Ischemic renal failure was produced in rabbits by occluding the renal arteries for 90 min. Group 1 (n = 8) received radiocontrast media at the time of occlusion, group 2 (n = 8) 24 h after occlusion, and group 3 (n = 8) 3 days after occlusion. Group 4 (n = 12) was subjected to ischemic injury alone, group 5 (n =4) served as sham-operated controls and group 6 (n = 4) did not undergo surgery but received radiocontrast media. Serum creatinine concentration in group 1 increased to a greater degree (p < 0.001) than all other groups and did not return to normal during the 8-day observation period. Creatinine concentration in groups 2, 3, 4, and 6 were comparable and significantly increased compared to sham-operated group (p < 0.05). Urinary excretion of alanine aïninopeptidase and N-acetyl-β-glucosaminidase in group 1 was significantly greater than all other groups (p < 0.05). Microscopic analysis indicated tubular necrosis was more prominent in group 1. Radiocontrast media is nephrotoxic and in the setting of ischemic injury may prevent recovery of renal function. Toxicity was dependent on the time of administration since functional impairment was not increased if dye was given 1 or 3 days after ischemic injury.
In a patient on continuous ambulatory peritoneal dialysis with localized abdominal and genital edema, the site of extraperitoneal dialysate leakage was determined by computerized tomographic scanning with intraperitoneal contrast enhancement. No adverse effects were encountered. The source of fluid leakage should be sought in CAPD patients with localized (i.e. genital) edema, because often they may have an undetected hernia or other peritoneal defect. Removal of the peritoneal dialysis catheter would not solve such a problem. In such cases, intraperitoneal contrast-enhanced CT scanning may represent an effective technique for identifying the site of dialysate leakage. Abdominal and inguinal hernias are well-recognized complications of con tinuous ambulatory peritoneal dialysis (CAPD). Dialysate may escape from the peritoneal space through such hernias; also the development of genital edema in a CAPD patient may indicate the presence of an inguinal hernia, which otherwise may be impossible to detect clinically (I). In CAPD patients who have had multiple abdominal operations, there may be numerous possible sites of hemia development and dialysate leakage, so that it may prove difficult to identify and repair the defect. We describe a patient in whom contrast-enhanced computerized tomographic scanning was used to identify the site of extraperitoneal dialysate leakage.
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