POST-CONTRAST ACUTE KIDNEY INJURY AFTER CATHETER ANGIOGRAPHY AND EVALUATION OF RISK FACTORS

Purpose : The present study aimed to determine the rate of post-contrast acute kidney injury (PC-AKI) after catheter angiography other than cardiac angiography (CAG), and identify relevant risk factors.Materials and methods : This retrospective study analyzed data from 314 patients who underwent angiography between October 2013 and September 2018. We investigated the incidence of PC-AKI, defined as a ≥50% increase or ≥0.3 mg/dL increase in serum creatinine (SCr) values 1-3 days after angiography according to the European Society of Urogenital Radiology guidelines on contrast media, version 10.0. The effects of patient- and procedure-related factors on the incidence of PC-AKI were evaluated. Data were analyzed using chi-squared and Mann-Whitney U tests, and multivariate logistic regression analysis.Results : PC-AKI developed in 16/314 patients (5.1%). Multivariate logistic regression analysis revealed a correlation of incidence of PC-AKI with advanced age, decreased estimated glomerular filtration rate (eGFR), shock symptoms, and high-dose contrast media within 24 hours. In all patients with PC-AKI, SCr values returned to baseline within 2 weeks.Conclusions : PC-AKI after angiographic examinations developed in 5.1% of patients, and the increase in SCr was reversible. Advanced age, decreased eGFR, shock symptoms, and highdose contrast media within 24 hours are possible risk factors

PREOPERATIVE EMBOLIZATION FOR SPINAL TUMORS USING GELATIN SPONGE PARTICLES WITH OR WITHOUT LIPIODOL

Purpose : To present our methods of performing preoperative embolization for spinal tumors using gelatin sponge particles with or without lipiodol. Materials and Methods : Twenty-one patients (median age, 70 years) with spinal tumors underwent preoperative embolization.　We injected embolus through a microcatheter placed proximally in the segmental arteries supplying the tumors.　Surgical decompression was performed within 24 hours after embolization.　We recorded tumor vascularity (classified into mild or increased), embolic agents used, complications related to the embolization, and intraoperative blood loss. Results : We successfully performed embolization with the particles for 63 of 69 (91%) segmental arteries supplying tumors.　Complete embolization was achieved in 16 patients (76.2%).　We injected lipiodol (median total dose, 1.5 ml) in 13 patients followed by gelatin sponge particles.　 Twelve of the 13 patients had increased tumor vascularity.　Median blood loss was 532 ml in the 14 patients with increased vascularity of tumor and 238 ml in the 7 with mild vascularity.　One patient experienced transient sensory disturbance after embolization. Conclusion : This study revealed that efficacy of particle injection from the proximal portion of the segmental artery and feasibility of using lipiodol for embolization in hypervascular tumors

COMPARISON OF VIRTUAL UNENHANCED AND TRUE UNENHANCED ATTENUATION VALUES BY DUAL-ENERGY CT FOR DETECTING INDISTINCT LIVER METASTASES ON CONTRAST-ENHANCED CT

Purpose : We aimed to evaluate the differences between true unenhanced (TUE) and virtual unenhanced (VUE) computed tomography (CT) performed by contrast-enhanced CT with dualenergy CT in the assessment of liver metastases that were difficult to visually identify with contrast- enhanced CT. Materials and methods : Between April 2018 and September 2019, we identified 266 patients with liver metastases who underwent unenhanced and contrast-enhanced CT with dual-energy CT at our institution, and enrolled 43 liver metastases in 19 patients (7.1%) that were indistinct on contrast-enhanced CT.　Mean CT attenuation values for liver metastases and liver parenchyma were measured, and differences between the CT attenuation values for liver metastases and liver parenchyma were analyzed using VUE CT and TUE CT. Results : The mean CT attenuation values for liver metastases and liver parenchyma in VUE CT versus TUE CT were 51.0 vs. 41.0 HU (p<0.001) and 58.2 HU vs. 61.2 HU (p=0.027), respectively.　The differences in CT attenuation values between liver metastases and liver parenchyma were 10.1 HU on VUE CT vs. 19.3 HU on TUE CT (p<0.001). Conclusion : The contrast between lesions and liver parenchyma on VUE CT was significantly lower than that on TUE CT.　VUE CT cannot currently replace TUE CT

Empagliflozin in Patients with Chronic Kidney Disease

Background The effects of empagliflozin in patients with chronic kidney disease who are at risk for disease progression are not well understood. The EMPA-KIDNEY trial was designed to assess the effects of treatment with empagliflozin in a broad range of such patients. Methods We enrolled patients with chronic kidney disease who had an estimated glomerular filtration rate (eGFR) of at least 20 but less than 45 ml per minute per 1.73 m(2) of body-surface area, or who had an eGFR of at least 45 but less than 90 ml per minute per 1.73 m(2) with a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 200. Patients were randomly assigned to receive empagliflozin (10 mg once daily) or matching placebo. The primary outcome was a composite of progression of kidney disease (defined as end-stage kidney disease, a sustained decrease in eGFR to &lt; 10 ml per minute per 1.73 m(2), a sustained decrease in eGFR of &amp; GE;40% from baseline, or death from renal causes) or death from cardiovascular causes. Results A total of 6609 patients underwent randomization. During a median of 2.0 years of follow-up, progression of kidney disease or death from cardiovascular causes occurred in 432 of 3304 patients (13.1%) in the empagliflozin group and in 558 of 3305 patients (16.9%) in the placebo group (hazard ratio, 0.72; 95% confidence interval [CI], 0.64 to 0.82; P &lt; 0.001). Results were consistent among patients with or without diabetes and across subgroups defined according to eGFR ranges. The rate of hospitalization from any cause was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.86; 95% CI, 0.78 to 0.95; P=0.003), but there were no significant between-group differences with respect to the composite outcome of hospitalization for heart failure or death from cardiovascular causes (which occurred in 4.0% in the empagliflozin group and 4.6% in the placebo group) or death from any cause (in 4.5% and 5.1%, respectively). The rates of serious adverse events were similar in the two groups. Conclusions Among a wide range of patients with chronic kidney disease who were at risk for disease progression, empagliflozin therapy led to a lower risk of progression of kidney disease or death from cardiovascular causes than placebo