Persistent Nephrogram on Abdominal Radiography and ...

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Picture　1A. Picture　1B.

Picture　2A. Picture　2B.

□ PICTURES IN CLINICAL MEDICINE □

Persistent Nephrogram on Abdominal Radiography andComputed Tomography

Michitaka Maekawa, Takahiro Imaizumi and Taishi Yamakawa

Key words: acute kidney injury (AKI), contrast-induced nephropathy, persistent nephrogram

(Intern Med 53: 2551-2552, 2014)(DOI: 10.2169/internalmedicine.53.3008)

A 51-year-old Japanese man presenting with acute abdo-

men was admitted to our hospital. Contrast-enhanced com-

puted tomography (CT) led to a diagnosis of gastroenteritis

on admission (Picture 1A). Contrast-induced oliguric acute

kidney injury followed by septic shock developed, and the

serum creatinine level rose from 0.98 mg/dL to 5.07 mg/dL,

requiring temporary hemodialysis. Kidney-shaped enhance-

ment was observed on an abdominal X-ray after 24 hours of

Department of Nephrology, Toyohashi Municipal Hospital, Japan

Received for publication April 3, 2014; Accepted for publication April 22, 2014

Correspondence to Dr. Michitaka Maekawa, [email protected]

Intern Med 53: 2551-2552, 2014 DOI: 10.2169/internalmedicine.53.3008

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contrast injection (Picture 2A). Delayed enhancement CT

performed after 42 hours demonstrated duodenal perforation,

peritonitis and diffuse enhancement of the kidney (Pic-

ture 1B). Vigorous fluid resuscitation resulted in the disap-

pearance of the enhanced kidney on abdominal X-ray im-

ages (Picture 2B).

A recent study reported that the persistence of contrast

material in the kidney is predictive of contrast-induced

nephropathy (1). The pathogenesis of persistent nephrogram

is presumed to involve compromise of the renal circulation

that results in a slowed urine flow in the collecting system,

with subsequent reabsorption of water and electrolytes that

allows concentrated contrast material to remain in the kid-

ney (2). The observation of kidney enhancement for a pro-

longed period alerts us to the possible development of per-

sistent kidney dysfunction which is attributable to acute tu-

bular necrosis.

The authors state that they have no Conflict of Interest (COI).

References

1. Chou SH, Wang ZJ, Kuo J, et al. Persistent renal enhancement af-

ter intra-arterial versus intravenous iodixanol administration. Eur J

Radiol 80: 378-386, 2011.

2. Saunders HS, Dyer RB, Shifrin RY, Scharling ES, Bechtold RE,

Zagoria RJ. The CT nephrogram: implications for evaluation of

urinary tract disease. Radiographics 15: 1069-1081, 1995.

Ⓒ 2014 The Japanese Society of Internal Medicine

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