Contrast media. Myeloma protein precipitates in urography

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Abstract
Acute renal failure in multiple myeloma is a relatively rare event compared to chronic failure and, when it occurs, is associated in a high percentage of cases with pyelography. In all recorded cases to date, the contrast material utilized was either iodopyracet or sodium acetrlzoate. These 2 contrast media, In addition to meglumine iodipamide, are capable of producing in vitro precipitates In the urines of patients with multiple myeloma at a pH range of 4.5 to 5.5. Since the dehydration utilized in the preparation of patients for intravenous pyelography will tend to optimize the circumstances for precipitation of the abnormal urine proteins, it would seem reasonable to suggest that patients with myeloma should not be prepared for this examination by dehydration. The occurrence of acute renal failure following intravenous urography in patients without myeloma Is an almost negligible consideration. Large dosages of contrast media were utilized in patients with renal impairment, but not myeloma, to enhance opaciflcation of the collecting system without obvious further impairment of the renal status. The potential role that meglumine iodinamide injections may play In inducing acute renal failure in myeloma patients must be further explored. Dehydration is not a standard preparatory procedure for an Intravenous cholangiogram. In the presence of impaired hepatic function or biliary obstruction, the excretory route would be shifted from the bile to the urine. If this alteration were to be accompanied by an inadvertant dehydration or any other circumstance that predisposed the urine to acidification, the potential for a protein and contrast-material precipitation in the renal tubules would be enhanced.

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