|Nefrologia 2008;28(3):357-358 | Doi.|
|Acute renal failure after venography|
|Insuficiencia renal aguda tras venografía|
|Enviado a Revisar: 30 Nov. 2009 | Aceptado el: 30 Nov. 2009 | En Publicación: 16 Feb. 2010|
|Jesus Javier Castellanos Monedero1, A. Carreño Parrilla2, M. Arambarri Segura2, G. Caparrós Tortosa2|
|1Servicio de Medicina Interna. Hospital La Mancha Centro. Alcázar de San Juan (España)|
2Servicio de Nefrologia. Hospital General de Ciudad Real. Ciudad Real (España)
|Correspondencia para Jesus Javier Castellanos Monedero, Servicio de Medicina Interna, Hospital La Mancha Centro, Alcázar de San Juan, España|
To the editor:
Venography is a procedure intended to ascertain the location of veins in the arm in order to select the most adequate for performing the arteriovenous fistula required for haemodialysis. The case of a 73-year old female patient with a history of diabetes mellitus and high blood pressure, both starting 20 years before, atrial fibrillation, mitral and aortic stenosis, chronic anaemia, and chronic kidney disease diagnosed five years before and monitored at our department of nephrology, with creatinine levels of 3 mg/dL and a creatinine clearance of 15 mL/min, is reported here. She was being treated with insulin, acenocoumarol, furosemide, oral iron, doxazosin, atenolol, isosorbide dinitrate patches, folic acid, and omeprazole. The patient attended the hospital reporting oligoanuria (150 mL/24 h) for the past 24 hours after a venography. There was no other potential triggering factor of oligoanuria. Physical examination found no fever and blood pressure values of 130/60 mmHg. CA: Rhythmic heart sounds. PA: Preserved vesicular murmur. Lower limbs: No oedema or signs of DVT. Laboratory tests showed a normal WBC differential, haemoglobin 8.9, platelet count 159,000. Urea 104, creatinine 7.2, sodium 128, potassium 4.6, LDH 564, elemental urine analysis: pH 5, specific gravity 1005, positive protein (+++), sodium 13 mEq/L, and potassium 53 mEq/L. The ECG showed atrial fibrillation with controlled ventricular response at approximately 80 bpm. Chest and abdominal X-rays revealed no radiographic changes. During admission, patient received intravenous fluid therapy, diuretics, and N-acetyl cysteine, showing basal creatinine levels of 4 mg/dL at three days of admission.
Renal failure triggered by intravenous contrast after a venography is very uncommon, but has been reported as one of its complications.1,2 Acute renal failure caused by a contrast agent is defined in absolute form as a 0.5 mg/dL increase and in relative form as a 25% increase in creatinine levels 48-72 h after administration.3
Contrast-induced renal failure is more common in patients who previously have some grade of renal insufficiency, those with a prediabetic state, those with diabetes mellitus starting some years before,4-6 or patients with hyperuricemia7 (values higher than 7 mg/dL in males and 5.9 mg/dL in females). The most common clinical sign is oligoanuria from renal function impairment, occurring as a consequence of renal vasoconstriction and medullary hypoperfusion.8 There is no defined treatment for contrast toxicity, and there are different theories about the most adequate treatment. Effective treatment with fluid therapy and Nacetyl cysteine has been reported in the literature,9 but there are also articles reporting no benefits from use of these treatments.10
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