Nephrotoxicity of ionic and non-ionic contrast material in digital vascular imaging and selective renal arteriography.

We assessed the nephrotoxicity of ionic and non-ionic radiocontrast material (CM) in two groups of patients in a prospective study. One group of 25 potential live kidney donors was studied following conventional renal angiography, carried out as part of the routine pre-operative assessment. The other group of 49 renal transplant patients with varying degrees of renal impairment was studied following digital vascular imaging carried out for investigation of hypertension. Plasma creatine, urinary N-acetyl-D-glucosaminidase (NAG), urinary microglobulin (B2M) and urinary protein excretion were measured before and after the imaging procedure. There were no significant changes in these parameters following digital vascular imaging, but there were increases in plasma creatinine (p less than 0.005) and urinary NAG creatinine ratio (p less than 0.002) in the conventional angiography group following the procedure. Substantial proteinuria developed in 35% of patients following conventional angiography. The differences in nephrotoxicity of radiocontrast agents during the two procedures could not be accounted for by the dose of material used, but probably reflect the effect of differences in the route of administration on the maximal concentration of the material reaching the kidney. Non-ionic radiocontrast material proved less toxic than ionic and may be preferable in conventional angiography.

Assessment of erythrocyte delta-aminolaevulinate dehydratase for outpatient detection of alcoholic liver disease: comparison with gamma-glutamyltransferase and casual blood ethanol.

An enzyme temporarily depressed by alcohol ingestion, erythrocyte delta-aminolaevulinate dehydratase (delta-ALAD), was compared with afternoon casual blood ethanol and plasma gamma-glutamyltransferase (gamma-glutamyltransferase (gamma-GT) simultaneously measured in outpatients. These comprised 37 individuals with chronic alcoholism, of whom 14 had severe liver disease, 22 patients with non-alcoholic liver disease and 24 healthy control subjects. All tests distinguished poorly between those alcoholics with, and those without histological liver damage. The highest specificity for alcoholism was achieved by gamma-ALAD; the best overall performance, with highest sensitivity and specificity was, however, gamma-GT. Although there was no correlation between the results of tests in individuals, 32/37 (87%) of alcoholics had at least one of the three tests abnormal compared with 8% of controls and 64% of non-alcoholic liver disease patients. The tests are therefore complementary and may form a battery of tests for problem drinking and its physical consequences.