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Failure of Protective Measures to Prevent Contrast Media—Induced Renal Failure

Celia S. Levitz, MD; Eli A. Friedman, MD
Arch Intern Med. 1982;142(3):642-643. doi:10.1001/archinte.1982.00340160222039.
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To the Editor.  —We read with interest the article in the September 1981 Archives (141:1268-1270) by Kumar et al and the corresponding article (141:1271-1274) by Teruel et al containing differing views on the incidence of acute renal failure after angiography in patients with underlying renal insufficiency, diabetes, or hypertension. Harkonen and Kjellstrand1 reported a 76% incidence of contrast agent—induced nephropathy in diabetics with pre—intravenous pyelogram serum creatinine levels of 2 mg/dL or greater. To protect the kidney from dye-induced renal failure, preangiogram hydration and administration of intravenous (IV) mannitol2 have been proposed. We, however, noted a patient in whom contrast agent—induced renal failure developed, despite receiving these prophylactic measures.

Report of a Case.  —A 64-year-old man with a 24-year history of diabetes, who had been receiving insulin therapy for the past eight years and who was also receiving antihypertensive medications (his blood pressure was 140/70 mm Hg), was admitted


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