碘普罗胺致急性肾衰竭

Iopromide-induced acute renal failure

1例65岁男性2型糖尿病患者,因反应迟钝伴口齿不清入院。头颅磁共振成像示脑梗死(急性期),给予肠溶阿司匹林(0.1g,1次/d)、依达拉奉(30mg,1次/d)及甲钴胺等药物治疗。因胸部、腹部CT增强扫描,连续2d各使用造影剂碘普罗胺100ml(含碘30g),第3天出现双下肢水肿,尿量400ml/24h,随后无尿,静脉给予呋塞米未见好转。复查血肌酐475μmol/L,尿素氮24.5mmol/L。诊断为急性肾衰竭,考虑与碘普罗胺有关。连续血液透析治疗5d后,患者尿量增加,血肌酐降至284μmol/L。17d后血肌酐231μmol/L,尿素氮14.4mmol/L。患者双下肢水肿明显好转,出院。

A 65-year-old man with type 2 diabetes mellitus was hospitalized with slow response to stimuli and slurred speech. Cranial magnetic resonance imaging showed cerebral infarction （acute phase）. He was treated with enteric-coated aspirin 0. 1 g once daily, edaravone 30 mg once daily, methylcobalamin, etc. He received the contrast medium iopromide 100 ml （equivalent to 30 g iodine） once daily for two days for underg3ing contrast-enhanced CT scans of lung and abdomen. On day 3, he developed lower extremity edema, his 24 hour urine volume was 400 ml and then anuria occurred. An IV push of furosemide was given, but his symptoms did not improve. A repeat test showed a serum creatinine level of 475 I^mol/L and a serum urea nitrogen level of 24.5 mmol/L. Acute renal failure was diagnosed and considered to be related to iopromide. After five days of continuous hemodialysis, the patient＇s urine output increased and his serum creatinine level decreased to 284 μmol/L. Seventeen days later, his serum creatinine level dropped to 231 μmol/L and his serum urea nitrogen level was 14.4 mmol/L. Lower extremity edema significantly improved, and then he was discharged.