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Sousa NR, Rocha S, Santos-Silva A, Coimbra S, Valente MJ. Cellular and molecular pathways underlying the nephrotoxicity of gadolinium. Toxicol Sci 2021; 186:134-148. [PMID: 34878122 DOI: 10.1093/toxsci/kfab148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Mounting evidence on the short- and long-term adverse effects associated with gadolinium [Gd (III)]-based contrast agents used in magnetic resonance imaging have emerged in the past three decades. Safety issues arise from the release of Gd (III) from chelates and its deposition in tissues, which is exacerbated in patients with renal disease, since the kidney is the major excretion organ of most of these agents. This study aimed at unveiling the cellular and molecular mechanisms of nephrotoxicity of Gd (III), using an in vitro model of human proximal tubular cells (HK-2 cell line). Cell viability declined in a concentration- and time-dependent manner after exposure to GdCl3·6H2O. The estimated inhibitory concentrations (ICs) eliciting 1 to 50% of cell death, after 24 h of exposure, ranged from 3.4 to 340.5 µM. At toxic concentrations, exposure to Gd (III) led to disruption of the oxidative status, mitochondrial dysfunction, cell death by apoptosis, switching to necrosis at higher levels, and autophagic activation. Disturbance of the lipid metabolism was already observed at low-toxicity ICs, with accumulation of lipid droplets, and upregulation of genes related to both lipogenesis and lipolysis. Gd (III)-exposure, even at the subtoxic IC01, increased the expression of modulators of various signaling pathways involved in the development and progression of renal disease, including inflammation, hypoxia and fibrosis. Our results give new insights into the mechanisms underlying the nephrotoxic potential of Gd (III) and highlight the need to further clarify the risks versus benefits of the Gd (III)-based contrast agents currently in use.
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Affiliation(s)
- Nícia Reis Sousa
- TOXRUN-Toxicology Research Unit, University Institute of Health Sciences, CESPU, CRL, Gandra, Portugal.,Departamento de Ciências e Tecnologia da Saúde, Instituto Superior Politécnico de Benguela, Benguela, Angola
| | - Susana Rocha
- LAQV, REQUIMTE, Laboratório de Química Aplicada, Departamento de Ciências Químicas, Faculdade de Farmácia da Universidade do Porto, Porto, Portugal
| | - Alice Santos-Silva
- Associate Laboratory i4HB-Institute for Health and Bioeconomy, Faculdade de Farmácia da, Universidade do Porto, Porto, Portugal.,UCIBIO-Applied Molecular Biosciences Unit, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, Porto, Portugal
| | - Susana Coimbra
- TOXRUN-Toxicology Research Unit, University Institute of Health Sciences, CESPU, CRL, Gandra, Portugal.,Associate Laboratory i4HB-Institute for Health and Bioeconomy, Faculdade de Farmácia da, Universidade do Porto, Porto, Portugal.,UCIBIO-Applied Molecular Biosciences Unit, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, Porto, Portugal
| | - Maria João Valente
- Associate Laboratory i4HB-Institute for Health and Bioeconomy, Faculdade de Farmácia da, Universidade do Porto, Porto, Portugal.,UCIBIO-Applied Molecular Biosciences Unit, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, Porto, Portugal
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Peng L, Shui X, Tan F, Li Z, Ling Y, Wu B, Chen L, Li S, Peng H. Folic Acid Attenuates Contrast-Induced Nephropathy in Patients With Hyperhomocysteinemia Undergoing Coronary Catheterization: A Randomized Controlled Trial. Front Cardiovasc Med 2021; 8:707328. [PMID: 34660712 PMCID: PMC8517125 DOI: 10.3389/fcvm.2021.707328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 09/06/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Hyperhomocysteinemia is a risk factor for contrast-induced nephropathy. Folic acid can attenuate such nephropathies in rats. The protective effect of folic acid against contrast-induced nephropathy has not been studied in humans. We aimed to investigate the effect of folic acid on the incidence of contrast-induced nephropathy (CIN) after coronary catheterization in patients with hyperhomocysteinemia. Methods: This was a single-center, prospective, double-blind, randomized controlled trial (ClinicalTrials.gov, NCT02444013). In total, 412 patients (mean age: 65 ± 12 years, 268 male) with plasma homocysteine ≥15 μM, who underwent coronary arteriography (CAG) or percutaneous coronary intervention (PCI) from May 2015 to August 2018, were enrolled. Patients were randomly assigned to two groups: a treatment group (n = 203), taking 5 mg of folic acid (orally, three times/day) immediately after enrollment and for 72 h after operation, and a control group (n = 209), taking placebo. Contrast-induced nephropathy was defined as an increase in serum creatinine of >25% or 44 μM within 48 or 72 h after contrast medium administration. Results: In total, 50 (12%) patients developed CIN after 48 h after catheterization, including 16 (8%) in the treatment group and 34 (16%) in the control group (P = 0.009). Meanwhile, 53 (13%) patients developed CIN after 72 h of CAG/PCI, including 18 (9%) in the treatment group and 35 (17%) in the control group (P = 0.017). The incidence of contrast-induced nephropathy in the treatment group was lower than that in the control group (P = 0.017). Logistic regression analysis confirmed that administration of folic acid was a protective factor against contrast-induced nephropathy (RD = 0.0788, 95%CI: 0.0105–0.1469, P = 0.019). We found no serious adverse events associated with folic acid. No death or hemodialysis occurred in either group. Conclusions: Perioperative administration of folic acid attenuates the incidence of contrast-induced nephropathy after coronary catheterization in patients with hyperhomocysteinemia. Clinical Trial Registration:ClinicalTrials.gov, identifier [NCT02444013].
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Affiliation(s)
- Long Peng
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xing Shui
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Fang Tan
- Department of Anaesthesiology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China.,Department of Anaesthesiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zexiong Li
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Cardiovascular Medicine, Jieyang People's Hospital, Jieyang, China
| | - Yesheng Ling
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bingyuan Wu
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lin Chen
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Suhua Li
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hui Peng
- Nephrology Division, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Oral hydration as a safe prophylactic measure to prevent post-contrast acute kidney injury in oncologic patients with chronic kidney disease (IIIb) referred for contrast-enhanced computed tomography: subanalysis of the oncological group of the NICIR study. Support Care Cancer 2021; 30:1879-1887. [PMID: 34613475 DOI: 10.1007/s00520-021-06561-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/08/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND T he objective of this study is to evaluate oral hydration compared to intravenous (i.v.) hydration in the prevention of post-contrast acute kidney injury (PC-AKI) in the oncologic subgroup of patients with stage IIIb chronic kidney disease (CKD) included in the NICIR study referred for elective contrast-enhanced computed tomography (CE-CT). MATERIAL AND METHODS We performed a retrospective subanalysis of the oncological subgroup (174/228 patients, 74%) from a continuous prospective database of patients included in the recently published non-inferiority NICIR study. Patients received prophylaxis against PC-AKI with either oral hydration (500 mL of water 2 h before and 2000 mL during the 24 h after CE-CT) or i.v. hydration (sodium bicarbonate (166 mmol/L) 3 mL/kg/h starting 1 h before and 1 mL/kg/h during the first hour after CE-CT). The primary outcome was to compare the proportion of PC-AKI in the first 48 to 72 h after CE-CT in the two hydration groups. Secondary outcomes were to compare persistent PC-AKI, the need for haemodialysis, and the occurrence of adverse events related to prophylaxis in each group. RESULTS Of 174 patients included in the subanalysis, 82 received oral hydration and 92 received i.v. hydration. There were no significant differences in clinical characteristics or risk factors between the two study arms. Overall the PC-AKI rate was 4.6% (8/174 patients), being 3.7% in the oral hydration arm (3/82 patients) and 5.4% (5/92 patients) in the i.v. hydration arm. The persistent PC-AKI rate was 1.2% (1/82 patients) in the oral hydration arm and 3.3% (3/92 patients) in the i.v. hydration arm. No patient required dialysis during the first month after CE-CT or had adverse effects related to the hydration regime. CONCLUSION In oncological patients with stage IIIb CKD referred for elective CE-CT, the rate of PC-AKI in those receiving oral hydration did not significantly differ from that of patients receiving i.v. hydration.
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Nagamatsu M, Ruparel S, Tanaka M, Fujiwara Y, Uotani K, Arataki S, Yamauchi T, Takeshita Y, Takamoto R, Tanaka M, Moriue S. Assessment of 3D Lumbosacral Vascular Anatomy for OLIF51 by Non-Enhanced MRI and CT Medical Image Fusion Technique. Diagnostics (Basel) 2021; 11:diagnostics11101744. [PMID: 34679442 PMCID: PMC8534854 DOI: 10.3390/diagnostics11101744] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 09/14/2021] [Accepted: 09/19/2021] [Indexed: 12/24/2022] Open
Abstract
Study design: Prospective study. Objective: Medical image fusion can provide information from multiple modalities in a single image. The present study aimed to determine whether three-dimensional (3D) lumbosacral vascular anatomy could be adequately portrayed using a non-enhanced CT–MRI medical image fusion technique. Summary of Background Data: Lateral lumbar interbody fusion has gained popularity for the surgical treatment of adult spinal deformity (ASD). Oblique lumbar interbody fusion at L5–S1 (OLIF51) is receiving considerable attention as a method of creating good L5–S1 lordosis. Access in OLIF51 requires evaluation of the vascular anatomy in the lumbosacral region. Conventional imaging modalities need a contrast medium to describe the vascular anatomy. Methods: Participants comprised 15 patients with ASD or degenerative lumbar disease who underwent corrective surgery at our hospital between January 2020 and June 2021. A 3D vascular image with bony structures was obtained by fusing results from MRI and CT. We processed the merged image and measured the distance between left and right common iliac arteries and veins at two levels: the lower end of the L5 vertebral body (Window A) and the upper end of the S1 vertebral body (Window B). Results: The mean sizes of Window A and Window B were 29.7 ± 10.7 mm and 36.9 ± 10.3 mm, respectively. The mean distance from the bifurcation to the lower end of the L5 vertebra was 23.7 ± 10.9 mm. Coronal deviation of the bifurcation was, from center to left, 12.6 ± 12.3 mm, and the distance from the center of the L5 vertebral body to the bifurcation was 0.79 ± 7.3 mm. Only one case showed a median sacral vein (6.7%). Clinically, we performed OLIF51 in 12 of the 15 cases (80%). Conclusion: Evaluating 3D lumbosacral vascular anatomy using a non-enhanced MRI and CT medical image fusion technique is very useful for OLIF51, particularly for patients in whom the use of contrast medium is contraindicated.
