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