Catheterography in the diagnosis of catheter failure in peritoneal dialysis.

A total of 43 catheterograms were performed on 29 patients receiving treatment by chronic peritoneal dialysis. Thirteen of the catheterograms were carried out because of localized abdominal pain thought to originate from the catheter tip. In 6 of these cases catheter malposition was the cause of pain. Twenty-eight catheterograms were carried out because of one-way obstruction of the catheter. Envelopment by omentum of the distal part of the catheter was found to be the cause of malfunction in 8 cases. Catheter malposition either alone or in combination with blockage of the end hole and/or side holes caused malfunction in another 8 cases. Of the 28 catheters with one-way obstruction 15 (53%) could be preserved after repositioning and cleaning; the remaining 13 had to be changed. Total obstruction of the catheter was the indication for catheterography in 2 cases, and both catheters had to be changed. Catheterography is a simple and painless procedure which should be carried out when a patient on chronic peritoneal dialysis develops localized abdominal pain, or in the event of catheter malfunction.

Cellular and renal toxicity of a urographic contrast medium used in high concentration in uremic patients.

The potential toxicity of the urographic contrast medium sodium iothalamate (Conray) has been tested after a bolus injection of 160 ml (66 g iodine) on patients with advanced renal insufficiency. Experiments were performed to investigate the effect of uremic plasma from 5 patients sampled before and after contrast injection on human mononuclear phagocytes cultured in vitro. To investigate the nephrotoxicity, endogenous creatinine clearance was measured before, during and after urography in 25 patients with advanced renal insufficiency (group 1) and in 9 transplanted patients with chronic kidney rejection (group 2). Uremic plasma did not exert further depressive effect on the mononuclear phagocytes after contrast injection when compared to normal plasma indicating no toxicity on this cell model. Neither did the contrast injection exert any depressive effect on creatinine clearance in any of the groups indicating no measurable nephrotoxicity. The urographic technique, particularly the control of fluid balance is found to be very important.