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Li B, Chen QL, Yao BC, Jiang N, Zhao F, Ren M, Sun J, Xu LN, Guo ZG. Risk factors of continuous renal replacement therapy following total aortic arch replacement under moderate hypothermia. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1448. [PMID: 34734000 PMCID: PMC8506709 DOI: 10.21037/atm-21-3905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 08/30/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Stanford type A aortic dissection (TAAD) has a sudden onset and high mortality, and emergency total aortic arch replacement (TAAR) is the main treatment option for TAAD. The mortality rate of patients with postoperative acute kidney injury (AKI) combined with continuous renal replacement therapy (CRRT) is remarkable higher than that of patients without AKI. However, incidence of AKI and risk factors for CRRT following TAAR isn't entirely understood. METHODS From October 2018 to March 2021, all patients with Stanford type A dissection who underwent total arch replacement surgery under MHCA were enrolled. According to whether CRRT treatment was performed, participants were divided into a CRRT group (n=49) and control group (n=72). Both groups incorporated the brain protection strategy of moderate hypothermia, and the left common carotid artery and the innominate artery were perfused anteriorly. Relevant medical data was collected. RESULTS Age, gender, and a history of smoking and drinking were not significantly different between the 2 groups (P>0.1). There were statistical differences between the 2 groups in aortic sinus diameter and Bentall procedure (P≤0.05). Univariate analysis revealed that fresh frozen plasma was a protective factor (P<0.05) and the intraoperative transfusion volume of red blood cells, platelets, fresh frozen plasma, autologous blood used for intraoperative bleeding, aortic sinus diameter, and Bentall procedure were risk factors (P<0.1). Multivariate analysis showed that the Bentall procedure and intraoperative bleeding were risk factors for CRRT (P<0.05), and the aortic sinus diameter and intraoperative transfusion score were also risk factors for CRRT (P<0.05). Receiver operating characteristic (ROC) analysis demonstrated that the model of aortic sinus diameter and intraoperative transfusion score had more significantly different discriminatory powers. CONCLUSIONS The Bentall procedure, intraoperative bleeding, aortic sinus diameter, and intraoperative transfusion score were risk factors for postoperative CRRT. The model of aortic sinus diameter and intraoperative transfusion score had more significantly different discriminatory powers.
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Affiliation(s)
- Bo Li
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Qing-Liang Chen
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Bo-Chen Yao
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Nan Jiang
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Feng Zhao
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Min Ren
- Tianjin Institute of Cardiovascular Diseases, Tianjin, China
| | - Jing Sun
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Li-Na Xu
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Zhi-Gang Guo
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, China
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Oh H, Choi A, Seo N, Lim JS, You JS, Chung YE. Protective effect of glycyrrhizin, a direct HMGB1 inhibitor, on post-contrast acute kidney injury. Sci Rep 2021; 11:15625. [PMID: 34341389 PMCID: PMC8329191 DOI: 10.1038/s41598-021-94928-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 07/13/2021] [Indexed: 12/27/2022] Open
Abstract
Post contrast-acute kidney injury (PC-AKI) is defined as the deterioration of renal function after administration of iodinated contrast media. HMGB1 is known to play an important role in the development of acute kidney injury. The purpose of this study was to investigate the association between HMGB1 and PC-AKI and the protective effect of glycyrrhizin, a direct inhibitor of HMGB1, in rats. Rats were divided into three groups: control, PC-AKI and PC-AKI with glycyrrhizin. Oxidative stress was measured with MDA levels and H2DCFDA fluorescence intensity. The mRNA expressions of pro-inflammatory cytokines (IL-1α, IL-1β, IL-6 and TNF-α) and kidney injury markers (KIM-1, NGAL and IL-18) were assessed using RT-PCR and ELISA in kidney tissue. In addition, the serum and intracellular protein levels of HMGB1were analyzed with the enzyme-linked immunosorbent assay (ELISA) and western blotting. Histologic changes were assessed with H&E staining using the transmission electron microscope (TEM). Moreover, serum creatinine (SCr), blood urea nitrogen (BUN) and lactate dehydrogenase (LDH) levels were assessed. Oxidative stress, pro-inflammatory cytokines, kidney injury markers and LDH were significantly higher in PC-AKI compared to the controls, but were lower in PC-AKI with glycyrrhizin. Intracellular and serum HMGB1 levels significantly increased after contrast media exposure, whereas they markedly decreased after glycyrrhizin pretreatment. SCr and BUN also decreased in PC-AKI with glycyrrhizin compared to PC-AKI. In PC-AKI, we could frequently observe tubular dilatation with H&E staining and cytoplasmic vacuoles on TEM, whereas these findings were attenuated in PC-AKI with glycyrrhizin. Our findings indicate that HMGB1 plays an important role in the development of PC-AKI and that glycyrrhizin has a protective effect against renal injury and dysfunction by inhibiting HMGB1 and reducing oxidative stress.
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Affiliation(s)
- Hyewon Oh
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Arom Choi
- Department of Emergency Medicine, Yonsei University College of Medicine, 211 Eonju-Ro, Gangnam-Gu, Seoul, 06273, Republic of Korea
| | - Nieun Seo
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Joon Seok Lim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Je Sung You
- Department of Emergency Medicine, Yonsei University College of Medicine, 211 Eonju-Ro, Gangnam-Gu, Seoul, 06273, Republic of Korea.
| | - Yong Eun Chung
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Zhang X, Chen J, Yu N, Ren Z, Tian Q, Tian X, Jia Y, He T, Guo C. Reducing contrast medium dose with low photon energy images in renal dual-energy spectral CT angiography and adaptive statistical iterative reconstruction (ASIR). Br J Radiol 2021; 94:20200974. [PMID: 33684310 DOI: 10.1259/bjr.20200974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the value of using low energy (keV) images in renal dual-energy spectral CT angiography (CTA) and adaptive statistical iterative reconstruction (ASIR) to reduce contrast medium dose. METHODS 40 patients with renal CTA on a Discovery CT750HD were randomly divided into two groups: 20 cases (Group A) with 600 mgI kg-1 and 20 cases (Group B) with 300 mgI kg-1. The scan protocol for both groups was: dual-energy mode with mA selection for noise index of 10 HU, pitch 1.375:1, rotating speed 0.6 s/r. Images were reconstructed at 0.625 mm thickness with 40%ASIR, Group A used the conventional 70keV monochromatic images, and Group B used monochromatic images from 40 to 70 keV at 5 keV interval for analysis. The CT values and standard deviation (SD) values of the renal artery and erector spine in the plain and arterial phases were measured with the erector spine SD value representing image noise. The enhancement degree of the renal artery (ΔCT = CT(arterial) -CT(plain)), signal-to-noise ratio (SNR=CTrenal-artery/SDrenal-artery) and contrast-to-noise ratio (CNR=(CTrenal-artery-CTerector spine)/SDerector-spine) were calculated. The single factor analysis of variance was used to analyze the difference of ΔCT, SNR and CNR among image groups with p < 0.05 being statistically significant. The subjective image scores of the groups were assessed blindly by two experienced physicians using a 5-point system and the score consistency was compared by the κ test. RESULTS Contrast medium dose in the 300 mgI kg-1 group was reduced by 50% compared with the 600 mgI kg-1 group, while radiation dose was similar between the two groups. The subjective scores were 4.00 ± 0.65, 4.50 ± 0.60 and 3.70 ± 0.80 for images at 70 keV (600 mgI kg-1 group), 40 keV (300 mgI kg-1 group) and 45 keV (300 mgI kg-1 group), respectively with good consistency between the two reviewers (p > 0.05). The 40 keV images in the 300 mgI kg-1 group had similar ΔCT (469.77 ± 86.95 HU vs 398.54 ± 73.68 HU) and CNR (15.52 ± 3.32 vs 18.78 ± 6.71) values as the 70 keV images in the 600 mgI kg-1) group but higher SNR values (30.19 ± 4.41 vs 16.91 ± 11.12, p < 0,05). CONCLUSION Contrast dose may be reduced by 50% while maintaining image quality by using lower energy images combined with ASIR in renal dual-energy CTA. ADVANCES IN KNOWLEDGE Combined with ASIR and energy spectrum, can reduce the amount of contrast dose in renal CTA.
