobstructive diuresis is a polyuric response initiated by the kidneys after the relief of a substantial bladder outlet obstruction. To investigate the pathogenesis of postobstructive diuresis, a state of functional anuria during ureteral obstruction was created in awake rats by a bilateral obstruction bo.
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