Acute Renal Failure After Excretory Urography in Diabetic Patients

Díaz-Buxó, José A.; Wagoner, Richard D.; Hattery, Robert R.; Palumbo, P. J.

doi:10.7326/0003-4819-83-2-155

Cited by 109 publications

(21 citation statements)

References 9 publications

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“…Of 8 patients with mildly elevated pre-IVP serum creatinines (1.5-1.8 mg/dl), 3 demonstrated a sig nificant rise in serum creatinine following IVP; 1 patient became transiently oliguric. In addition, there are several case reports of similar oliguric episodes in diabetic pa tients with evidence of only mild renal insufficiency [9,18,20,23,34,65]. These cases underscore the suscepti bility of any diabetic patient with renal disease.…”

Section: Diabetes Mellitusmentioning

confidence: 96%

“…As awareness of the toxicity of contrast media has grown over the past few years, so have estimates of the frequency of complica tions. Several predisposing factors have been implicated; the most significant are preexisting renal insufficiency [8,18,20,22,[29][30][31][32][33] and diabetes mellitus [3,5,11,18,20,25,31,33]. Of the more than 250 published cases of con trast nephropathy, over 90% involved patients with renal insufficiency and over 50% involved patients with dia betes mellitus.…”

Section: Incidence and Risk Factorsmentioning

confidence: 99%

“…The first is that the incidence of contrast nephropathy in the overall hospitalized population is higher than gen erally appreciated [18,37,65]; a 5% incidence of some degree of renal impairment is a reasonable estimate. The incidence in an outpatient population would likely be lower because of fewer underlying risk factors, but follow up studies in these patients are lacking.…”

Section: General Populationmentioning

confidence: 99%

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Contrast Nephropathy

Harkonen

Kjellstrand²

1981

Am J Nephrol

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Section: Diabetes Mellitusmentioning

confidence: 96%

Section: Incidence and Risk Factorsmentioning

confidence: 99%

Section: General Populationmentioning

confidence: 99%

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Contrast Nephropathy

Harkonen

Kjellstrand²

1981

Am J Nephrol

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“…ARF in patients with diabetic nephropathy may be caused by 1) dehydration during prolonged vomiting or diarrhea, frequently seen in patients with autonomic neuropathy, 2) hypotension in patients with autonomic neuropathy, and 3) contrast material injection (34). The importance of preventing ARF in this population becomes evident if consideration is given to its frequency and severity, and the possibility that it may prove irreversible in patients with moderately advanced renal insufficiency.…”

Section: Progression Of Nephropathymentioning

confidence: 99%

Managing the Diabetic with Renal Insufficiency

Díaz-Buxó

1986

Int J Artif Organs

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Diabetic nephropathy is responsible for the largest increase in new patients accepted for renal replacement therapy in industrialized countries (1). In Europe, the proportion of new dialysis patients who are diabetic has increased from less than 0.5% in 1972 to 7.3% in 1981 (2). In the U.S., about 3,200 diabetics reach end-stage renal disease (ESRD) each year, representing 20-25% of all new ESRD patients (3).Despite progress in dialysis the diabetic patient remains a formidable challange. ESRD develops pari passu with other complications that ultimately limit the quality of life. As our foremost goal should be to prevent all the complications of diabetes, the recent advances in diabetic nephropathy, retinopathy and neuropathy deserve our attention. PROGRESSION OF NEPHROPATHYThe role of arterial hypertension. Mogensen has thoroughly reviewed the relationship between diabetic nephropathy and arterial hypertension and called attention to its complexity and need for systematic evaluation (4,5). Complicating the analysis of this relationship is the frequent occurrence of both hypertension and diabetes in the general population and differences between Type I and Type II diabetics (body weight, age, incidence of hypertension, presence or absence of autonomic neuropathy and control of glycemia). The different stage of diabetic nephropathy and their characteristic renal hemodynamics must also be considered (5).A wealth of clinical data is being accumulated showing amelioration in the rate of decline of glomerular filtration rate GFR or protein excretion when blood pressure is lowed (6-13). A recent prospective, longitudinal and cross-sectional study showed a strong correlation between arterial blood pressure, urinary albumin excretion, and renal hemodynamics. The changes suggested a continuum of abnormalities, with distinct stages in the development of diabetic nephropathy (14).Parring et al have studied the effects of long-term, ag-The International Journal Of Artificial Organs I Vol. 9 no. 4, 1986 I p.p. 207-212 gressive antihypertensive therapy on GFR and albiminuria in young Type I patients (13). Their results suggest that prolonged reduction of blood pressure to near normal reduces the rate of decline of GFR and albuminuria. The role of glycemic control. The experimental diabetic rat model and experience with human renal transplantation have provided data suggesting that diabetic nephropathy is the result of hyperglycemia (15). Strict metabolic control with insulin prevents the thickening of the glomerular basement membrane (GBM), the increase in mesangial volume, the increases in GFR, and the onset of albuminuria (16,17). More impressive has been the reversal of renal diabetic changes in rats after pancreatic islet transplantation (18-22). The mesangial changes were reversed, glomerular volume diminished and albumin excretion returned to normal. The GBM, however, remained abnormally thickened.When the human non-diabetic kidney is transplanted into a diabetic host, the characteristic mesangial and GBM changes occ...

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“…Serum creatinine peaks within 3-5 days, then returns to baseline by 7-10 days. [6][7][8] How high the serum creatinine must increase for the diagnosis of RCIN is somewhat arbitrary. For research purposes, RCIN is defi ned as a serum creatinine increase of 0.5 mg/dL or 25% above baseline within 2-3 days of radiocontrast administration.…”

mentioning

confidence: 99%

B‐Natriuretic Peptide for the Prevention of Radiocontrast‐Induced Nephropathy

Kamalakannan

Lattupalli

Mesiha

et al. 2008

Dialysis & Transplantation

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BACKGROUND: The hypothesis of the study was that infusion of B-natriuretic peptide (BNP), by increasing renal vasodilatation and glomerular fi ltration, would reduce the incidence of radiocontrast nephropathy (RCIN) after cardiac catheterization in patients with preexisting renal insuffi ciency. METHODS:The study was a single-center, prospective, randomized, double-blind, placebo-controlled pilot study of 50 patients. Patients with a baseline serum creatinine (SCr) Ͼ 1.5 mg/dL not on dialysis undergoing elective cardiac catheterization with visipaque (nonionic, iso-osmolal contrast) were enrolled. Patients were randomly assigned to receive intravenous BNP or placebo infusion. RCIN was defi ned as SCr increase Ն 0.5 mg/dL at 48 hours post-contrast administration.RESULTS: There were no signifi cant differences in baseline characteristics between the 2 groups. The incidence of RCIN was 3.8% (1 of 26) in the BNP group versus 12.5% (3 of 24) in the placebo group (p ϭ 0.340). None of the patients who developed RCIN required renal replacement therapy, and all their SCr values returned to baseline on posthospital follow-up. On logistic regression only the baseline SCr was an independent predictor of RCIN.CONCLUSIONS: BNP infusion shows a nonsignifi cant trend of reduction in the incidence of RCIN in patients with chronic renal insuffi ciency undergoing elective cardiac catheterization. Further large-scale trials are needed to determine the usefulness of BNP infusion to prevent RCIN.

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Acute Renal Failure After Excretory Urography in Diabetic Patients

Cited by 109 publications

References 9 publications

Contrast Nephropathy

Contrast Nephropathy

Managing the Diabetic with Renal Insufficiency

B‐Natriuretic Peptide for the Prevention of Radiocontrast‐Induced Nephropathy

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