51
|
Katsiki N, Fonseca V, Mikhailidis DP. Contrast-induced acute kidney injury in diabetes mellitus: Clinical relevance and predisposing factors. Could statins be of benefit? J Diabetes Complications 2018; 32:982-984. [PMID: 30131213 DOI: 10.1016/j.jdiacomp.2018.08.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/10/2018] [Accepted: 08/05/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Niki Katsiki
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Vivian Fonseca
- Professor of Medicine and Pharmacology, Tullis Tulane Alumni Chair in Diabetes, Chief in Section of Endocrinology, Tulane University Health Sciences Center, 1430 Tulane Avenue, SL 53, New Orleans, LA 70112, USA
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK.
| |
Collapse
|
52
|
Szalat A, Perlman A, Muszkat M, Khamaisi M, Abassi Z, Heyman SN. Can SGLT2 Inhibitors Cause Acute Renal Failure? Plausible Role for Altered Glomerular Hemodynamics and Medullary Hypoxia. Drug Saf 2018; 41:239-252. [PMID: 28952138 DOI: 10.1007/s40264-017-0602-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Sodium-glucose co-transporter-2 inhibitors (SGLT2i) provide outstanding long-term cardiovascular and renal protection in high-risk patients with type 2 diabetes mellitus. Yet, despite encouraging renal safety outcomes reported in the EMPA-REG study, scattered reports suggest that there might be a risk for acute kidney injury (AKI), which may occasionally be fatal or might require renal replacement therapy. Reduced trans-glomerular pressure with a modest decline in kidney function, an inherent characteristic of SGLT2i therapy, conceivably forms the basis for the long-term renal protection, resembling agents that block the renin-angiotensin-aldosterone (RAAS) axis. Yet, a major decline in kidney function occasionally occurs, often associated with an acute illness or with specific co-administered medications. SGLT2i may lead to AKI by (a) effective volume depletion, due to excessive diuresis, particularly in hemodynamically unstable and volume-depleted patients; (b) excessive decline in trans-glomerular pressure, specifically in patients on RAAS blockade; and (c) induction of renal medullary hypoxic injury, related to enhanced distal tubular transport, especially with concomitant use of agents impairing medullary oxygenation, such as non-steroidal anti-inflammatory drugs and radiocontrast agents. The risk of developing renal impairment with SGLT2i and the role of these suggested mechanisms are yet to be defined, as there are conflicting data and inconsistent reporting with the various agents currently in use.
Collapse
Affiliation(s)
- Auryan Szalat
- Department of Medicine, Hadassah Hebrew University Hospital, Mt. Scopus, P.O. Box 24035, 91240, Jerusalem, Israel
| | - Amichai Perlman
- Department of Medicine, Hadassah Hebrew University Hospital, Mt. Scopus, P.O. Box 24035, 91240, Jerusalem, Israel
| | - Mordechai Muszkat
- Department of Medicine, Hadassah Hebrew University Hospital, Mt. Scopus, P.O. Box 24035, 91240, Jerusalem, Israel
| | - Mogher Khamaisi
- Department of Internal Medicine, Rambam Medical Center, Haifa, Israel
| | - Zaid Abassi
- Department of Physiology and Systems Biology, The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Laboratory Medicine, Rambam Health Campus, Haifa, Israel
| | - Samuel N Heyman
- Department of Medicine, Hadassah Hebrew University Hospital, Mt. Scopus, P.O. Box 24035, 91240, Jerusalem, Israel.