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Affiliation(s)
- Xirong Zhang
- Department of Medical Techniques, Shaanxi University of Chinese medicine, Xianyang, China.,Department of Radiology, Affiliated Hospital of Shaanxi University of Chinese medicine, Xianyang, China.,Department of Radiology, The Second Affiliated Hospital of Shaanxi University of Chinese medicine, Xianyang, China
| | - Jing Chen
- Department of Medical Techniques, Shaanxi University of Chinese medicine, Xianyang, China.,Department of Radiology, Affiliated Hospital of Shaanxi University of Chinese medicine, Xianyang, China.,Department of Radiology, The Second Affiliated Hospital of Shaanxi University of Chinese medicine, Xianyang, China
| | - Nan Yu
- Department of Medical Techniques, Shaanxi University of Chinese medicine, Xianyang, China.,Department of Radiology, Affiliated Hospital of Shaanxi University of Chinese medicine, Xianyang, China.,Department of Radiology, The Second Affiliated Hospital of Shaanxi University of Chinese medicine, Xianyang, China
| | - Zhanli Ren
- Department of Medical Techniques, Shaanxi University of Chinese medicine, Xianyang, China.,Department of Radiology, Affiliated Hospital of Shaanxi University of Chinese medicine, Xianyang, China.,Department of Radiology, The Second Affiliated Hospital of Shaanxi University of Chinese medicine, Xianyang, China
| | - Qian Tian
- Department of Medical Techniques, Shaanxi University of Chinese medicine, Xianyang, China.,Department of Radiology, Affiliated Hospital of Shaanxi University of Chinese medicine, Xianyang, China.,Department of Radiology, The Second Affiliated Hospital of Shaanxi University of Chinese medicine, Xianyang, China
| | - Xin Tian
- Department of Medical Techniques, Shaanxi University of Chinese medicine, Xianyang, China.,Department of Radiology, Affiliated Hospital of Shaanxi University of Chinese medicine, Xianyang, China.,Department of Radiology, The Second Affiliated Hospital of Shaanxi University of Chinese medicine, Xianyang, China
| | - Yongjun Jia
- Department of Medical Techniques, Shaanxi University of Chinese medicine, Xianyang, China.,Department of Radiology, Affiliated Hospital of Shaanxi University of Chinese medicine, Xianyang, China.,Department of Radiology, The Second Affiliated Hospital of Shaanxi University of Chinese medicine, Xianyang, China
| | - Taiping He
- Department of Medical Techniques, Shaanxi University of Chinese medicine, Xianyang, China.,Department of Radiology, Affiliated Hospital of Shaanxi University of Chinese medicine, Xianyang, China.,Department of Radiology, The Second Affiliated Hospital of Shaanxi University of Chinese medicine, Xianyang, China
| | - Changyi Guo
- Department of Medical Techniques, Shaanxi University of Chinese medicine, Xianyang, China.,Department of Radiology, Affiliated Hospital of Shaanxi University of Chinese medicine, Xianyang, China.,Department of Radiology, The Second Affiliated Hospital of Shaanxi University of Chinese medicine, Xianyang, China
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Kirby RS, Halegoua-DeMarzio D. Coronary artery disease and non-alcoholic fatty liver disease: Clinical correlation using computed tomography coronary calcium scans. JGH Open 2021; 5:390-395. [PMID: 33732887 PMCID: PMC7936612 DOI: 10.1002/jgh3.12509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/28/2021] [Accepted: 02/08/2021] [Indexed: 12/30/2022]
Abstract
Background and Aim Non‐alcoholic fatty liver disease (NAFLD) and coronary artery disease (CAD) have been explored using coronary angiography, which showed a link between severe NAFLD and cardiovascular disease risk. This study's aim is to determine if computed tomography (CT) coronary artery calcium (CAC) scores used to determine CAD severity in asymptomatic populations can help predict the presence of NAFLD. Methods This was a retrospective cross‐sectional study of positive CT CAC scores and liver imaging with either CT; ultrasound; magnetic resonance imaging of the abdomen; or CT of the chest, which included liver images. Drinking 7 or 14 drinks per week for a female or male, respectively, and chronic viral hepatitis diagnosis were the exclusion criteria. CT CAC scores, hepatic steatosis, age, gender, lipid and liver panels, weight, blood pressure, F‐4/BARD scores, and hemoglobin A1c were correlated to CAD severity and NAFLD by logistic regression. Results A total of 134 patients with a mean age of 62.3 years (σ = 9.1), with 65% males, body mass index 28.5 (σ = 6.0), and 8% diabetics, were recruited. CAD severity was not associated with the presence of hepatic steatosis (odds ratio 1.96 [95% confidence interval, confidence interval 0.74–5.23] P = 0.36). Adjusted for variables, a link between hepatic steatosis, CAD severity, body mass index over 30 (odds ratio 6.77 [95% confidence interval 1.40–32.66] P = 0.02), and diabetes (odds ratio 9.60 [95% confidence interval 0.56–165.5] P = 0.01) was observed. Conclusions In patients with CAD detected using a positive CT CAC scan, we determined that BMI over 30 and diabetes were correlated with the presence of NAFLD. There was no direct relationship between CAD presence and hepatic steatosis presence.
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Affiliation(s)
- Richard S Kirby
- Sidney Kimmel Medical College Thomas Jefferson University Philadelphia Pennsylvania USA
| | - Dina Halegoua-DeMarzio
- Department of Medicine, Division of Gastroenterology and Hepatology Thomas Jefferson University Philadelphia Pennsylvania USA
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Acetylbritannilactone attenuates contrast-induced acute kidney injury through its anti-pyroptosis effects. Biosci Rep 2021; 40:221974. [PMID: 31998952 PMCID: PMC7029155 DOI: 10.1042/bsr20193253] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/21/2020] [Accepted: 01/24/2020] [Indexed: 02/07/2023] Open
Abstract
Contrast-induced acute kidney injury (CI-AKI) is a severe complication caused by intravascular applied radial contrast media (CM). Pyroptosis is a lytic type of cell death inherently associated with inflammation response and the secretion of pro-inflammatory cytokines following caspase-1 activation. The aim of the present study was to investigate the protective effects of acetylbritannilactone (ABL) on iopromide (IOP)-induced acute renal failure and reveal the underlying mechanism. In vivo and in vitro, IOP treatment caused renal damage and elevated the caspase-1 (+) propidium iodide (PI) (+) cell count, interleukin (IL)-1β and IL-18 levels, lactate dehydrogenase (LDH) release, and the relative expression of nucleotide-binding domain, leucine-rich repeat containing protein 3 (NLRP3), apoptosis-associated speck-like protein (ASC), and gasdermin D (GSDMD), suggesting that IOP induces AKI via the activation of pyroptosis. Furthermore, the pretreatment of ABL partly mitigated the CI-AKI, development of pyroptosis, and subsequent kidney inflammation. These data revealed that ABL partially prevents renal dysfunction and reduces pyroptosis in CI-AKI, which may provide a therapeutic target for the treatment of CM-induced AKI.
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Microfluidic-assisted synthesis of multifunctional iodinated contrast agent polymeric nanoplatforms. Int J Pharm 2021; 599:120447. [PMID: 33676989 DOI: 10.1016/j.ijpharm.2021.120447] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/13/2021] [Accepted: 02/26/2021] [Indexed: 02/07/2023]
Abstract
Contrast Induced Nephropathy is the most severe side-effect arising after non-ionic iodinated contrast agents (CAs) intravenous administration. The use of antioxidants (i.e., N-Acetylcysteine; NAC) is one of the attempted prevention approaches. Herein, we describe the microfluidic-assisted synthesis of iodinated polymeric nanoparticles (NPs) as new multifunctional blood pool CA. The aim of this research is to co-encapsulate Iohexol (IOX; iodinated CA) and NAC (preventive agent) into poly-D,L-lactide-co-glycolide (PLGA) and PEGylated-PLGA (PLGA-PEG) NPs to exploit CA diagnostic proprieties and NAC preventing antioxidant activity. A microfluidic-assisted nanoprecipitation protocol has been set-up for PLGA and PLGA-PEG NPs, evaluating the effect of formulation and microfluidic parameters by analysing the size, PDI and IOX and NAC encapsulation efficiency. The optimized NPs (PLGA-PEG, L:G 50:50, 5% PEG, Mw 90 kDa) formulated with a size of 67 ± 2.8 nm with PDI < 0.2, spherical shape, and an IOX and NAC encapsulation efficiency of 38% and 20%, respectively. The IOX and NAC encapsulation was confirmed by FTIR and DSC. In vitro release study showed an IOX retention into the polymeric matrix and NAC sustained release up to 24-48 h stating microfluidics as powerful tool for the formulation of multifunctional nanoplatforms. Finally, the protective effect of NPs and NAC were preliminary assessed on human kidney cells.
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Teig MK. Anesthetic Management of Patients Undergoing Intravascular Treatment of Cerebral Aneurysms and Arteriovenous Malformations. Anesthesiol Clin 2021; 39:151-162. [PMID: 33563378 DOI: 10.1016/j.anclin.2020.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Arteriovenous malformation (AVM) rupture risk is a complex calculation, and the risks of rupture are influenced by the location and anatomy of the AVM, as well as any history of recurrence. Endovascular treatment of AVMs commonly includes embolization using a liquid embolizate of ethyl vinyl alcohol copolymer. The technique has been enhanced by the invention of detachable tip microcatheters. Embolization may be curative or may be used as part of multimodal therapy for AVMs to reduce their size before open or radiosurgery approaches. These therapies and the consideration necessary to plan for and effectively anesthetize patients undergoing them are discussed.
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Affiliation(s)
- Magnus Knut Teig
- Department of Anesthesiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5048, USA.
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Caiati C, Scardapane A, Iacovelli F, Pollice P, Achille TI, Favale S, Lepera ME. Coronary Flow and Reserve by Enhanced Transthoracic Doppler Trumps Coronary Anatomy by Computed Tomography in Assessing Coronary Artery Stenosis. Diagnostics (Basel) 2021; 11:245. [PMID: 33562448 PMCID: PMC7914993 DOI: 10.3390/diagnostics11020245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/30/2021] [Accepted: 02/03/2021] [Indexed: 12/28/2022] Open
Abstract
We report the case of a 71-year-old patient with many risk factors for coronary atherosclerosis, who underwent computed coronary angiography (CTA), in accordance with the guidelines, for recent onset atypical chest pain. CTA revealed critical (>50% lumen diameter narrowing) stenosis of the proximal anterior descending coronary, and the patient was scheduled for invasive coronary angiography (ICA). Before ICA he underwent enhanced transthoracic echo-Doppler (E-Doppler TTE) for coronary flow detection by color-guided pulsed-wave Doppler recording of the left main (LMCA) and whole left anterior descending coronary artery (LAD,) along with coronary flow reserve (CFR) in the distal LAD calculated as the ratio, of peak flow velocity during i.v. adenosine (140 mcg/Kg/m) to resting flow velocity. E-Doppler TTE mapping revealed only mild stenosis (28% area narrowing) of the mid LAD and a CFR of 3.20, in perfect agreement with the color mapping showing no flow limiting stenosis in the LMCA and LAD. ICA revealed only a very mild stenosis in the mid LAD and mild atherosclerosis in the other coronaries (intimal irregularities). Thus, coronary stenosis was better predicted by E-Doppler TTE than by CTA. Coronary flow and reserve as assessed by E-Doppler TTE trumps coronary anatomy as assessed by CTA, without exposing the patient to harmful radiation and iodinated contrast medium.
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Affiliation(s)
- Carlo Caiati
- Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantations, University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.I.); (P.P.); (T.I.A.); (S.F.); (M.E.L.)
| | - Arnaldo Scardapane
- Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Bari Medical School, 70124 Bari, Italy;
| | - Fortunato Iacovelli
- Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantations, University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.I.); (P.P.); (T.I.A.); (S.F.); (M.E.L.)
| | - Paolo Pollice
- Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantations, University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.I.); (P.P.); (T.I.A.); (S.F.); (M.E.L.)
| | - Teresa Immacolata Achille
- Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantations, University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.I.); (P.P.); (T.I.A.); (S.F.); (M.E.L.)
| | - Stefano Favale
- Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantations, University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.I.); (P.P.); (T.I.A.); (S.F.); (M.E.L.)
| | - Mario Erminio Lepera
- Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantations, University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.I.); (P.P.); (T.I.A.); (S.F.); (M.E.L.)
