摘要:

The nephrotoxic potentials of a high-osmolar contrast medium, diatrizoate, and of a low-osmolar contrast medium, ioxaglate, were compared during early degenerative gentamicin-induced nephropathy in the rat. Male rats (13-22/group) were uninephrectomized. Six days later, the aorta was clamped above the renal artery, and either diatrizoate or ioxaglate was administered (1 ml/min for 3 min) via an aortic puncture into the remaining kidney. Some of the rats received chronic treatment with gentamicin (50 mg/kg/day i.m., 4 days), starting 2 days before and ending 1 day after contrast medium administration. Two control groups, only one of which received gentamicin, were subjected to a 3-min renal ischemia. The creatinine clearance (CrCl) per 100 g body weight was determined before and 24 and 48 h after contrast medium injection. A second study (6 rats/group) evaluated urinary N-acetyl-β-D -glucosaminidase (NAG) excretion and the histologic appearance of the kidneys (blinded analysis) in the same experimental groups. Gentamicin induced a significant decrease in CrCl at baseline(0.35 ± 0.19vs.0.41 ± 0.19 ml/min; p < 0.01) and an increase in urinary NAG(128 ± 92 vs. 39 ± 57 µmol/h/mmol creatinine; p < 0.01). Taking into account these differences at baseline, univariate repeated-measures analysis showed that on day 1 diatrizoate caused a more marked decrease in CrCl than ioxaglate (p < 0.05), whether or not gentamicin was also administered. On day 2, the depressant effect of diatrizoate associated with gentamicin persisted (CrCl vs. day 0 = -0.19 ± 0.10 ml/min), while that of diatrizoate alone returned to baseline (-0.05 ± 0.24 ml/min). Conversely, the effects of ioxaglate did not differ from those of the control groups at the two measuring times. Although the effects of contrast medium-gentamicin interaction were not significant for urinary NAG, the gentamicin plus diatrizoate combination suggested greater toxic potential than the gentamicin plus ioxaglate combination on day 2 (NAG vs. day 0 = +260 ± 528 vs. +22 ± 119 µmol/h/mmol creatinine). In contrast to ioxaglate alone, which only induced vacuolization, diatrizoate alone provoked foci of tubular necrosis associated with vascular lesions. Gentamicin alone induced irregular vacuolization. Contrary to the findings for gentamicin plus diatrizoate, no necrotic foci were observed with gentamicin plus ioxaglate. The nephrotoxic potential of diatrizoate after intra-renal administration is greater than that of ioxaglate administered in the rat during the early degenerative phase of gentamicin-induced n

ISSN:0250-8095    

DOI:10.1159/000168803

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

We report a case of an 18-year-old female who presented with severe hypomagnesemia due to idiopathic renal magnesium wasting. Only a partial response was noted with magnesium oxide replacement. Treatment with the potassium-sparing diuretic amiloride led to a further rise in the serum magnesium level, a decrease in the fractional excretion of magnesium and improvement in her symptoms. This case demonstrates an effective treatment for idiopathic renal magnesium wasting.

ISSN:0250-8095    

DOI:10.1159/000168804

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Metastatic bacterial endophthalmitis is a rare but devastating complication of septicaemia. We present 3 recent cases occurring in dialysis patients. Septicaemic dialysis patients seem particularly prone to staphylococcal endophthalmitis which developed in the face of therapeutic serum concentrations of appropriate antibiotics in all 3 cases. Prompt treatment, including consideration of intravitreal antibiotics, is required if vision is to be preserved. Early signs of endophthalmitis should be actively sought in septicaemic dialysis patients, as they are easily overlooked.

ISSN:0250-8095    

DOI:10.1159/000168805

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Bacterial endocarditis, particularly involving the left side, has been shown to occur in patients in regular hemodialysis. We report a case of right-sided endocarditis characterized by a very torpid evolution. Although the diagnosis was suspected early in the course, confirmation was obtained 2 months after the onset. Flaobaterium odoratum was identified in the fourth month of evolution and only after multiple blood cultures had been obtained. We believe the very low infectivity of F. odoratum and its very slow growth in culture media prevented an early diagnosis.

ISSN:0250-8095    

DOI:10.1159/000168806

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

We report a patient with severe chronic renal failure who developed spontaneous bone fractures. He was found to have hypercalcemia, normal calcitriol levels (probably due to extrarenal production by noncaseating granulomas), and functional hypoparathyroidism. The bone biopsy showed low bone turnover and the presence of noncaseating granulomas. Treatment with corticosteroids decreased the calcium and calcitriol levels and the parathyroid hormone levels rose. No further fractures occurred. A repeat bone biopsy revealed the presence of osteitis fibrosa. Renal osteodystrophy may be modulated by extrarenal production of calcitriol. In this case, excessive suppression of parathyroid hormone by endogenous calcitriol presumably caused an adynamic bone lesion and spontaneous fractures.

ISSN:0250-8095    

DOI:10.1159/000168807

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

A case of acute oliguric renal failure due to bilateral renal artery occlusion is described. The renal function was restored to normal 36 h after the embolic event by revascularization with streptokinase.

ISSN:0250-8095    

DOI:10.1159/000168808

出版商:S. Karger AG    

年代:1995

数据来源: Karger

ISSN:0250-8095    

DOI:10.1159/000168809

出版商:S. Karger AG    

年代:1995

数据来源: Karger