| |
Collapse
|
53
|
Joo C, Park E, Min JW, Kang H, Yoo DS, Jung HJ. Contrast Media-Induced Nephropathy in Patients with Unruptured Cerebral Aneurysm After Coiling Endovascular Treatment. World Neurosurg 2018; 121:e39-e44. [PMID: 30196168 DOI: 10.1016/j.wneu.2018.08.206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/24/2018] [Accepted: 08/27/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND The endovascular coiling procedure to treat cerebral aneurysms using contrast media has become more popular. However, studies of the incidence of, and risk factors for, contrast media-induced nephropathy (CIN) after coiling procedures have been limited. Thus, we evaluated the incidence and risk factors for CIN in patients who had undergone cerebral aneurysmal coiling procedures. METHODS We retrospectively reviewed the electric medical records of 380 patients who had undergone cerebral aneurysmal coiling treatment under general anesthesia. CIN was defined as an absolute increase in serum creatinine (≥0.5 mg/dL) or a relative increase (≥25%) in the baseline serum creatinine value at 48-72 hours after exposure to a contrast agent. RESULTS Elective cerebral aneurysmal coiling procedures were performed in 230 patients. Of the 230 patients, CIN developed in 13 (5.6%). The presence of diabetes mellitus (30.8% vs. 9.7%; P = 0.040) and patient age >75 years (30.8% vs. 6.5%; P = 0.012) were risk factors for CIN. CONCLUSIONS Our study has demonstrated that the incidence of CIN in patients undergoing elective cerebral aneurysmal coiling procedures is ∼6.0%. We also identified underlying diabetes mellitus and advanced age (≥75 years) as potential risk factors.
Collapse
Affiliation(s)
- Chunghee Joo
- Department of Anesthesia and Pain Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eunhye Park
- Department of Anesthesia and Pain Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joo-Won Min
- Department of Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Myongji Hospital, Seonam University College of Medicine, Goyang-si, Republic of Korea
| | - Hyun Kang
- Department of Department of Anesthesia and Pain Medicine, Chung-Ang University, College of Medicine, Seoul, Republic of Korea
| | - Do-Sung Yoo
- Department of Neurosurgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyun Ju Jung
- Department of Anesthesia and Pain Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| |
Collapse
|
54
|
Martins ALCDL, Watanabe M, Fernandes SM, Fonseca CDD, Vattimo MDFF. Diabetes Mellitus: fator de risco para toxicidade de medicamentos. Rev Esc Enferm USP 2018; 52:e03347. [DOI: 10.1590/s1980-220x2017033503347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 01/31/2018] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo Avaliar o efeito do antibiótico gentamicina em modelo experimental na presença de Diabetes Mellitus por meio da função renal e perfil oxidativo. Método Ratos Wistar, adultos, machos, foram distribuídos nos grupos: Citrato; Gentamicina (Genta), (gentamicina 100 mg/kg de peso corporal, 1 vez ao dia, intraperitoneal, i.p., 5 dias); DM (60 mg/kg de STZ, intravenosa, i.v., dose única, diluída em tampão citrato) e DM+Genta. Foram avaliados os parâmetros fisiológicos, a função renal (clearance de creatinina), a lesão oxidativa (peróxidos e substâncias reativas ao ácido tiobarbitúrico − TBARS urinários) e a hemodinâmica renal. Resultados O grupo Diabetes Mellitus apresentou hiperglicemia crônica, associada à perda de peso corporal, polifagia, polidipsia e poliúria, além de redução da função renal, com aumento na excreção de metabólitos oxidativos. A administração de gentamicina induziu a redução do fluxo sanguíneo renal e o aumento da resistência vascular renal em ratos saudáveis. A associação do Diabetes Mellitus com gentamicina resultou em redução adicional na função renal e elevação de metabólitos oxidativos, com aumento de resistência vascular renal. Conclusão A existência de Diabetes Mellitus determinou a elevação da nefrotoxicidade da gentamicina e se confirmou como fator de risco para nefrotoxicidade de medicamentos.
