~ r G ; T E R M SERUM C R E A T I N I N E A F T E R -~~: C A L N E P H R E C T O M Y . . . . . . .
crest the article by K. ,~rm Serum Creatinine :omy, published in the ¢s 114-116, 1990) of inine (Ser) values, the ?unction remains adep in patients w h o have r and have undergone nclusions do not agree studies ~,s that demont patients with unilatrenal function in kida significant increase on is demonstrable. 3-~ ~ss of half of the total on a long-term basis. used by Wishnow and r a w any reliable conntration, indeed, canglomerular filtration patients, 7 because Scr ~tion, which is related a renal elimination of ~dicted more reliably age, and weight using
Ccr = (140 - age) (wt) mL/min Scr x 72 led b y 0,85 in evident that Scr Ccr of 116 mL/ th a 70-kg body x 72) while the of 50 m L / m i n in -kg body weight ~). This example rscoring a severe i the basis of an ase reported by ies at follow-up ~dian, 72 years). hulas are invalid inical situations 9 genous Cer, prore) are currently function. Neverlsidered by the
i JULY1990 / VOLUMEXXXVI, NUMBER 1
Franeesco Aragona, M.D. Istituto di Urologia Monoblocco Ospedaliero Via Giustiniani, 2 35100 Padua, Italy References 1. Zucehelli P, et al: Focal glomerulosclerosisin patients with unilateral nephrectomy, Kidney Int 24:649 (1983). 2. Case Records of the Massachusetts General Hospital: Case 17-1985, N Engl J Med 312:1111 (1985). 3. Hakim RM, Goldzer RC, and Brenner BM: Hypertension and proteinuria: long-term sequelae of uninephrectomy in humans, Kidney Int 25:930 (1984). 4. Vincenti F, et ah Long-term renal function in kidney donors. Sustained compensatory hyperfiltration with no adverse effects, Transplantation 36:626 (1983). 5. Choeair PIt, et ah Long-term follow-up of related kidney donors, incidence of hypertension and proteinuria (Abstr.), 9th Int Congr Nephrol, Los Angeles, 1984, p 471A. 6. Rivolta E, et ah De novo focal glomerular sclerosis in an identical twin renal transplant recipient, Transplantation 35:328 (1983). 7. Eseande M, et ah Evaluation pratique de la fonction r6nale chez le sujet ag6, R~v Geriatr 8:502 (1983). 8. Coekcroft DW, and Gault MH: Prediction of creatinine clearance from serum creatinine, Nephron 16" 31 (1976). 9. Smith SA: Estimation of glomerular filtration rate from the serum creatinine concentration, Postgrad Med J 64:204 (1988).
A C U T E VASOSPASM O F P E N I L E ARTERIES IN RESPONSE TO C I G A R E T T E SMOKING To t h e E d i t o r : The association between cigarette smoking and male impotence is well established. 1 While it is assumed that smoking impairs erectile function by compromising arterial inflow to the penis, this has not been shown conclusively in humans. We have examined the effect of cigarette smoking on the penile arteries in a thirty-eight-year-old impotent male, using arteriographic evaluation. This patient, with a 25-pack/year smoking history, underwent selective pelvic arteriography as part of his evaluation for a complaint of erectile dysfunction. T h e r e was no evidence of endocrine, neurogenic, or psychogenic abnormality. Duplex ultrasound revealed adequate ( > 3 0 cm/sec) flow velocity in the deep penile arteries. Cavernosometry and cavernosography revealed extensive venous leakage in the deep dorsal and cavernosal venous system. Contrast medium injection in association with intracorporeal administration of papaverine and phentolamine initially demonstrated normal deep and dorsal penile arteries. After the patient smoked 2 cigarettes, contrast agent injection was again performed. This revealed a decrease in the caliber of the entire pudendal artery and nonvisualization of the deep penile