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Sebastià C, Páez-Carpio A, Guillen E, Paño B, Garcia-Cinca D, Poch E, Oleaga L, Nicolau C. Oral hydration compared to intravenous hydration in the prevention of post-contrast acute kidney injury in patients with chronic kidney disease stage IIIb: A phase III non-inferiority study (NICIR study). Eur J Radiol 2021; 136:109509. [PMID: 33516141 DOI: 10.1016/j.ejrad.2020.109509] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/03/2020] [Accepted: 12/28/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To evaluate the non-inferiority of oral hydration compared to intravenous (i.v.) hydration in the prevention of post-contrast acute kidney injury (PC-AKI) in patients with stage IIIb chronic kidney disease (CKD) referred for an elective contrast-enhanced computed tomography (CE-CT). MATERIAL AND METHODS This is a prospective, randomized, phase 3, parallel-group, open-label, non-inferiority trial. Patients were randomly assigned 1:1 to receive prophylaxis against PC-AKI either with oral hydration: 500 mL of water two hours before and 2000 mL during the 24 h after performing CE-CT or i.v. hydration: sodium bicarbonate (166 mmol/L) 3 mL/kg/h starting one hour before and sodium bicarbonate (166 mmol/L) 1 mL/kg/h during the first hour after CE-CT. 100 mL of non-ionic iodinated contrast was administered in all cases. The primary outcome was the proportion of PC-AKI in the first 48-72 h after CE-CT. Secondary outcomes were persistent PC-AKI, the need for hemodialysis, and the occurrence of adverse events related to prophylaxis. RESULTS Of 264 patients randomized between January 2018 and January 2019, 114 received oral hydration, and 114 received i.v. hydration and were evaluable. No significant differences were found (p > 0.05) between arms in clinical characteristics or risk factors. PC-AKI rate was 4.4 % (95 %CI: 1.4-9.9 %) in the oral hydration arm and 5.3 % (95 %CI: 2.0-11.1%) in the i.v. hydration arm. The persistent PC-AKI rate was 1.8 % (95 %CI: 0.2-6.2 %) in both arms. No patient required dialysis during the first month after CE-CT or had adverse effects related to the hydration regime. CONCLUSION In those with stage IIIb CKD referred for an elective CE-CT, we provide evidence of non-inferiority of oral hydration compared to i.v. hydration in the prevention of PC-AKI.
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Affiliation(s)
- Carmen Sebastià
- Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain.
| | | | - Elena Guillen
- Department of Nephrology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Blanca Paño
- Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Esteban Poch
- Department of Nephrology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Laura Oleaga
- Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain; Universitat de Barcelona, Campus Clínic, Barcelona, Spain
| | - Carlos Nicolau
- Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain; Universitat de Barcelona, Campus Clínic, Barcelona, Spain
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Laniyonu A, Ouyang Y, Cohen J, Awe S, Dina O, Biade S, Hargus S, Kokate T. Nonclinical Product Developmental Strategies, Safety Considerations and Toxicity Profiles of Medical Imaging and Radiopharmaceuticals Products. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00039-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Bock M. [Contrast Agents for Magnetic Resonance Imaging: Curse or Blessing?]. Z Med Phys 2020; 31:1-3. [PMID: 33358320 DOI: 10.1016/j.zemedi.2020.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Self-navigated 3D whole-heart MRA for non-enhanced surveillance of thoracic aortic dilation: A comparison to CTA. Magn Reson Imaging 2020; 76:123-130. [PMID: 33309920 DOI: 10.1016/j.mri.2020.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/02/2020] [Accepted: 12/06/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE To prospectively compare image quality and reliability of a non-contrast, self-navigated 3D whole-heart magnetic resonance angiography (MRA) sequence with contrast-enhanced computed tomography angiography (CTA) for sizing of thoracic aortic aneurysm (TAA). METHODS Self-navigated 3D whole-heart 1.5 T MRA was performed in 20 patients (aged 67 ± 9 years, 75% male) for sizing of TAA; a subgroup of 18 (90%) patients underwent additional contrast-enhanced CTA on the same day. Subjective image quality was scored according to a 4-point Likert scale and ratings between observers were compared by Cohen's Kappa statistics. For MRA, subjective motion blurring and signal inhomogeneity was rated according to a 3-point scale, respectively. Objective signal inhomogeneity of MRA was quantified as standard deviation of the voxel intensities in a circular region of interest (ROI) placed in the ascending aorta divided by their mean value. Continuous MRA and CTA measurements were analyzed with regression and Bland-Altman analysis. RESULTS Overall subjective image quality as rated by two observers was 1 [interquartile range (IQR) 1-2] for self-navigated MRA and 1.5 [IQR 1-2] for CTA (p = 0.717). For MRA, perfect inter-observer agreement was found regarding presence of artefacts and subjective image sharpness (κ = 1). Subjective signal inhomogeneity agreed moderately between the observers (κ = 0.58, p = 0.007), however, it correlated strongly with objectively quantified inhomogeneity of the blood pool signal (r = 0.78, p < 0.0001). Maximum diameters of TAA as measured by self-navigated MRA and CTA showed very strong correlation (r = 0.99, p < 0.0001) without significant inter-method bias (bias -0.03 mm, lower and upper limit of agreement -0.74 and 0.68 mm, p = 0.749). Inter-observer correlation of aortic aneurysm as measured by MRA was very strong (r = 0.96) without significant bias (p = 0.695). CONCLUSION Self-navigated 3D whole-heart MRA enables reliable contrast- and radiation free aortic dilation surveillance without significant difference to standardized CTA while providing predictable acquisition time and offering excellent image quality.
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Brito C, Falcão L, Raimundo M, Fernandes S, Fernandes A, Silva S, Vilela P, Almeida ED. Contrast-induced acute kidney injury in acute ischaemic stroke patients. Neuroradiol J 2020:1971400920977206. [PMID: 33283660 DOI: 10.1177/1971400920977206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The potential nephrotoxicity of intravenous iodinated contrast media is a major concern for acute ischaemic stroke imaging evaluation. This study aimed to assess the incidence of acute kidney injury after intravenous iodinated contrast media exposure in acute ischaemic stroke patients. METHODS We conducted a retrospective cohort analysis between January 2012 and July 2018 to select adult patients admitted to the emergency department with acute ischaemic stroke. The exposed patients received a uniform intravenous dose of low osmolar non-ionic iodinated contrast media, as part of the imaging protocol for acute ischaemic stroke. The unexposed patients underwent a non-enhanced cranial computed tomography scan. Acute kidney injury was defined according to the Kidney Disease Improving Global Outcomes criteria, limited to the first 72 hours. RESULTS A total of 161 and 105 patients were included in the exposed and unexposed groups, respectively. The median age was 72.8 years (interquartile range 20), 53% were men and 97% were white. Demographic and baseline characteristics were similar between the groups. The incidence of acute kidney injury between exposed (n = 10, 6.2%) and unexposed (n = 1, 1%) groups (P = 0.073) was similar and contrast exposure was not a significant predictor of acute kidney injury. CONCLUSION Intravenous iodinated contrast media exposure during acute ischaemic stroke imaging protocols is not an independent predictor of acute kidney injury in patients with normal or near-normal renal function. Studies with larger sample sizes would help to clarify if patients with both cardiovascular risk factors and impaired renal function could benefit from prophylactic measures.
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Affiliation(s)
- Catarina Brito
- Neuroradiology Department, Hospital Beatriz Ângelo, Lisbon, Portugal
- University College London, UK
- *These authors contributed equally to the study and final manuscript
| | - Luís Falcão
- Nephrology Department, Hospital Beatriz Ângelo, Lisbon, Portugal
- *These authors contributed equally to the study and final manuscript
| | - Mário Raimundo
- Nephrology Department, Hospital Beatriz Ângelo, Lisbon, Portugal
| | - Sara Fernandes
- Nephrology Department, Hospital Beatriz Ângelo, Lisbon, Portugal
| | | | - Sónia Silva
- Nephrology Department, Hospital Beatriz Ângelo, Lisbon, Portugal
| | - Pedro Vilela
- Neuroradiology Department, Hospital Beatriz Ângelo, Lisbon, Portugal
- Institutional Council of the European Society of Neuroradiology
- Portuguese Neuroradiology Society, Portugal
- Spanish Neuroradiology Society, Spain
| | - Edgar de Almeida
- Nephrology Department, Hospital Beatriz Ângelo, Lisbon, Portugal
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Kidney function testing prior to contrast-enhanced CT: a comparative cost analysis of a personalised risk-stratified pathway versus a test all approach. Clin Radiol 2020; 76:202-212. [PMID: 33109348 DOI: 10.1016/j.crad.2020.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/17/2020] [Indexed: 12/18/2022]
Abstract
AIM To map current contrast-enhanced computed tomography (CT) pathways, develop a risk-stratified pathway, and model associated costs and resource use. MATERIALS AND METHODS Phase 1 comprised multicentre mapping of current practice and development of an alternative pathway, replacing pre-assessment of estimated glomerular filtration rate (eGFR) with a scan-day screening questionnaire for risk stratification and point of care (PoC) creatinine. Phase 2 measured resource use and analysis of routinely collected data, used to populate a model comparing the costs of current and risk-stratified pathways in Phase 3. RESULTS Site variation across a range of processes within the clinical care pathway was identified. Data from a single centre suggested that 78% (n=347/447) could have avoided their pre-scan laboratory test as they did not have post-contrast acute kidney injury (AKI) risk factors. Only 24% of outpatients who underwent computed tomography (CT) would have identified risk factors, which would have prompted a scan-day PoC test. There was a 94% probability that the risk-stratified pathway was cost-saving, with an estimated 5-year potential cost saving of £69,620 (95% CI: -£13,295-£154,603). Although the cost of a laboratory serum creatinine test is cheaper than the PoC equivalent (£5.29 versus £5.96), the screening questionnaire ruled out the need for a large majority of the eGFR measurements specifically for the CT examination. CONCLUSION The present study proposes an alternative pathway, which has the potential to improve the efficiency of the current CT pathway. A multicentre appraisal is required to demonstrate the impact of embedding this new pathway on a wider NHS level, particularly in light of new diagnostic guidance (DG37) published by NICE.
