Scattered striated persistent nephrogram in sepsis

Abstract

Persistent nephrogram, the hallmark of radiocontrast-induced kidney failure, is usually homogenous throughout the kidney and is considered as a generalized shutoff of glomerular filtration, the consequence of altered glomerular hemodynamics, affecting most glomeruli. Herein, we report an incidental finding of scattered persistent nephrogram that was noted in a septic prediabetic hypertensive patient during computerized tomography-guided drainage of a liver abscess. The peculiar patchy striated distribution pattern suggests more centrally altered renal hemodynamics, with hypoperfusion at the level of interlobar and intralobular arteries. Altered renal microcirculation in this case is likely related to the combined effects of prediabetes, sepsis and contrast medium upon renal blood flow regulation, perhaps with consequent focal hypoxic tubular damage.

Acute Renal Failure with Severe Loin Pain and Patchy Renal Vasoconstriction in a Patient without Hypouricemia, Provoked by Epileptic Seizure

“…Ishikawa et al proposed that unknown nephrotoxins from injured muscle tissue other than myoglobin may cause renal vasoconstriction, resulting in acute tubular necrosis and the deterioration of the renal function ( 1 ). However, a recent study on ALPE advocated a pathophysiological basis of free radicals produced by exercise leading to renal vasoconstriction and ischemic damage ( 4 ), indicating that the pathophysiology of ALPE is independent of muscle injury. Since the epileptic seizures in the present patient resolved spontaneously before he reached our emergency room, hypoxemia was not documented.…”

“…While renal hypouricemia is a known predisposing factor for recurrent episodes of non-myoglobinuric AKI, significant proportions of patients suffer from this condition without renal hypouricemia ( 1 , 3 ). Although the pathogenesis of ALPE remains unclear, free radicals or myogenic toxins are assumed to cause renal damage ( 4 ).…”

Persistent Nephrogram

“…The prolonged renal cortical retention of contrast media is called persistent nephrogram. While details regarding the mechanism of persistent nephrogram are unclear, some have hypothesized that it represents a tubular obstruction or a generalized shutoff of glomerular filtration, as a consequence of altered glomerular hemodynamics ( 1 ).…”