[Gadolinium for DSA in two patients with azotemia: Images of suitable quality and risk of acute renal failure]. / Angiografia con Gadolinio in due pazienti azotemici: la qualita' diagnostica ed il rischio d'insufficienza renale acuta.

BACKGROUND: Gadolinium is an alternative angiographic contrast agent in patients with impaired renal function and high risk for iodinated contrast adverse reaction. We report two cases of acute renal failure caused by gadolinium (0.6 and 0.9 mmol/kg of body weight) after the execution of digital subtraction angiography (DSA) to produce diagnostic-quality images in two elderly diabetic patients with pre-existing renal insufficiency. Both patients needed dialysis treatments for as long as a few weeks until their renal function improved. In our opinion, and according to the guidelines of European Society of Urogenital Radiology, gadolinium has not been assessed as less nephrotoxic than iodinated contrast agents. In fact, 1.8 to 4.8 g of iodine, equally attenuated with a relatively high dose (0.2 to 0.4 mmol) of a gadolinium chelate, is a low iodine dose and could hardly have any important nephrotoxic effects. CONCLUSIONS: The maximum dose of gadolinium-based contrast agents should never exceed 0.2 to 0.4 mmol/kg in azotemic patients who are undergoing DSA, even though these doses of gadolinium may not provide images of suitable quality for diagnosis and intervention.

[Local therapy with platelet-derived growth factors for chronic diabetic ulcers in haemodialysis patients]. / Terapia locale con fattori di crescita piastrinici nelle ulcere croniche diabetiche in emodializzati.

BACKGROUND: The increasing number of diabetic patients who need dialysis treatment is the cause for the growing interest of nephrologists in ulcers of the lower limbs. It has been reported that platelet-derived growth factors, such as PDGF and TGF beta 1, are able to heal skin lesions due to diabetes. Therefore, a platelet gel (PG) has been developed to locally treat foot ulcers with a limited number of applications (3+/-1.7). METHOLOGY AND PATIENTS: The PG is a mix of concentrated platelets and cryoprecipitate activated by batroxobin in the presence of calcium chloride (or gluconate) that must be applied to the wound for three days. The surgeon and the dermatologist should then plan successive treatments because the necrotic tissue needs to be removed. We treated a 62-year-old diabetic man, who has been under treatment with insulin since the age of 36 and has been dialysed for three years. His right lower leg was amputated and he developed a chronic left foot ulcer that resulted in many septic episodes. His ulcer recovered in two months after 8 PG applications. CONCLUSIONS: Conventional therapy is not successful in 15-20% of diabetic feet. Uraemia and malnutrition may represent important risk factors for foot ulcers in diabetic patients who need advanced technology to stimulate tissue repair. The use of platelet growth factor may ameliorate ulcer healing thus reducing disease-associated morbidity and lowering health care costs.