Anuria Following Urography with Meglumine Diatrizoate (Renografin) in Multiple Myeloma

Abstract

Only 11 cases of multiple myeloma with anuria attributable to urography have been documented. The agents used in the previous cases have been iodopyracet (Diodone and Diodrast), diodondiaethanolaminum (Nycotract), and sodium acetrizoate (Urokon Sodium) (1–10). This is the first reported case of anuria following the use of meglumine diatrizoate (Renografin) as the contrast medium. Case Report A normotensive 59-year-old Caucasian woman was admitted on March 8, 1967, with intermittent, severe lumbosacral pain of three weeks duration, urinary frequency, oral temperature of 101° F, and slight dehydration. Urinalysis revealed 1+ proteinuria, granular casts, and bacteriuria. Abdominal roentgenography demonstrated bilateral calcific densities opposite the lumbar vertebrae. Urography performed on March 9 with 50 cc of Renografin-60 (before the results of the renal function tests were obtained) showed nonvisualization of the collecting system. Laboratory determinations revealed a blood urea nitrogen of 130 mg per 100 cc, hematocrit of 31 per cent, and a hyponatremic acidosis. Urine output was 600 cc. On March 10, 1967, 300 cc of urine were excreted. No urine was obtained on March 11 or 12. On March 13 the blood urea nitrogen was 195 mg per 100 cc and creatinine was 17.0 mg per 100 cc. Bilateral pyelograms demonstrated a normal urinary tract with the radiodensities being extrinsic to the ureters. Further evaluation revealed rouleaux formation on the peripheral blood smear, presence of Bence Jones proteinuria and serum cryoglobulins, gamma globulin peak on serum electrophoresis, and 40 per cent plasmacytosis on the sternal bone marrow. Peritoneal dialysis was instituted and continued until March 18, at which time the blood urea nitrogen was 60 mg per 100 cc and the creatinine was 11.0 mg per 100 cc. On March 22 with a blood urea nitrogen of 100 mg per 100 cc and creatinine of 16.5 mg per 100 cc, dialysis was started again. On March 26 because of peritonitis and an oral temperature of 103.6° F, intraperitoneal and intravenous antibiotics were administered with a favorable response. The daily urine output since March 13 varied from 10 to 400 cc. On April 4, at which time chemical determinations demonstrated a blood urea nitrogen of 30 mg per 100 cc, creatinine of 4.5 mg per 100 cc, sodium of 143 mEq∕L, potassium of 4.3 mEq∕L, chloride of 105 mEq∕L, and CO2 of 30 mEq∕L, the blood pressure fell to 80∕50. In spite of adequate volume replacement, the blood pressure remained low. The patient died at 4:10 a.m. on April 6, 1967. Discussion Multiple myeloma is often overlooked as the cause of renal failure. It should be considered in all patients over the age of forty years who present with the syndrome of low back pain, proteinuria, and normotensive uremia (11, 12).