Anaphylaxis induced by peanuts.

Year patients suggested powerful renal vasoconstriction, possibly due to neurogenic or humoral influences. The stimulus to this might be a raised renal pelvic pressure, although this is, however, appreciably lower than the bladder pressure measured concurrently.' Surgical relief of chronic retention was accompanied by a prompt and sustained rise in glomerular filtration rate and effective renal plasma flow that persisted for several years. Possibly this prolonged recovery of renal function might have been due to amelioration of vasoconstrictive changes, with a gradual process of regeneration of the residual nephron population due to functional adaptation. This latent improvement of renal function was not inhibited by recrudescence of hypotension in one patient, and this suggests that hypertension is not an adverse factor for renal function in these circumstances. Renal damage is probably related to the duration and degree of the preceding high pressure chronic retention, but this might be difficult to prove as the high pressure chronic retention syndrome may be clinically silent, or may present with secondary effects such as hypertension or cardiac failure. Unfortunately, the duration of secondary hypertension, which is probably a late manifestation, gives no indication of how long high pressure chronic retention has been present. Whether the renal damage is reversible depends on the timing of surgical intervention. It is therefore imperative to avoid long delays in referral to hospital and to circumvent lengthy waiting lists to expedite urological assessment and early prostatectomy.5