Contrast nephropathy in azotemic diabetic patients undergoing coronary angiography
Article Abstract:
Contrast nephropathy is the development of kidney disease after the administration of contrast agents during diagnostic imaging procedures. Contrast agents are radioactive solutions that provide a contrast in density between the tissue or organ being filmed and the medium. The incidence, risk factors, and outcome of contrast nephropathy was assessed in 59 diabetic patients with azotemia, the presence of nitrogen-containing compounds in the blood. These patients underwent coronary angiography, or X-ray of the coronary arteries, the major blood vessels supplying the heart. Blood levels of creatinine, a nonprotein element of the blood that is increased in advanced kidney disease, were increased 24 hours after exposure to contrast agents in patients who underwent coronary angiography compared with diabetics who did not undergo angiography. Dialysis, the artificial filtration of the blood, was required for seven patients at six days after angiography, and for two patients within two weeks of angiography. Contrast nephropathy with a greater than 25 percent increase in creatine levels in the blood occurred in 50 percent of patients subjected to coronary angiography, but did not develop in patients who did not undergo angiography. Risk factors for contrast nephropathy included the quantity of the contrast agent, a blood pressure of greater than 100 millimeters mercury (mm Hg), and an ejection fraction, (percentage of blood emptied from the left ventricle with contraction) of less than 50 percent. These findings show that azotemic diabetes patients are at increased risk for developing contrast nephropathy. Although the kidney disorder can be reversed, the affected patients may require short-term dialysis. The incidence of contrast nephropathy may be decreased by using less than 30 milliliters of contrast agent. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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Recurrent nocturnal hypoglycemia in an insulin-dependent diabetic patient receiving a small daily dose of insulin
Article Abstract:
Hypoglycemia is an abnormal drop in blood sugar and is frequently associated with insulin treatment of diabetes, and usually results from apparent causes. Unusual causes of hypoglycemia include pan-pituitary necrosis, or deterioration of the pituitary gland, occurring spontaneously or during childbirth; impaired function of the pituitary gland after brain disease; and growth hormone deficiency after cerebral edema, or fluid accumulation within the brain. A case is described of a 41-year-old woman with a 33-year history of insulin-dependent diabetes mellitus and six-year history of frequent, nightly attacks of hypoglycemia. The patient was shown to have a deficiency in growth hormone that developed during her pregnancy. Growth hormone is an important regulatory factor that antagonizes or counteracts insulin effects. The hypoglycemia attacks occurred at night when growth hormone is normally released from the pituitary in its maximal or greatest amounts. Administration of growth hormone corrected the hypoglycemic episodes, indicating that growth hormone deficiency caused the hypoglycemia. The actions of other metabolic regulators such as glucagon and catecholamines, which normally counteract hypoglycemia, may have been impaired in this patient. Because growth hormone can cause complications of the small blood vessels, particularly within the retina, which is the inner lining of the eye, the use of growth hormone therapy should be accompanied by routine examination of the retina. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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Effect of dietary protein restriction on functional renal reserve in diabetic nephropathy
Article Abstract:
Kidney disease affects up to 40 percent of patients with insulin-dependent (IDD) diabetes and is usually progressive, leading to end-stage disease. Meticulous treatment may prevent kidney complications in diabetics but, once started, progression can be delayed, but not halted. Restriction of dietary protein has effectively decreased the rate of kidney disease progression, as measured by the glomerular filtration rate (GFR; volume filtered by the kidney over a period of time). Another way to measure kidney function is by functional renal reserve, which measures the increase in GFR following the stimulus of a protein meal. The change in functional renal reserve was measured in eight patients with IDD who decreased protein intake by 40 percent. Results were then compared with those of seven patients who maintained their usual protein intake. Kidney excretion of protein, a sign of kidney dysfunction, decreased in the low-protein group, but increased significantly in the normal diet group. After 12 months, the GFR decreased in both groups, a consequence of kidney disease progression, but was significantly lower in the normal diet group. As expected, the functional renal reserve increased in the low-protein group, but decreased in the normal diet group. These findings suggest that kidney function and functional reserve are preserved in patients with IDD who are placed on protein-restricted diets. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
User Contributions:
Comment about this article or add new information about this topic:
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