Marked bilateral global persistent CT nephrogram 48?h after percutaneous coronary intervention with contrast-induced nephropathy requiring transient hemodialysis with severe cardiac dysfunction
Marked bilateral global persistent CT nephrogram 48?h after percutaneous coronary intervention with contrast-induced nephropathy requiring transient hemodialysis with severe cardiac dysfunction
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经皮冠状动脉介入治疗后 48 小时显着的双侧整体持续 CT 肾图，伴有造影剂肾病，需要短暂血液透析并伴有严重心功能不全
DOI：
10.1007/s13730-022-00713-2
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发表时间：
2022
期刊：
影响因子：
1
通讯作者：
Tanaka Marenao
中科院分区：
文献类型：
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作者：
Moniwa Norihito;Kimura Ayumu;Nishikawa Ryo;Tanaka Marenao
碘化造影剂(CM)一般在给药后3分钟内排入尿路。然而，一些病例在服用CM数小时后出现持续性肾图。这一现象似乎与造影剂肾病(CIN)的发展和加速有关。一位74岁的女性，患有慢性肾脏疾病，射血分数(EF)非常低(11%)，因心力衰竭住进札幌医科大学医院。入院第21天冠状动脉造影显示左前降支(LAD)闭塞。于第28天静脉滴注218ml碘海醇行经皮冠状动脉介入治疗(PCI)，预防CIN。经皮冠状动脉介入治疗后，她患上了CIN，需要血液透析。经皮冠状动脉介入治疗后48小时非对比CT显示双侧持续性肾图，皮质衰减值为168HU。在小肠和结肠有代谢性的CM排泄。她的肾功能逐渐恢复，在第43天10次治疗后停止血液透析。此病例的研究结果表明，EF非常低的患者，由于CM持续滞留在肾皮质，CIN的风险很高。
An iodinated contrast medium (CM) is generally excreted into the urinary tract within 3 min after administration. However, some cases present a persistent kidney nephrogram several hours after administration of CM. This phenomenon seems to be associated with the development and acceleration of contrast-induced nephropathy (CIN). A 74-year-old woman with chronic kidney disease and a very low ejection fraction (EF) (11%) was admitted to Sapporo Medical University Hospital because of heart failure. Coronary angiography revealed occlusion of the left anterior descending artery (LAD) on day 21 of admission. Percutaneous coronary intervention (PCI) to the LAD using 218 ml of iohexol was performed with a preventive measure for CIN by saline infusion on day 28. After PCI, she developed CIN requiring hemodialysis. Non-contrast computed tomography 48 h after PCI showed a marked bilateral persistent nephrogram with a cortical attenuation value of 168 HU. Vicarious excretion of CM was noted in the small bowel and colon. Her kidney function gradually recovered and hemodialysis was discontinued after ten sessions on day 43. The findings from this case suggest that a patient with a very low EF is at a high risk for CIN through persistent retention of the CM in the kidney cortex.