A recent report in this journal of a case of renal tubular necrosis and death after oral cholecystography1 and similar reports recently published elsewhere2,3 have prompted us to submit the present communication which deals with (a) a possible mechanism for renal damage caused by cholecystographic agents, (b) measures which may prevent or reduce the likelihood of renal injury, and (c) other aspects of the pharmacodynamics of cholecystographic agents which deserve consideration in connection with the observed toxic effects of these agents.
Cholecystographic agents are weak acids with low solubility in aqueous media. Their solubility increases at higher pH to an extent depending upon their acid dissociation constant (Ka) and the pH of the aqueous medium. In a previous report,4 one of us (E. N.) has shown that, on the basis of their physicochemical properties and the presently available knowledge of their metabolic fate, most cholecystographic agents
NELSON E, LEVY G. Precautions Indicated With Cholecystographic Agents. Arch Surg. 1964;88(6):921-922. doi:10.1001/archsurg.1964.01310240017005