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Ventilatory function during urography: a comparison of iopamidol and sodium iothalamate.

The effects on respiratory function during intravenous urography of the ionic contrast medium sodium iothalamate and the non-ionic contrast medium iopamidol were compared. Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were recorded in 37 non-atopic patients referred for intravenous urography. Nineteen patients received iopamidol and 18 patients received sodium iothalamate. Both the sodium iothalamate and the iopamidol groups showed a significant fall in FEV1 and FVC (P less than 0.001). The reductions in FEV1 and FVC were comparable and were not symptomatic. The differences in the percentage changes of the FEV1 and FVC in the iopamidol and the sodium iothalamate groups were not statistically significant (P greater than 0.5 and P greater than 0.1 respectively). No significant change in the ratio of the FEV1 and the FVC was demonstrated in either the iopamidol or the sodium iothalamate groups. Both the ionic and the non-ionic contrast media produced a measurable but asymptomatic and biologically insignificant fall in static ventilatory function. Bronchospasm does not appear to be an important contrast-induced effect in non-atopic individuals. Iopamidol offers no advantage over sodium iothalamate with respect to ventilatory effects in non-atopic patients undergoing intravenous urography.

Adult↗

Development of a fetal renal function test using endogenous creatinine clearance.

Selecting appropriate management for the fetus with obstructive uropathy depends on our ability to accurately assess the severity of existing renal damage and to predict the potential for recovery of renal function if the obstruction is relieved. Diagnosis and treatment would be markedly enhanced by a simple, safe, quantitative fetal renal function test. To answer the question of whether endogenous fetal creatinine clearance (CrC) is an accurate measure of glomerular filtration rate (GFR) in the obstructed fetal kidney, we compared fetal CrC to a standard test for GFR--iothalamate clearance (IC). Six fetal lambs underwent unilateral ureteral ligation at 60 to 63 days gestation (term = 145 days). The contralateral unobstructed kidneys served as a control. At a second operation at 113 to 120 days, renal function was measured by hourly split urine collections for determination of CrC, IC, and fractional sodium excretion on each side over a 4-hr study period. There was excellent correlation of CrC with IC in all kidneys (r = 0.997, P less than 0.001, y = 1.14 x). Compared to the control side, the obstructed fetal kidneys had significantly decreased GFR and abnormal tubular function with marked sodium loss.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

3-dimensional imaging of the pelviocaliceal system by computerized tomographic reconstruction.

Safe and efficient performance of percutaneous nephrolithotomy requires 3-dimensional visualization of the pelviocaliceal anatomy. However, currently available modalities offer only 2-dimensional images, from which the operator must mentally reconstruct a 3-dimensional picture of the pelviocaliceal configuration. We evaluated the feasibility of obtaining 3-dimensional images of the pelviocaliceal system with the aid of computerized tomographic reconstruction and present 3 illustrative cases.

Computer Graphics↗

Infusion pyelography in anuric patients.

The spectrum for the use of retrograde pyelography in renal failure has been narrowed further by extending the facility of infusion urography to anuric patients. The latter study has helped greatly in sifting apart pre-renal and renal anuria patients from those with obstructive uropathy. In obstructive anuria infusion urography has proved comprehensive in influencing judgment about the exact site and nature of obstruction, in affixing laterality towards the better functioning renal unit and in deciding a suitable definitive operation or planned staged procedures.

Acute Kidney Injury↗

Platelet-inhibitor treatment of diabetic nephropathy: a 10-year prospective study.

We prospectively evaluated a platelet-inhibitor regimen of dipyridamole and aspirin in 28 patients with insulin-dependent diabetes mellitus and well-established nephropathy. After a mean treatment period of 4.3 years, iothalamate clearance (Ciot) was reasonably well maintained and urinary protein excretion was reduced in 7 patients (25%), whereas 21 (75%) had progressive nephropathy. Analysis of outcome revealed that all 7 patients with stable nephropathy and 9 of the 21 with progressive disease had baseline Ciot values that exceeded 50 ml/min per 1.73 m2. Shortened platelet survival improved after 3 months of treatment, and the distribution between patients who had stable and those who had progressive disease was approximately equal. Mean changes in fasting plasma glucose level, glycosylated hemoglobin, and blood pressure did not differ between these two groups. In a short-term protocol, urinary protein and thromboxane B2 significantly declined, whereas variable urinary levels of prostaglandin E2, 6-ketoprostaglandin F1 alpha, and Ciot did not change after 3 months of treatment with dipyridamole and aspirin. These findings suggest that treatment with dipyridamole and aspirin may stabilize renal function by reducing platelet hypersensitivity and production of thromboxanes by platelet or renal tissue (or both). In turn, constrictor activity in the glomerular vessels, mesangial contractility, and glomerular membrane permeability are decreased. These data also add evidence in support of a role for thromboxane A2 in the pathogenesis of experimental and human glomerular disease.

Adult↗