Abstract
A small but significant proportion of patients given X-ray contrast agents subsequently experience a decline in renal function. Experimental studies in rats aimed at identifying the mechanism of renal effects show vacuolation of proximal convoluted tubules. This report documents that such vacuoles normally have a proteinaceous content and that14C-radiolabelled contrast agent (iodixanol) is specifically localised within the vacuolated tubules 24 h after administration. On the basis of the persistence of some large droplets in proximal tubules, a small percentage of the administered dose of X-ray contrast agent appears to be trapped intracellularly within large proteinaceous droplets (the vacuoles) and slowly released over several weeks. Enzyme histochemistry identifies contrast-medium-induced droplets as an abnormal population of lysosomes. We propose that in the absence of pre-existing renal impairment, this slowly reversing lysosomal abnormality of proximal tubules is within the kidney's functional reserve capacity.
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