title: [Late recovery of renal function in a patient with acute on chronic renal failure treated with peritoneal dialysis].
abstract: Contrast-induced nephropathy has become a significant source of hospital morbidity and mortality particularly in patients with multi-organs defects. No current treatment can reverse or ameliorate contrast induced nephropathy once it occurs, but prophylaxis is possible. We present the case of a 61-year-old male patient with concomitant chronic kidney disease (CKD stage III K/DOQI) and diabetes complicated by severe multi-vascular disease, who developed acute kidney damage probably due to the simultaneously exposure to intravascular contrast media and cholesterol crystal embolism. In addition, owing to rapid deterioration of renal function, this patient started renal replacement therapy. No renal biopsy was performed due to the poor clinical condition of the patient. After a month of hemodialysis, he switched to a peritoneal dialysis procedure to which specific treatment for vascular lesions, including antibiotics, prostanoids, hyperbaric oxygen therapy, antiaggregants/anticoagulants and physiotherapy, was associated. After 7 months, the dialysis treatment was stopped and he began intensive clinical follow-up. At present, the patient is in conservative medical treatment (the Tenckhoff catheter has been removed), he is in good condition and severe vascular lesions are absent. Our conclusion is that contrast-induced nephropathy in vasculopathic diabetic patients requires a multidisciplinary approach. In particular, good cooperation between nephrologists and angiologists is useful to avoid rapid and chronic deterioration of renal failure and to prevent the onset and development of severe vascular damage.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Trubian
authors.forename: Carlo
authors.initials: C
authors.lastname: Rugiu
authors.forename: Vincenzo
authors.initials: V
authors.lastname: De Biase
authors.forename: Diana
authors.initials: D
authors.lastname: Zarantonello
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Rigoni
authors.forename: Sergio
authors.initials: S
authors.lastname: De Marchi
authors.forename: Enrico
authors.initials: E
authors.lastname: Arosio
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Zaza
authors.forename: Antonio
authors.initials: A
authors.lastname: Lupo
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000628:therapy*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003287:Contrast Media / Q000009:adverse effects; D003925:Diabetic Angiopathies / Q000150:complications / Q000628:therapy; D003928:Diabetic Nephropathies / Q000628:therapy; D017700:Embolism, Cholesterol / Q000150:complications; D006801:Humans; D006931:Hyperbaric Oxygenation; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000150:complications; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D026741:Physical Therapy Modalities; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011453:Prostaglandins / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D000925:Anticoagulants; D003287:Contrast Media; D010975:Platelet Aggregation Inhibitors; D011453:Prostaglandins