Acute renal failure rarely occurs following the administration of iothalamate or diatrizoate salts. The authors present a case of acute renal failure following the use of methylglucamine iothalamate 60%. Renal function, as determined by serum creatinine and blood urea nitrogen levels, returned to essentially the same state which existed prior to the use of methylglucamine iothalamate. INDEX TERMS: Contrast Media, toxicity s Kidneys, effects of drugs on • Kidneys, failure Radiology 104:561-562, September 1972 . S EVE RAL MILLION diagnostic radiological examinations utilizing diatrizoate, iothalamate, or metrizoate salts are performed each year with relatively few complications.Acute renal failure is less frequent than most of the complications associated with the use of these agents. There have been several previous reports of acute renal failure following the administration of methylglucamine diatrizoate in the absence of multiple myeloma (2, 3, 5, 8, 10); most involved azotemic diabetics who had been dehydrated prior to excretory urography (3, 8). However, cases have also been reported following aortography (10) and angiocardiography (5). Cases of acute renal failure following the intravenous administration of sodium diatrizoate in the absence of multiple myeloma have also been reported (2, 4). We wish to report the first known case of methylglucamine iothalamateinduced acute renal failure. To our knowledge, this complication has not been reported previously.
CASE REPORTA 62-year-old Caucasian man was admitted here on March 8, 1971 with a four-month history of progressive paraparesis and difficulty in voiding. Sixteen months prior to admission, he began to experience difficulty in walking secondary to weakness and numbness of the legs. On admission to another hospital one month earlier for evaluation of progressive neurological deterioration, examination revealed (a) a widebased gait, (b) distal weakness and 4+ deep tendon reflexes of both legs, (c) bilateral extensor toe reflexes upon plantar stimulation, (d) marked sustained clonus of the right foot and minimal clonus of the left foot, (e) lack of lower abdominal reflexes and brisk upper abdominal reflexes, (j) lack of cremasteric reflex response, (g) lack of sensory deficit of the right leg and perianal region, and (h) equivocal hypoesthesia of the left leg from the midthigh to the toes. On February 9, myelography revealed irregular, serpentine filling defects of the Pantopaque column. Cerebrospinal fluid obtained by lumbar puncture on the following day (presumably to remove the Pantopaque) was clear, but the protein level was elevated to 91 mg per 100 ml, The patient's neurological status began to deteriorate rapidly following the second lumbar puncture. By February 11, he was unable to void, Fig. 1. Supine plain film of the abdomen, obtained approximately 24 hours after the onset of acute renal failure, demonstrates a dense nephrogram bilaterally.had a definite sensory deficit extending to the level of L1, and was markedly paraparetic to the extent that he ...
