• PDF / 170,481 Bytes
• 1 Pages / 595.245 x 841.846 pts (A4) Page_size
• 110 Downloads / 153 Views

DOWNLOAD

REPORT

---

1 S

Diatrizoate-meglumine Anuria secondary to acute renal shut-down: case report

A 65-year-old man developed anuria secondary to acute renal shut-down following administration of diatrizoate-meglumine as contrast agent during retrograde pyelography. The man, who had been receiving regular treatment for hypertension and a prior left stroke, presented with gross haematuria for 6 months. He was a smoker since the age of 35 years. The urine culture was sterile. His urine output was 1 200 mL/day. Serum creatinine levels were 1.9 mg/dL. Urine cytology revealed malignant cells. Kidneys and bladder CT scan showed papillary growth in the left lateral wall with normal upper tracts. Transurethral resection of the bladder tumour (TURBT) demonstrated inflammatory atypia on histopathology. Due to continued haematuria cystoscopy, bilateral ureteric washings for cytology and retrograde pyelography were performed. The procedure was performed under spinal anaesthesia. During cystoscopy no bloodstained efflux, normal ureteric orifices and inflamed mucosa were observed at the TURBT site. Urine was aspirated from the ureter for cytology and 6mL of diatrizoate-meglumine [meglumine diatrizoate] 76% (1:2 dilution) was injected bilaterally. No abnormality or pyelosinus/ venous or lymphatic back-flow was observed on both sides. At the end of surgery, a 14-French Foley per urethral catheter was placed. The intraoperative course was uneventful. Immediately after procedure, he developed anuria with worsening renal parameters secondary to acute renal shut-down [time to reaction onset not stated]. The man was treated with intravenous fluid boluses of normal saline 0.9% over 1 hour at a gap of 4 hours in addition to intravenous fluids at 50 mL/hour. However, the urine output failed to improve. By postoperative day 5, his blood urea was 90 mg/dL and serum creatinine 7.5 mg/dL. He received three sessions of haemodialysis. Thereafter, his urine output started improving. The infectious work-up was negative. He was not receiving any nephrotoxic medications. Ultrasound did not show hydroureteronephrosis. By postoperative day 12, the renal parameters reached baseline. Anuria was considered to be secondary to upper urinary tract oedema due to diatrizoate-meglumine, which settled after 5 days leading to renal function improvement. At 12 months post procedure, his serum creatinine was stable at 1.8 mg/dL. Mallya A, et al. Bilateral retrograde pyelography leading to anuria. National Medical Journal of India 32: 20-21, No. 1, Jan-Feb 2019. Available from: URL: http:// www.nmji.in/text.asp?2019/32/1/20/272110

0114-9954/20/1788-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved

803448280

Reactions 25 Jan 2020 No. 1788