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All Journal Universa Medicina Indonesian Journal of Kidney and Hypertension
Mahadita, Gede Wira
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Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Contrast media induced nephropathy: case series and review of the literature focusing on management Marciyasa, Putu Agus; Kandarini, Yenny; Mahadita, Gede Wira; Ayu, Nyoman Paramita
Universa Medicina Vol. 43 No. 2 (2024)
Publisher : Faculty of Medicine, Universitas Trisakti

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2024.v43.252-261

Abstract

BackgroundContrast media administration during diagnostic and invasive procedures in high risk patients for nephrotoxicity is a common problem in clinical practice. Radiological procedures using intravascular iodinated contrast injection media have been widely used for therapeutic purposes. Contrast-induced nephropathy (CIN) is a serious complication of angiographic procedures and results from administration of contrast media (CM), which increases morbidity and mortality rates. Case Description                                                                                                                                                                                                               We present these 10 cases with high risk of CIN and diverse characteristics. A new generation iso-osmolar CM (iodixanol) was administered in these cases. Three of the cases experienced CIN events, where one patient experienced an improvement in his condition, but two other patients experienced complications and eventually died due to the underlying disease. The other 6 cases did not experience CIN after receiving CM, which was due to better preparation beforehand. One patient with a history of regular hemodialysis, underwent immediate post-operative dialysis with CM, and no evaluation of the incidence of CIN was required. Conclusion Of the 10 cases observed, 3 of them experienced CIN which was caused by the severity of the patient’s condition and lack of preparation time before the CM procedure. Management of CIN is complex, starting from the pre-treatment evaluation until 72 hours or more after the CM procedure. This case series suggests that even new generation CM (including iodixanol) may be severely nephrotoxic, when administered to high risk patients. The amount of CM given must be below the maximum limit and adjusted to the patient’s condition. Additionally, we review the complex mechanisms involved in management of CM nephrotoxicity.
Mechanical and Technical Complication in Patient with Continous Ambulatory Peritoneal Dialysis (CAPD) with Encapsulated Peritoneal Sclerosis Kandarini, Yenny; Mahadita, Gede Wira; Tedjamartono, Theodore Dharma
Indonesian Journal of Kidney and Hypertension Vol 2 No 3 (2025): Volume 2 No. 3, December 2025
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32867/inakidney.v2i3.197

Abstract

Continuous Ambulatory Peritoneal Dialysis (CAPD) relies on an intraperitoneal catheter for the inflow and outflow of dialysate fluid; therefore, mechanical complications are often encountered. Encapsulated peritoneal sclerosis (EPS) is one of the rare complications in CAPD patients, but it has high mortality and morbidity rates. A case of a patient with EPS was reported in a 53-year-old man in the form of a problem with the dwelling of the CAPD. Patients complain of a longer duration of dwelling with a positive fluid balance. There are no complaints of fever or abdominal pain. Abdominal inspection shows symmetrical, no mass, no wound or pus from the CAPD tip. The patient had a history of recurrent peritonitis. CAPD Cuff was released due to laparoscopy findings with grade IV adhesions in the omentum and peritoneum; it also showed omental cakes and peritoneal fluid with debris. Diagnosis of EPS was established based on the presence of clinical symptoms due to intestinal obstruction and structural disorders due to peritoneal fibrosis, like thickening and adhesions of the intra-abdomen, accompanied by findings of fibrous cocoon or omental cakes in the intestine, with laparotomy and/or laparoscopy. CAPD is related to various complications of infections and non-infections. Although complications related to infections are more often found, non-infection complications such as EPS can also occur in CAPD Patients; therefore, clinicians need to be aware of this complication, especially in patients with a history of recurrent peritonitis.
Co-Authors Ayu, Nyoman Paramita Marciyasa, Putu Agus Tedjamartono, Theodore Dharma Yenny Kandarini