Acute renal failure after cerebral arteriography in a diabetic patient

Weinrauch, Larry A.; Friedberg, Scott; D’Elia, John A.

doi:10.1007/bf00332368

Cited by 6 publications

(2 citation statements)

References 10 publications

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“…However, there are only few reports dealing with immunological mechanisms. Uric acid crystals have been noted in the urinary sediment of diabetic patients with contrast media-induced renal failure (12).…”

Section: Discussionmentioning

confidence: 99%

Fatal Reaction Following Renal Angiography and Biopsy in Diabetic Patients with Azotemia

Hietala

Lindqvist

Lithner

et al. 1982

Journal of Internal Medicine

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Severe reactions to contrast media in two diabetic patients with azotemia are described. Both patients also showed signs of immunopathy. The reaction was fatal in one of them. Little is known about contrast media reactions and their natural history. Patients with diabetes mellitus and impaired renal function should be studied with caution and with careful consideration of the indication for the procedure. If an examination with contrast media is considered unavoidable, all diabetic patients with renal failure should be supervised closely to detect the development of acute renal failure. Dehydration should be avoided. Carehl monitoring of blood glucose, serum electrolytes, serum creatinine and blood pressure will aid in the early detection of the adverse reaction.

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Section: Discussionmentioning

confidence: 99%

Fatal Reaction Following Renal Angiography and Biopsy in Diabetic Patients with Azotemia

Hietala

Lindqvist

Lithner

et al. 1982

Journal of Internal Medicine

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“…Patients with diabetes are also more likely to require hemodialysis from CIN. [19][20][21][22] Special care should be taken in patients undergoing arteriography while taking dimethylbiguanide (Metformin), an oral hypoglycemic agent. Metformin use in the presence of renal dysfunction can result in lactic acidosis in patients developing contrastinduced nephropathy.…”

mentioning

confidence: 99%

Arterial imaging in patients with lower extremity ischemia and diabetes mellitus

Pomposelli

2010

Journal of Vascular Surgery

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Precise, comprehensive imaging of the arterial circulation is the cornerstone of successful revascularization of the ischemic extremity in patients with diabetes mellitus. Arterial imaging is challenging in these patients because the disease is often multisegmental with a predilection for the distal tibial and peroneal arteries. Occlusive lesions and the arterial wall itself are often calcified and patients presenting with ischemic complications frequently have underlying renal insufficiency. Intra-arterial digital subtraction angiography (DSA), contrast enhanced magnetic resonance angiography (MRA), and more recently, computerized tomographic angiography (CTA) have been used as imaging modalities in lower extremity ischemia. Each has specific advantages and shortcomings in this patient population, which will be summarized and contrasted in this review. DSA is an invasive technique most often performed from a femoral arterial puncture and requires the injection of arterial contrast, which can occasionally cause allergic reactions. In patients with pre-existing renal insufficiency, contrast infusion can result in worsening renal failure; although usually self-limited, it may occasionally require hemodialysis, especially in patients with diabetes. However, DSA provides the highest degree of spatial resolution and image quality. It is also the only modality in which the diagnosis and treatment of arterial disease can be performed simultaneously. MRA is noninvasive, and when enhanced with gadolinium contrast injection provides arterial images of comparable quality to DSA and in some circumstances may uncover distal arterial targets not visualized on DSA. However, spatial resolution is inferior to DSA and erroneous interpretations due to acquisition artifacts are common. Specialized equipment and imaging techniques are necessary to minimize their occurrence in the distal lower extremity. In addition, due to the risk of inducing nephrogenic systemic fibrosis, gadolinium-enhanced MRA cannot be used in patients with renal insufficiency. CTA is noninvasive and rapidly performed, with better spatial resolution than MRA, but requires the largest volume of contrast infusion, exposes patients to high-doses of radiation, and is subject to interpretive error due to reconstruction artifacts especially in heavily calcified arteries, limiting its usefulness in many patients with diabetes. For patients in whom the planned intervention is a surgical bypass, DSA and MRA will provide high quality images of the lower extremity arterial anatomy. For patients in whom a catheter-based intervention is the likely treatment, a diagnostic DSA immediately followed by a catheter-based treatment in the same procedure is the preferred approach. In patients with pre-existing renal dysfunction, in which gadolinium-enhanced MRA is contraindicated, DSA or CTA can be performed. However, patients should have an infusion of intravenous normal saline solution or sodium bicarbonate before the procedure to reduce the incidence of contrast-induced nephropathy.

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Neuroradiology of Intracranial Aneurysms

Lin¹,

Kricheff²

1985

Cerebrovascular Surgery

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Acute renal failure after cerebral arteriography in a diabetic patient

Cited by 6 publications

References 10 publications

Fatal Reaction Following Renal Angiography and Biopsy in Diabetic Patients with Azotemia

Fatal Reaction Following Renal Angiography and Biopsy in Diabetic Patients with Azotemia

Arterial imaging in patients with lower extremity ischemia and diabetes mellitus

Neuroradiology of Intracranial Aneurysms

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