PURPOSE: Computed tomography (CT) with contrast media (CM) is often performed on patients with elevated serum creatinine (sCr), however, due to the risk of contrast induced nephropathy (CIN), the confirmatory use of intravenous contrast CT is not routine. This aim of this study was to differentiate between pre-renal acute kidney injury (AKI) due to severe sepsis and CIN. METHODS: Of 330 patients with sepsis who presented to an emergency center in a tertiary care hospital and who underwent CT from January 2009 until May 2010, 232 were enrolled in this study. A group of 115 septic patients with CM and a group of 117 septic patients without CM were analyzed. RESULTS: When considering the change according to difference in initial sCr, the 2~3 day increase of serum creatinine (sCr) observed in both groups did not differ significantly (p=0.236). Use of CM and the amount of iodine showed no significant association with AKI within a period of three days (p=0.64 and p=0.558, respectively). Regardless of the use of CM, elevated sCr at the time of hospital presentation was likely to lead to elevated sCr at day 2-3 (odds ratio 4, p=0.034). CONCLUSION: CIN can be confused with other causes, particularly renal failure due to sepsis. The effect of performing intravenous contrast CT on the kidney may be less than thought. The risk of checking intravenous contrast CT, which was delayed for prevention of renal impairment in patients with elevated sCr, should be reconsidered.
Acute Kidney Injury ; Contrast Media ; Creatinine ; Emergencies ; Humans ; Iodine ; Kidney ; Renal Insufficiency ; Sepsis ; Tertiary Healthcare

Coronary artery disease is the most important cause of mortality in patients with systemic lupus erythematous (SLE). After stenting for coronary artery disease in SLE patients similar to non-SLE patients, the risk of stent thrombosis is always present. Although there are reports of stent thrombosis in SLE patients, very late recurrent stent thrombosis is rare. We experienced a case of very late recurrent stent thrombosis (4 times) in a patient with SLE.
Coronary Artery Disease ; Drug-Eluting Stents ; Humans ; Lupus Erythematosus, Systemic ; Stents ; Thrombosis

Stress cardiomyopathy is characterized by transient systolic dysfunction of the apical and/or mid segment of the left ventricle. The main pathophysiology of stress cardiomyopathy is the excessive release of catecholamine. Opioid withdrawal can initiate a surge of catecholamine and an attack of stress cardiomyopathy. In this case, we report a case of stress cardiomyopathy due to iatrogenic withdrawal from transdermal fentanyl.
Aged* ; Fentanyl* ; Heart Ventricles ; Humans ; Takotsubo Cardiomyopathy*