ABSTRACT
Experiments injecting Indian ink have confirmed the theory that postangiographic renal damage is due primarily to ischaemia. Cortical ischaemia is due to vascular spasm and sludging caused by contrast medium. Current and previous experimental findings suggest the following course in the pathomechanism: vasospasm reduced blood velocity--aggregation of erythrocytes--further deterioration in the circulation--microemboli--irreversible sludge formation--arterial and venous thromboses--ischaemic foci--necrosis or infarction. It is not possible to prevent this damage by alpha blocking sympathicolytic drugs.
Subject(s)
Contrast Media/toxicity , Kidney Diseases/chemically induced , Acetrizoic Acid/toxicity , Animals , Dogs , Iatrogenic Disease , Ischemia/chemically induced , Kidney Cortex/blood supply , Kidney Cortex Necrosis/chemically induced , Kidney Cortex Necrosis/prevention & control , Kidney Diseases/prevention & control , Kidney Glomerulus/drug effects , Microcirculation/drug effects , Phentolamine/pharmacology , Regional Blood Flow/drug effectsABSTRACT
The authors have twice observed undesirable effects of adrenaline during the demonstration of malignant renal tumours. Following adrenaline there was less flow of contrast medium into the tumour vessels than during angiography without the drug. In their opinion, this is due to the fact that constriction of the inter-lobar arteries occludes the vessels supplying the tumour, and that in some cases the new-formed vessels react strongly to adrenaline. In a third case, the tumour vessels reacted much more strikingly to adrenaline than would have been expected from previous experience. They therefore doubt whether pharmaco-angiography with adrenaline is always indicated for demonstrating malignant renal tumours; adrenaline may be expected to produce a positive result only in these cases in which there is a central origin of the artery supplying the tumour. They therefore suggest a change to some other, more suitable drug.