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Hepburn M, Mullaguri N, Battineni A, Dani D, George P, Newey CR. Fatal Brain Injury Following Carbon Dioxide Angiography. J Stroke Cerebrovasc Dis 2020; 29:105350. [PMID: 33254372 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/14/2020] [Accepted: 09/17/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Carbon dioxide (CO2) as a contrast agent has been in use as early as the 1920s for visualization of retroperitoneal structures. Digital subtraction angiography (DSA) using CO2 as a contrast agent for vascular imaging was developed in the 1980s. Currently, CO2 angiography is an alternative agent in patients with chronic kidney disease (CKD) and those who are at risk of developing contrast-induced nephropathy. However, CO2 causes neurotoxicity if the gas inadvertently enters the cerebrovascular circulation leading to fatal brain injury. CASE PRESENTATION A 71-year-old female with h/o sickle cell trait, hypertension, obesity, metastatic renal cell cancer status post nephrectomy, bone metastasis, chronic kidney disease was admitted for elective embolization of the humerus bone metastasis. Given the high probability of contrast-induced nephropathy, CO2 angiography was chosen for embolization of the metastasis. During the procedure, the patient became unresponsive. Emergent medical management with hyperventilation, 100% fraction oxygen inhalation was performed. Her neuroimaging showed global cerebral edema. An intracranial pressure monitor was placed which confirmed intracranial hypertension. Hyperosmolar therapy was administered with no improvement in clinical examination. She progressed to brain stem herniation. Given poor prognosis, the family opted for comfort measures and the patient expired. DISCUSSION AND CONCLUSIONS Inadvertent carbon dioxide entry into cerebrovascular circulation during angiography can cause fatal brain injury. Caution must be exercised while performing CO2 angiography in blood vessels above the diaphragm.
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Affiliation(s)
- Madihah Hepburn
- Neurocritical care, Cerebrovascular Center, Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
| | - Naresh Mullaguri
- Neurocritical care, Cerebrovascular Center, Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | - Dhimant Dani
- Neurocritical care, Cerebrovascular Center, Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
| | - Pravin George
- Neurocritical care, Cerebrovascular Center, Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
| | - Christopher R Newey
- Neurocritical care, Cerebrovascular Center, Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Epilepsy Center, Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Medical Director, Neurocritical Care, Cleveland Clinic Akron General Hospital, Akron, Ohio, USA.
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Digumarthy SR, Singh R, Rastogi S, Otrakji A, Homayounieh F, Zhang EW, McDermott S, Kalra MK. Low contrast volume dual-energy CT of the chest: Quantitative and qualitative assessment. Clin Imaging 2020; 69:305-310. [PMID: 33045474 DOI: 10.1016/j.clinimag.2020.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/18/2020] [Accepted: 10/01/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE To evaluate the image quality of chest CT performed on dual-energy scanners using low contrast volume for routine chest (DECT-R) and pulmonary angiography (DECTPA) protocols. MATERIALS AND METHODS This retrospective study included dual-energy CT scans of chest performed with low contrast volume in 84 adults (34M:50F; Age 69 ± 16 years: Weight 71 ± 16kg). There were 42 patients with DECT-R and 42 patients with DECT-PA protocols. Images were reviewed by two thoracic radiologists. Qualitative assessment was done on a four-point scale, for subjective assessment of contrast enhancement and artifacts (1 = Excellent, 2 = optimal, 3 = suboptimal, and 4 = Limited) in the pulmonary arteries and thoracic aorta, on virtual monoenergetic and material decomposition iodine (MDI) images. Quantitative assessment was performed by measuring the CT (Hounsfield) units in aorta and pulmonary arteries. The estimated glomerular filtration rate (eGFR) was calculated before and after CT scans. Two tailed student's t-test was performed to assess the significance of findings, and strength of correlation between readers was determined by Cohen's kappa test. RESULTS DECT-PA and DECT-R demonstrated excellent/adequate contrast density within the pulmonary arteries (up to segmental branch), and aorta. There was no suboptimal or limited examination. There was strong interobserver agreement for arterial enhancement in pulmonary arteries (kappa = 0.62-0.89) and for thoracic aorta (kappa = 0.62-0.94). Pulmonary emboli were seen in 3/42(7%) in DECT-R and in 5/42(12%) in DECT-PA. There was no significant change in eGFR before and after IV contrast injection (p = 0.46-0.52). CONCLUSION DECT-R and DECT-PA performed with low contrast volume provide diagnostic quality opacification of the pulmonary vessels and aorta vessels.
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Affiliation(s)
- Subba R Digumarthy
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America.
| | - Ramandeep Singh
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Shivam Rastogi
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Alexi Otrakji
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Fatemeh Homayounieh
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Eric W Zhang
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Shaunagh McDermott
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Mannudeep K Kalra
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
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Crist RM, Dasa SSK, Liu CH, Clogston JD, Dobrovolskaia MA, Stern ST. Challenges in the development of nanoparticle-based imaging agents: Characterization and biology. WILEY INTERDISCIPLINARY REVIEWS-NANOMEDICINE AND NANOBIOTECHNOLOGY 2020; 13:e1665. [PMID: 32830448 DOI: 10.1002/wnan.1665] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 12/15/2022]
Abstract
Despite imaging agents being some of the earliest nanomedicines in clinical use, the vast majority of current research and translational activities in the nanomedicine field involves therapeutics, while imaging agents are severely underrepresented. The reasons for this lack of representation are several fold, including difficulties in synthesis and scale-up, biocompatibility issues, lack of suitable tissue/disease selective targeting ligands and receptors, and a high bar for regulatory approval. The recent focus on immunotherapies and personalized medicine, and development of nanoparticle constructs with better tissue distribution and selectivity, provide new opportunities for nanomedicine imaging agent development. This manuscript will provide an overview of trends in imaging nanomedicine characterization and biocompatibility, and new horizons for future development. This article is categorized under: Diagnostic Tools > in vivo Nanodiagnostics and Imaging Toxicology and Regulatory Issues in Nanomedicine > Toxicology of Nanomaterials Toxicology and Regulatory Issues in Nanomedicine > Regulatory and Policy Issues in Nanomedicine.
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Affiliation(s)
- Rachael M Crist
- Nanotechnology Characterization Laboratory, Cancer Research Technology Program, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, Maryland, USA
| | - Siva Sai Krishna Dasa
- Nanotechnology Characterization Laboratory, Cancer Research Technology Program, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, Maryland, USA
| | - Christina H Liu
- Nanodelivery Systems and Devices Branch, Cancer Imaging Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, Maryland, USA
| | - Jeffrey D Clogston
- Nanotechnology Characterization Laboratory, Cancer Research Technology Program, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, Maryland, USA
| | - Marina A Dobrovolskaia
- Nanotechnology Characterization Laboratory, Cancer Research Technology Program, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, Maryland, USA
| | - Stephan T Stern
- Nanotechnology Characterization Laboratory, Cancer Research Technology Program, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, Maryland, USA
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Iordache AM, Buga AM, Albulescu D, Vasile RC, Mitrut R, Georgiadis G, Zisis IE, Mamoulakis C, Tsatsakis A, Docea AO, Calina D. Phosphodiesterase-5 inhibitors ameliorate structural kidney damage in a rat model of contrast-induced nephropathy. Food Chem Toxicol 2020; 143:111535. [PMID: 32622850 DOI: 10.1016/j.fct.2020.111535] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/11/2020] [Accepted: 06/13/2020] [Indexed: 12/11/2022]
Abstract
The aim of the study was to investigate the potential of sildenafil and tadalafil to ameliorate structural kidney damage in contrast-induced nephropathy (CIN). A rat model of CIN was developed by dehydration, administration of a nitric oxide inhibitor and a prostaglandin synthesis inhibitor (L-NAME/indomethacin) and contrast media exposure to iopromide. The effect of pre-treatment with sildenafil, tadalafil or N-acetyl cysteine (NAC) for 7 days prior to CIN induction was investigated. All animals were sacrificed at 24 h after CIN induction and both kidneys were collected. Histopathological examination was performed under light microscopy in serial tissue sections stained with hematoxylin and eosin. CIN group showed hydropic changes of the renal tubules (proximal and distal convoluted tubules and Henle's loop), an increased Bowman space with lobulated glomerulus and alteration of macula densa region of distal convolute tubules. The groups pretreated with sildenafil and tadalafil showed nearly normal histological aspects of renal tissue. The group pretreated with NAC showed similar but less intense histopathologic changes compared to CIN group. Sildenafil and tadalafil pre-treatment ameliorates CIN-related structural kidney damage and the protective potential of these agents is superior to NAC.
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Affiliation(s)
- Andrei Mihai Iordache
- Department of Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, 200349, Craiova, Romania.
| | - Ana Maria Buga
- Department of Biochemistry, University of Medicine and Pharmacy of Craiova, 200349, Craiova, Romania.
| | - Dana Albulescu
- Department of Radiology, University of Medicine and Pharmacy of Craiova, 200349, Craiova, Romania.
| | - Ramona Constantina Vasile
- Department of Epidemiology and Primary Healthcare, University of Medicine and Pharmacy of Craiova, 200349, Craiova, Romania.
| | - Radu Mitrut
- Department of Cardiology, University and Emergency Hospital, 050098, Bucharest, Romania.
| | - George Georgiadis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece; Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, Heraklion, Crete, 71003, Greece.
| | - Ioannis-Erineos Zisis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece; Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, Heraklion, Crete, 71003, Greece.
| | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece.
| | - Aristidis Tsatsakis
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, Heraklion, Crete, 71003, Greece.
| | - Anca Oana Docea
- Department of Toxicology, University of Medicine and Pharmacy of Craiova, 200349, Craiova, Romania.
| | - Daniela Calina
- Department of Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, 200349, Craiova, Romania.
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Future of Diagnostic Computed Tomography: An Update on Physicochemical Properties, Safety, and Development of X-ray Contrast Media. Invest Radiol 2020; 55:598-600. [PMID: 32452883 DOI: 10.1097/rli.0000000000000686] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Iodinated contrast media (CM) are utilized in approximately 40% of the 300 million computed tomography (CT) scans undertaken annually. This review focuses on the physicochemical properties and safety of iodinated CM, and the development of new x-ray CM, and it explores methods to optimize CT scanning parameters. It concludes that good x-ray CM should have high structural stability, hydrophilicity, and CT attenuation; low viscosity, osmolality, and protein binding; no metabolism and tissue accumulation; and a complete elimination.
