Two studies have suggested that the use of ACEI alongside statins might be an effective regimen to prevent a substantial number of CRS cases in high risk patients and improve survival and quality of life in these people. There are data suggesting combined use of statin and an ACEI improves clinical outcome more than a statin alone and considerably more than ACE inhibitor alone.Natriuretic peptides
Nesiritide which is an analogue of brain natriuretic peptide (BNP) was shown to result in poorer kidney outcome or have no effect.Vasopressin antagonists
Tolvaptan showed to have no benefit. It is also a very costly drug.Adenosine antagonists
Adenosine is responsible for constriction of afferent arteriole and reduction in GFR. It was found that an adenosine A1-receptor antagonist called KW-3902 was able to improve kidney function in CRS patients.Ultrafiltration
Many case reports have shown improved kidney function with ultrafiltration.Inotropes
Their roles remain unknown. Epidemiology
Kidney failure is very common in patients with congestive heart failure. It was shown that kidney failure complicates one-third of all admissions for heart failure, which is the leading cause of hospitalization in the United States among adults over 65 years old. Not only is this the leading cause of hospitalization, it also increases the stays in the ICU.These complications led to longer hospital stay, higher mortality, and greater chance for readmission. The impatient mortality was seen to be much higher for patients with much more sever renal dysfunction. The increase of hospital and ICU stays also increases the cost of care in the hospital.
It can cause frequent blockage of the ureter leading to serious kidney damage. In other cases, a small, upper portion of the kidney is congenitally non-functional. Though often benign, this problem can necessitate the removal of non-functioning parts. Causes
Definitive causes of ureterocele have not been found. While the abnormal growth occurs within the uterus, it has not been substantiated that genetics are to blame. Congenital abnormalities of the mesonephric duct in males can lead to the formation of a ureterocele, which often coincide with ipsilateral agenesis of the kidney (atrophic kidney) and seminal vesicle cysts, this is known as Zinner Syndrome. Diagnosis
IVU-shows Adder head appearance or Cobra head appearance. Cystoscopy-shows translucent cyst which is thin walled surrounding ureteric orifice

Treatment
Single-system ureterocele: initial management is usually endoscopic incision of the ureterocele, which can be followed by surgical ureteric re-implantation to preserve renal function and prevent reflux. Duplex-system ureterocele: treatment options vary with the individual and include: endoscopic incision of the corresponding ureteric orifice in case of ureteric meatal stricture; upper pole nephrectomy for a poorly functioning unit with ureterectomy or, where there is useful renal function, ureteropyelostomy. References
Further reading


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