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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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