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74
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Xue FS, Liu SH, Wan L. Does preoperative contrast administration really not affect the occurrence of acute kidney injury after major gastrointestinal surgery? Br J Surg 2020; 107:e232. [PMID: 32379352 DOI: 10.1002/bjs.11622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 03/17/2020] [Indexed: 11/11/2022]
Affiliation(s)
- F S Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - S H Liu
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - L Wan
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
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Pamminger M, Klug G, Kranewitter C, Reindl M, Reinstadler SJ, Henninger B, Tiller C, Holzknecht M, Kremser C, Bauer A, Jaschke W, Metzler B, Mayr A. Non-contrast MRI protocol for TAVI guidance: quiescent-interval single-shot angiography in comparison with contrast-enhanced CT. Eur Radiol 2020; 30:4847-4856. [PMID: 32318849 PMCID: PMC7431439 DOI: 10.1007/s00330-020-06832-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/07/2020] [Accepted: 03/25/2020] [Indexed: 12/18/2022]
Abstract
Objectives To prospectively compare unenhanced quiescent-interval single-shot MR angiography (QISS-MRA) with contrast-enhanced computed tomography angiography (CTA) for contrast-free guidance in transcatheter aortic valve intervention (TAVI). Methods Twenty-six patients (mean age 83 ± 5 years, 15 female [58%]) referred for TAVI evaluation underwent QISS-MRA for aortoiliofemoral access guidance and non-contrast three-dimensional (3D) “whole heart” MRI for prosthesis sizing on a 1.5-T system. Contrast-enhanced CTA was performed as imaging gold standard for TAVI planning. Image quality was assessed by a 4-point Likert scale; continuous MRA and CTA measurements were compared with regression and Bland-Altman analyses. Results QISS-MRA and CTA-based measurements of aortoiliofemoral vessel diameters correlated moderately to very strong (r = 0.572 to 0.851, all p ≤ 0.002) with good to excellent inter-observer reliability (intra-class correlation coefficient (ICC) = 0.862 to 0.999, all p < 0.0001) regarding QISS assessment. Mean diameters of the infrarenal aorta and iliofemoral vessels differed significantly (bias 0.37 to 0.98 mm, p = 0.041 to < 0.0001) between the two modalities. However, inter-method decision for transfemoral access route was comparable (κ = 0.866, p < 0.0001). Aortic root parameters assessed by 3D whole heart MRI strongly correlated (r = 0.679 to 0.887, all p ≤ 0.0001) to CTA measurements. Conclusion QISS-MRA provides contrast-free access route evaluation in TAVI patients with moderate to strong correlations compared with CTA and substantial inter-observer agreement. Despite some significant differences in minimal vessel diameters, inter-method agreement for transfemoral accessibility is strong. Combination with 3D whole heart MRI facilitates unenhanced TAVI guidance. Key Points • QISS-MRA and CTA inter-method agreement for transfemoral approach is strong. • QISS-MRA is a very good alternative to CTA and MRA especially in patients with Kidney Disease Outcomes Quality Initiativestages 4 and 5. • Combination of QISS-MRA and 3D “whole heart” MRI facilitates fully unenhanced TAVI guidance.
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Affiliation(s)
- Mathias Pamminger
- University Clinic of Radiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Gert Klug
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Christof Kranewitter
- University Clinic of Radiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Martin Reindl
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Sebastian J Reinstadler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Benjamin Henninger
- University Clinic of Radiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Christina Tiller
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Magdalena Holzknecht
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Christian Kremser
- University Clinic of Radiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Axel Bauer
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Werner Jaschke
- University Clinic of Radiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Bernhard Metzler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Agnes Mayr
- University Clinic of Radiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria.
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76
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Shah R, Le FK, Labroo A, Khan MR. Contrast-associated acute kidney injury. Quant Imaging Med Surg 2020; 10:891-894. [PMID: 32355657 DOI: 10.21037/qims.2020.03.20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Rahman Shah
- Department of Medicine, Gulf Coast Medical Center, The Alabama College of Osteopathic Medicine, Panama City, Florida, USA
| | - Francis K Le
- Department of Medicine, Gulf Coast Medical Center, The Alabama College of Osteopathic Medicine, Panama City, Florida, USA
| | - Ajay Labroo
- Department of Medicine, Gulf Coast Medical Center, The Alabama College of Osteopathic Medicine, Panama City, Florida, USA
| | - M Rehan Khan
- Department of Radiology, Virginia Commonwealth University, School of Medicine, Richmond, Virginia, USA
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Davenport MS, Perazella MA, Yee J, Dillman JR, Fine D, McDonald RJ, Rodby RA, Wang CL, Weinreb JC. Use of Intravenous Iodinated Contrast Media in Patients with Kidney Disease: Consensus Statements from the American College of Radiology and the National Kidney Foundation. Radiology 2020; 294:660-668. [PMID: 31961246 DOI: 10.1148/radiol.2019192094] [Citation(s) in RCA: 257] [Impact Index Per Article: 64.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Intravenous iodinated contrast media are commonly used with CT to evaluate disease and to determine treatment response. The risk of acute kidney injury (AKI) developing in patients with reduced kidney function following exposure to intravenous iodinated contrast media has been overstated. This is due primarily to historic lack of control groups sufficient to separate contrast-induced AKI (CI-AKI; ie, AKI caused by contrast media administration) from contrast-associated AKI (CA-AKI; ie, AKI coincident to contrast media administration). Although the true risk of CI-AKI remains uncertain for patients with severe kidney disease, prophylaxis with intravenous normal saline is indicated for patients who have AKI or an estimated glomerular filtration rate less than 30 mL/min/1.73 m2 who are not undergoing maintenance dialysis. In individual high-risk circumstances, prophylaxis may be considered in patients with an estimated glomerular filtration rate of 30-44 mL/min/1.73 m2 at the discretion of the ordering clinician. This article is a simultaneous joint publication in Radiology and Kidney Medicine. The articles are identical except for stylistic changes in keeping with each journal's style. Either version may be used in citing this article.
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Affiliation(s)
- Matthew S Davenport
- From the Departments of Radiology (M.S.D.) and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, Mich 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (M.S.D.); American College of Radiology, Reston, Va (M.S.D., J.R.D., R.J.M., C.L.W., J.C.W.); National Kidney Foundation, New York, NY (M.A.P., D.F., R.A.R.); Section of Nephrology (M.A.P., J.C.W.) and Department of Radiology and Biomedical Imaging (J.C.W.), Yale University School of Medicine, New Haven, Conn; Department of Nephrology, Henry Ford Health System, Detroit, Mich (J.Y.); Department of Radiology, Cincinnati Children's Hospital Medical Center at University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Nephrology, Johns Hopkins Medicine, Baltimore, Md (D.F.); Department of Radiology Mayo Clinic, Rochester, Minn (R.J.M.); Department of Nephrology, Rush University Medical Center, Chicago, Ill (R.A.R.); and Department of Radiology, University of Washington, Seattle, Wash (C.L.W.)
| | - Mark A Perazella
- From the Departments of Radiology (M.S.D.) and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, Mich 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (M.S.D.); American College of Radiology, Reston, Va (M.S.D., J.R.D., R.J.M., C.L.W., J.C.W.); National Kidney Foundation, New York, NY (M.A.P., D.F., R.A.R.); Section of Nephrology (M.A.P., J.C.W.) and Department of Radiology and Biomedical Imaging (J.C.W.), Yale University School of Medicine, New Haven, Conn; Department of Nephrology, Henry Ford Health System, Detroit, Mich (J.Y.); Department of Radiology, Cincinnati Children's Hospital Medical Center at University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Nephrology, Johns Hopkins Medicine, Baltimore, Md (D.F.); Department of Radiology Mayo Clinic, Rochester, Minn (R.J.M.); Department of Nephrology, Rush University Medical Center, Chicago, Ill (R.A.R.); and Department of Radiology, University of Washington, Seattle, Wash (C.L.W.)
| | - Jerry Yee
- From the Departments of Radiology (M.S.D.) and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, Mich 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (M.S.D.); American College of Radiology, Reston, Va (M.S.D., J.R.D., R.J.M., C.L.W., J.C.W.); National Kidney Foundation, New York, NY (M.A.P., D.F., R.A.R.); Section of Nephrology (M.A.P., J.C.W.) and Department of Radiology and Biomedical Imaging (J.C.W.), Yale University School of Medicine, New Haven, Conn; Department of Nephrology, Henry Ford Health System, Detroit, Mich (J.Y.); Department of Radiology, Cincinnati Children's Hospital Medical Center at University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Nephrology, Johns Hopkins Medicine, Baltimore, Md (D.F.); Department of Radiology Mayo Clinic, Rochester, Minn (R.J.M.); Department of Nephrology, Rush University Medical Center, Chicago, Ill (R.A.R.); and Department of Radiology, University of Washington, Seattle, Wash (C.L.W.)
| | - Jonathan R Dillman
- From the Departments of Radiology (M.S.D.) and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, Mich 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (M.S.D.); American College of Radiology, Reston, Va (M.S.D., J.R.D., R.J.M., C.L.W., J.C.W.); National Kidney Foundation, New York, NY (M.A.P., D.F., R.A.R.); Section of Nephrology (M.A.P., J.C.W.) and Department of Radiology and Biomedical Imaging (J.C.W.), Yale University School of Medicine, New Haven, Conn; Department of Nephrology, Henry Ford Health System, Detroit, Mich (J.Y.); Department of Radiology, Cincinnati Children's Hospital Medical Center at University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Nephrology, Johns Hopkins Medicine, Baltimore, Md (D.F.); Department of Radiology Mayo Clinic, Rochester, Minn (R.J.M.); Department of Nephrology, Rush University Medical Center, Chicago, Ill (R.A.R.); and Department of Radiology, University of Washington, Seattle, Wash (C.L.W.)
| | - Derek Fine
- From the Departments of Radiology (M.S.D.) and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, Mich 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (M.S.D.); American College of Radiology, Reston, Va (M.S.D., J.R.D., R.J.M., C.L.W., J.C.W.); National Kidney Foundation, New York, NY (M.A.P., D.F., R.A.R.); Section of Nephrology (M.A.P., J.C.W.) and Department of Radiology and Biomedical Imaging (J.C.W.), Yale University School of Medicine, New Haven, Conn; Department of Nephrology, Henry Ford Health System, Detroit, Mich (J.Y.); Department of Radiology, Cincinnati Children's Hospital Medical Center at University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Nephrology, Johns Hopkins Medicine, Baltimore, Md (D.F.); Department of Radiology Mayo Clinic, Rochester, Minn (R.J.M.); Department of Nephrology, Rush University Medical Center, Chicago, Ill (R.A.R.); and Department of Radiology, University of Washington, Seattle, Wash (C.L.W.)
