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