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August 14, 1948


Author Affiliations

Dallas, Texas

JAMA. 1948;137(16):1378-1382. doi:10.1001/jama.1948.82890500013006a

Transurethral prostatectomy, with water as the irrigating fluid, is associated with prominent intravascular hemolysis, following which acute renal insufficiency develops in a proportion of cases.1 This syndrome of acute renal insufficiency has been given various designations, such as the "renal anoxia syndrome,"2 "lower nephron nephrosis"3 and "hemoglobinuric nephrosis."4 It has become apparent that the syndrome may result from a multiplicity of other causes, among which may be included prolonged hypotension (the shock state),5 incompatible (hemolytic) blood transfusion reactions,6 crush injuries, carbon tetrachloride poisoning,8 uteroplacental damage9 and certain infections.10 The clinical picture and renal lesions are similar, regardless of the causative background. An outstanding feature of this syndrome has been the highrate of mortality.

The methods of treatment for this condition have varied. The occasional spontaneous recovery in isolated cases has for some time demonstrated the reversible nature of the process involving

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