| | - Robert J McDonald
- From the Departments of Radiology (M.S.D.) and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, Mich 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (M.S.D.); American College of Radiology, Reston, Va (M.S.D., J.R.D., R.J.M., C.L.W., J.C.W.); National Kidney Foundation, New York, NY (M.A.P., D.F., R.A.R.); Section of Nephrology (M.A.P., J.C.W.) and Department of Radiology and Biomedical Imaging (J.C.W.), Yale University School of Medicine, New Haven, Conn; Department of Nephrology, Henry Ford Health System, Detroit, Mich (J.Y.); Department of Radiology, Cincinnati Children's Hospital Medical Center at University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Nephrology, Johns Hopkins Medicine, Baltimore, Md (D.F.); Department of Radiology Mayo Clinic, Rochester, Minn (R.J.M.); Department of Nephrology, Rush University Medical Center, Chicago, Ill (R.A.R.); and Department of Radiology, University of Washington, Seattle, Wash (C.L.W.)
| | - Roger A Rodby
- From the Departments of Radiology (M.S.D.) and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, Mich 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (M.S.D.); American College of Radiology, Reston, Va (M.S.D., J.R.D., R.J.M., C.L.W., J.C.W.); National Kidney Foundation, New York, NY (M.A.P., D.F., R.A.R.); Section of Nephrology (M.A.P., J.C.W.) and Department of Radiology and Biomedical Imaging (J.C.W.), Yale University School of Medicine, New Haven, Conn; Department of Nephrology, Henry Ford Health System, Detroit, Mich (J.Y.); Department of Radiology, Cincinnati Children's Hospital Medical Center at University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Nephrology, Johns Hopkins Medicine, Baltimore, Md (D.F.); Department of Radiology Mayo Clinic, Rochester, Minn (R.J.M.); Department of Nephrology, Rush University Medical Center, Chicago, Ill (R.A.R.); and Department of Radiology, University of Washington, Seattle, Wash (C.L.W.)
| | - Carolyn L Wang
- From the Departments of Radiology (M.S.D.) and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, Mich 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (M.S.D.); American College of Radiology, Reston, Va (M.S.D., J.R.D., R.J.M., C.L.W., J.C.W.); National Kidney Foundation, New York, NY (M.A.P., D.F., R.A.R.); Section of Nephrology (M.A.P., J.C.W.) and Department of Radiology and Biomedical Imaging (J.C.W.), Yale University School of Medicine, New Haven, Conn; Department of Nephrology, Henry Ford Health System, Detroit, Mich (J.Y.); Department of Radiology, Cincinnati Children's Hospital Medical Center at University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Nephrology, Johns Hopkins Medicine, Baltimore, Md (D.F.); Department of Radiology Mayo Clinic, Rochester, Minn (R.J.M.); Department of Nephrology, Rush University Medical Center, Chicago, Ill (R.A.R.); and Department of Radiology, University of Washington, Seattle, Wash (C.L.W.)
| | - Jeffrey C Weinreb
- From the Departments of Radiology (M.S.D.) and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, Mich 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (M.S.D.); American College of Radiology, Reston, Va (M.S.D., J.R.D., R.J.M., C.L.W., J.C.W.); National Kidney Foundation, New York, NY (M.A.P., D.F., R.A.R.); Section of Nephrology (M.A.P., J.C.W.) and Department of Radiology and Biomedical Imaging (J.C.W.), Yale University School of Medicine, New Haven, Conn; Department of Nephrology, Henry Ford Health System, Detroit, Mich (J.Y.); Department of Radiology, Cincinnati Children's Hospital Medical Center at University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Nephrology, Johns Hopkins Medicine, Baltimore, Md (D.F.); Department of Radiology Mayo Clinic, Rochester, Minn (R.J.M.); Department of Nephrology, Rush University Medical Center, Chicago, Ill (R.A.R.); and Department of Radiology, University of Washington, Seattle, Wash (C.L.W.)
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Cosmai L, Porta C, Privitera C, Gesualdo L, Procopio G, Gori S, Laghi A. Acute kidney injury from contrast-enhanced CT procedures in patients with cancer: white paper to highlight its clinical relevance and discuss applicable preventive strategies. ESMO Open 2020; 5:e000618. [PMID: 32205339 PMCID: PMC7204797 DOI: 10.1136/esmoopen-2019-000618] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/27/2019] [Accepted: 12/31/2019] [Indexed: 01/09/2023] Open
Abstract
Patients with cancer are subjected to several imaging examinations which frequently require the administration of contrast medium (CM). However, it has been estimated that acute kidney injury (AKI) due to the injection of iodinated CM accounts for 11% of all cases of AKI, and it is reported in up to 2% of all CT examinations. Remarkably, the risks of developing AKI are increased in the elderly, in patients with chronic kidney disease or diabetes, and with dehydration or administration of nephrotoxic chemotherapeutics. Given the common occurrence of postcontrast acute kidney injury (PC-AKI) in clinical practice, primary care physicians and all specialists involved in managing patients with cancer should be aware of the strategies to reduce the risk of this event. In 2018, a panel of four experts from the specialties of radiology, oncology and nephrology were speakers at the annual meeting of the Italian Society of Medical Radiology (Società Italiana di Radiologia Medica e Interventistica), with the aim of commenting on existing evidence and providing their experience on the incidence and management of PC-AKI in patients with cancer. The discussion represented the basis for this white paper, which is intended to be a practical guide organised by statements describing methods to reduce renal injury risks related to CM-enhanced CT examinations in patients with cancer.
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Affiliation(s)
- Laura Cosmai
- Onconephrology Outpatients Clinic, Nephrology and Dialysis, ASST Santi Carlo e Paolo, San Paolo Hospital, Milan, Italy
| | - Camillo Porta
- Division of Translational Oncology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Carmelo Privitera
- Division of Radiology, Azienda Ospedaliero-Universitaria Policlinico Vittorio Emanuele, Catania, Italy
| | - Loreto Gesualdo
- Department of Emergency and Organ Transplantation, Nephrology, Dialysis and Transplantation Unit, University of Bari 'Aldo Moro', Bari, Italy
| | - Giuseppe Procopio
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milano, Italy
| | - Stefania Gori
- Oncologia Medica, Ospedale Don Calabria-Sacro Cuore di Negrar, Verona, Italy
| | - Andrea Laghi
- Department of Surgical and Medical Sciences and Translational Medicine, "Sapienza" University of Rome, Sant'Andrea University Hospital, Rome, Italy
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79
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Post-contrast acute kidney injury in a hospitalized population: short-, mid-, and long-term outcome and risk factors for adverse events. Eur Radiol 2020; 30:3516-3527. [PMID: 32080754 PMCID: PMC7248019 DOI: 10.1007/s00330-020-06690-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/12/2020] [Accepted: 01/29/2020] [Indexed: 12/21/2022]
Abstract
Objectives To investigate the prognosis including major adverse kidney events within 30 days (MAKE30) and 90-day and 1-year adverse outcome in hospitalized patients with post-contrast acute kidney injury (PC-AKI) to identify high-risk factors. Methods This retrospective observational study included 288 PC-AKI patients selected from 277,898 patients admitted to hospitals from January 2015 to December 2015. PC-AKI was defined according to the 2018 guideline of European Society of Urogenital Radiology. Multivariable Cox regression and logistic regression analyses were used to analyze main outcome and risk factors. Results PC-AKI patients with AKI stage ≥ 2 had much higher incidence of MAKE30 than those with AKI stage 1 (RR = 7.027, 95% CI 4.918–10.039). Persistent renal dysfunction, heart failure, central nervous system failure, baseline eGFR < 60 mL/min/1.73 m2, oliguria or anuria, blood urea nitrogen ≥ 7.14 mmol/L, respiratory failure, and shock were independent risk factors of 90-day or 1-year adverse prognosis (p < 0.05). Compared with transient renal dysfunction, PC-AKI patients with persistent renal dysfunction had a higher all-cause mortality rate (RR = 3.768, 95% CI 1.612–8.810; RR = 4.106, 95% CI 1.765–9.551) as well as combined endpoints of death, chronic kidney disease, or end-stage renal disease (OR = 3.685, 95% CI 1.628–8.340; OR = 5.209, 95% CI 1.730–15.681) within 90 days or 1 year. Conclusions PC-AKI is not always a transient, benign creatininopathy, but can result in adverse outcome. AKI stage is independently correlated to MAKE30 and persistent renal dysfunction may exaggerate the risk of long-term adverse events. Key Points • PC-AKI can result in adverse outcome such as persistent renal dysfunction, dialysis, chronic kidney disease (CKD), end-stage renal disease (ESRD), or death. • AKI stage is independently correlated to MAKE30. • Persistent renal dysfunction may exaggerate the risk of long-term adverse events. Electronic supplementary material The online version of this article (10.1007/s00330-020-06690-3) contains supplementary material, which is available to authorized users.
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80
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Davenport MS, Perazella MA, Yee J, Dillman JR, Fine D, McDonald RJ, Rodby RA, Wang CL, Weinreb JC. Use of Intravenous Iodinated Contrast Media in Patients With Kidney Disease: Consensus Statements from the American College of Radiology and the National Kidney Foundation. Kidney Med 2020; 2:85-93. [PMID: 33015613 PMCID: PMC7525144 DOI: 10.1016/j.xkme.2020.01.001] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 10/08/2019] [Accepted: 11/07/2019] [Indexed: 12/15/2022] Open
Abstract
Intravenous iodinated contrast media are commonly used with CT to evaluate disease and to determine treatment response. The risk of acute kidney injury (AKI) developing in patients with reduced kidney function following exposure to intravenous iodinated contrast media has been overstated. This is due primarily to historic lack of control groups sufficient to separate contrast-induced AKI (CI-AKI; ie, AKI caused by contrast media administration) from contrast-associated AKI (CA-AKI; ie, AKI coincident to contrast media administration). Although the true risk of CI-AKI remains uncertain for patients with severe kidney disease, prophylaxis with intravenous normal saline is indicated for patients who have AKI or an estimated glomerular filtration rate less than 30 mL/min/1.73 m2 who are not undergoing maintenance dialysis. In individual high-risk circumstances, prophylaxis may be considered in patients with an estimated glomerular filtration rate of 30-44 mL/min/1.73 m2 at the discretion of the ordering clinician.
