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Recurrent Radiographic Dye-Induced Acute Renal Failure

Harvey A. Feldman, MD; Stanley Goldfarb, MD; Donna K. McCurdy, MD
JAMA. 1974;229(1):72. doi:10.1001/jama.1974.03230390048026.
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AZOTEMIC, diabetic patients may be prone to acute renal failure after intravenous pyelography.1 Two of the proposed etiologic factors are dehydration and hyperuricosuria.2 We observed two such episodes in a diabetic patient despite hypouricemic therapy and vigorous hydration.

Report of a Case  A 43-year-old diabetic man with long-standing hypertension, coronary arteriosclerosis, diabetic retinopathy, and peripheral neuropathy was admitted to the Philadelphia Veterans Administration Hospital on Feb 8, 1973, for treatment of congestive heart failure. On admission, his serum creatinine level was 5.0 mg/100 ml, and uric acid concentration was 8.5 mg/100 ml. Daily urine output was 1,500 to 3,000 ml, and protein excretion averaged 1.0 gm/24 hr.On Feb 13, drip infusion pyelography with 300 ml of 25% diatrizoate sodium was performed without resulting hypotension, rash, or other acute reactions. The pyelogram showed no structural abnormalities. Despite no change in cardiac function, the patient became severely oliguric (urine


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