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Affiliation(s)
- Matthew S Davenport
- Department of Radiology, Michigan Medicine, Ann Arbor, MI.,Department of Urology, Michigan Medicine, Ann Arbor, MI.,Michigan Radiology Quality Collaborative, Ann Arbor, MI.,American College of Radiology, Reston, VA
| | - Mark A Perazella
- National Kidney Foundation, New York, NY.,Section of Nephrology, Yale University School of Medicine, New Haven, CT
| | - Jerry Yee
- Department of Nephrology, Henry Ford Health System, Detroit, MI
| | - Jonathan R Dillman
- American College of Radiology, Reston, VA.,Department of Radiology, Cincinnati Children's Hospital Medical Center at University of Cincinnati College of Medicine, Cincinnati, OH
| | - Derek Fine
- National Kidney Foundation, New York, NY.,Department of Nephrology, Johns Hopkins Medicine, Baltimore, MD
| | - Robert J McDonald
- American College of Radiology, Reston, VA.,Department of Radiology, Mayo Clinic, Rochester, MN
| | - Roger A Rodby
- National Kidney Foundation, New York, NY.,Department of Nephrology, Rush University Medical Center, Chicago, IL
| | - Carolyn L Wang
- American College of Radiology, Reston, VA.,Department of Radiology, University of Washington, Seattle, WA
| | - Jeffrey C Weinreb
- American College of Radiology, Reston, VA.,Section of Nephrology, Yale University School of Medicine, New Haven, CT.,Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT
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Kim J, Silva AB, Hsu JC, Maidment PSN, Shapira N, Noël PB, Cormode DP. Radioprotective garment-inspired biodegradable polymetal nanoparticles for enhanced CT contrast production. CHEMISTRY OF MATERIALS : A PUBLICATION OF THE AMERICAN CHEMICAL SOCIETY 2020; 32:381-391. [PMID: 33005071 PMCID: PMC7523649 DOI: 10.1021/acs.chemmater.9b03931] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Numerous formulations of nanoparticle-based X-ray computed tomography (CT) contrast agents made of heavy metal elements are under investigation for their ability to provide improved CT imaging. Thus far, most experimental nanoparticle-based CT contrast agents have been developed with atoms of a single element. However, inspired by the composites formed from multiple elements used in radioprotective garments, we hypothesized that contrast agents made of several elements whose K-edge energies are spaced out in the high photon flux region could achieve high, broadband X-ray attenuation across the energies used in X-ray source spectra. Herein, we synthesized sub-5 nm core inorganic nanoparticles containing gold, tantalum, and cerium, and encapsulated them in polymeric nanoparticles to form polymetal nanoparticles (PMNP). We found that PMNP with multiple payload elements generate higher and more stable CT contrast than contrast agents made from a single contrast generating material, demonstrating the potential benefits of incorporating multiple suitable elements as CT contrast payloads.
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Affiliation(s)
- Johoon Kim
- Department of Radiology, University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Philadelphia, PA 19104, USA
- Department of Bioengineering, University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Philadelphia, PA 19104, USA
| | - Alexander B. Silva
- Department of Bioengineering, University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Philadelphia, PA 19104, USA
| | - Jessica C. Hsu
- Department of Radiology, University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Philadelphia, PA 19104, USA
- Department of Bioengineering, University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Philadelphia, PA 19104, USA
| | - Portia S. N. Maidment
- Department of Radiology, University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Philadelphia, PA 19104, USA
| | - Nadav Shapira
- Department of Radiology, University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Philadelphia, PA 19104, USA
| | - Peter B. Noël
- Department of Radiology, University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Philadelphia, PA 19104, USA
| | - David P. Cormode
- Department of Radiology, University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Philadelphia, PA 19104, USA
- Department of Bioengineering, University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Philadelphia, PA 19104, USA
- Department of Medicine, Division of Cardiovascular Medicine, University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Philadelphia, PA 19104, USA
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Schutter R, Lantinga VA, Borra RJH, Moers C. MRI for diagnosis of post-renal transplant complications: current state-of-the-art and future perspectives. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2019; 33:49-61. [PMID: 31879853 DOI: 10.1007/s10334-019-00813-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/27/2019] [Accepted: 11/30/2019] [Indexed: 02/07/2023]
Abstract
Kidney transplantation has developed into a widespread procedure to treat end stage renal failure, with transplantation results improving over the years. Postoperative complications have decreased over the past decades, but are still an important cause of morbidity and mortality. Early accurate diagnosis and treatment is the key to prevent renal allograft impairment or even graft loss. Ideally, a diagnostic tool should be able to detect post-transplant renal dysfunction, differentiate between the different causes and monitor renal function during and after therapeutic interventions. Non-invasive imaging modalities for diagnostic purposes show promising results. Magnetic resonance imaging (MRI) techniques have a number of advantages, such as the lack of ionizing radiation and the possibility to obtain relevant tissue information without contrast, reducing the risk of contrast-induced nephrotoxicity. However, most techniques still lack the specificity to distinguish different types of parenchymal diseases. Despite some promising outcomes, MRI is still barely used in the post-transplantation diagnostic process. The aim of this review is to survey the current literature on the relevance and clinical applicability of diagnostic MRI modalities for the detection of various types of complications after kidney transplantation.
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Affiliation(s)
- Rianne Schutter
- University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
| | - Veerle A Lantinga
- University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ronald J H Borra
- University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Cyril Moers
- University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Iordache AM, Docea AO, Buga AM, Zlatian O, Ciurea ME, Rogoveanu OC, Burada F, Sosoi S, Mitrut R, Mamoulakis C, Albulescu D, Vasile RC, Tsatsakis A, Calina D. Sildenafil and tadalafil reduce the risk of contrast-induced nephropathy by modulating the oxidant/antioxidant balance in a murine model. Food Chem Toxicol 2019; 135:111038. [PMID: 31825855 DOI: 10.1016/j.fct.2019.111038] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/03/2019] [Accepted: 12/04/2019] [Indexed: 12/26/2022]
Abstract
The aim of the study was to evaluate the potential protective role of sildenafil and tadalafil in contrast-induced nephropathy (CIN) by modulating oxidative stress. Thirty Wistar male rats were equally assigned into five groups: sham, CIN, CIN + sildenafil (10 mg/kg bw/day), CIN + tadalafil (5 mg/kg bw/day) and CIN + N-Acetyl Cysteine (NAC) (100 mg/kg bw/day) as a positive control. CIN was induced by 12 h dehydration and administration of indomethacin (10 mg/kg bw), N-ω- nitro-L-arginine methyl ester (10 mg/kg bw), and iopromide (3 g/kg bw iodine). Blood was drawn prior to and 24 h after CIN induction for evaluating renal function and oxidative stress. In the CIN group, total antioxidant capacity (TAC), reduced glutathione (GSH) and catalase (CAT) levels were significantly decreased; and protein carbonyl (PROTC) and thiobarbituric reactive species (TBARS) were significantly increased compared to the sham group. Pre- Sildenafil and tadalafil pre-treatment reduced CIN risk and reversed oxidative stress almost to the sham group levels. These results suggest that PDE5Is can be good candidates for preventing CIN based on their ability to modulate the oxidant/antioxidant balance.
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Affiliation(s)
- Andrei Mihai Iordache
- Department of Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, 200349, Craiova, Romania.
| | - Anca Oana Docea
- Department of Toxicology, University of Medicine and Pharmacy of Craiova, 200349, Craiova, Romania.
| | - Ana Maria Buga
- Department of Biochemistry, University of Medicine and Pharmacy of Craiova, 200349, Craiova, Romania.
| | - Ovidiu Zlatian
- Department of Microbiology, University of Medicine and Pharmacy of Craiova, 200349, Craiova, Romania.
| | - Marius Eugen Ciurea
- Department of Plastic Surgery, University of Medicine and Pharmacy of Craiova, 200349, Craiova, Romania.
| | - Otilia Constantina Rogoveanu
- Department of Physical and Rehabilitation Medicine Department, University of Medicine and Pharmacy of Craiova, 200349, Craiova, Romania.
| | - Florin Burada
- Department of Human Genomics Laboratory, University of Medicine and Pharmacy of Craiova, 200349, Craiova, Romania.
| | - Simona Sosoi
- Department of Human Genomics Laboratory, University of Medicine and Pharmacy of Craiova, 200349, Craiova, Romania.
| | - Radu Mitrut
- Department of Pathology, University of Medicine and Pharmacy of Craiova, 200349, Craiova, Romania; Department of Cardiology, University and Emergency Hospital, 050098, Bucharest, Romania.
| | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece.
| | - Dana Albulescu
- Department of Radiology, University of Medicine and Pharmacy of Craiova, 200349, Craiova, Romania.
| | - Ramona Constantina Vasile
- Department of Epidemiology and Primary Healthcare, University of Medicine and Pharmacy of Craiova, 200349, Craiova, Romania.
| | - Aristides Tsatsakis
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, Heraklion, 71003, Greece.
| | - Daniela Calina
- Department of Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, 200349, Craiova, Romania.
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Delama A, Teixeira MI, Dorati R, Genta I, Conti B, Lamprou DA. Microfluidic encapsulation method to produce stable liposomes containing iohexol. J Drug Deliv Sci Technol 2019. [DOI: 10.1016/j.jddst.2019.101340] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Abstract
Acute kidney injury (AKI) is defined by a rapid increase in serum creatinine, decrease in urine output, or both. AKI occurs in approximately 10-15% of patients admitted to hospital, while its incidence in intensive care has been reported in more than 50% of patients. Kidney dysfunction or damage can occur over a longer period or follow AKI in a continuum with acute and chronic kidney disease. Biomarkers of kidney injury or stress are new tools for risk assessment and could possibly guide therapy. AKI is not a single disease but rather a loose collection of syndromes as diverse as sepsis, cardiorenal syndrome, and urinary tract obstruction. The approach to a patient with AKI depends on the clinical context and can also vary by resource availability. Although the effectiveness of several widely applied treatments is still controversial, evidence for several interventions, especially when used together, has increased over the past decade.
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Affiliation(s)
- Claudio Ronco
- Department of Medicine, University of Padova, Padova, Italy; International Renal Research Institute of Vicenza, Vicenza, Italy; Department of Nephrology, San Bortolo Hospital, Vicenza, Italy.
| | - Rinaldo Bellomo
- Critical Care Department, Austin Hospital, Melbourne, VIC, Australia
| | - John A Kellum
- Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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