Collapse
Affiliation(s)
| | - Mirian Watanabe
- Universidade de São Paulo, Brasil; Universidades Metropolitanas Unidas, Brasil
| | | | | | | |
Collapse
|
55
|
Hussien NI, Sorour SM, El-Kerdasy HI, Abdelrahman BA. The glucagon-like peptide-1 receptor agonist Exendin-4, ameliorates contrast-induced nephropathy through suppression of oxidative stress, vascular dysfunction and apoptosis independent of glycaemia. Clin Exp Pharmacol Physiol 2018; 45:808-818. [PMID: 29637584 DOI: 10.1111/1440-1681.12944] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 03/22/2018] [Accepted: 04/03/2018] [Indexed: 12/22/2022]
Abstract
Contrast-induced nephropathy (CIN) is a leading cause of hospital-acquired acute kidney injury, particularly in diabetic patients. Previous studies have shown renoprotective effects of glucagon-like peptide-1 (GLP-1) signalling; however, its role in CIN remains unexplored. This study investigates the prophylactic effect of exendin-4, a GLP-1R agonist, against CIN in a rat model mimicking both healthy and diabetic conditions. Animals were randomly divided into 7 groups: a control sham group (n = 8), and 2 identical sets of 3 disease groups, one received exendin-4 before exposure to contrast medium (CM), while the other served as untreated control. The 3 disease groups represented diabetes (n = 8), CIN (n = 8), or diabetes and CIN combined (n = 8). Untreated groups showed deteriorating renal function as indicated by significantly higher levels of serum creatinine and blood urea nitrogen, malondialdehyde, and endothelin-1 and caspase-3 expression compared to the sham control group. This was accompanied by a significant decrease in tissue reserves of reduced glutathione, superoxide dismutase, nitrate and endothelin nitric oxide synthase as well as deteriorating renal histology. The CM-induced changes in diabetic rats indicate impaired renal function, oxidative stress, vascular dysfunction, and apoptosis, and were significance higher in intensity compared to non-diabetic rats. Pretreatment with exendin-4 ameliorated all the aforementioned CM-induced nephropathic effects independent of the glycemic state. To our knowledge, this is the first study describing the prophylactic renoprotective effects of exendin-4 against CIN. With the current pharmaceutical use of exendin-4 as a hypoglycaemic agent, the GLP-1R agonist becomes an interesting candidate for human clinical trials on CIN prevention.
Collapse
Affiliation(s)
- Noha I Hussien
- Department of Physiology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Safwa M Sorour
- Department of Pharmacology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Hanan I El-Kerdasy
- Department of Anatomy, Faculty of Medicine, Benha University, Benha, Egypt
| | - Bakr A Abdelrahman
- Department of Pathology, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt
| |
Collapse
|
56
|
Zhang J, Jiang Y, Rui Q, Chen M, Zhang N, Yang H, Zhou Y. Iodixanol versus iopromide in patients with renal insufficiency undergoing coronary angiography with or without PCI. Medicine (Baltimore) 2018; 97:e0617. [PMID: 29718868 PMCID: PMC6393082 DOI: 10.1097/md.0000000000010617] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The use of contrast agents during coronary angiography can result in contrast-induced nephropathy (CIN), particularly in patients with renal dysfunction. On the contrary, different contrast agents can induce different degree of changes in cardiac function. The objective of our meta-analysis was to compare the clinical safety of iso-osmolar contrast medium iodixanol to low-osmolar contrast medium iopromide in patients with renal insufficiency undergoing coronary angiography with or without percutaneous coronary intervention (PCI). METHODS We searched Medline, Embase, Cochrane Library, and reference lists to identify randomized controlled trials that compared iodixanol to iopromide with the incidence of CIN as an endpoint in renal impaired patients undergoing coronary angiography. Outcome measures were the incidence of CIN, absolute peak serum creatinine (Scr) increase from baseline and a composite of cardiovascular adverse events. RESULTS A total of 8 trials with 3532 patients were pooled; 1759 patients received iodixanol and 1773 patients received iopromide. There was no significant difference in the incidence of CIN (summary odds ratio [OR] 0.50, 95% confidence interval [CI] 0.19-1.35, P = .17) and peak Scr increase (mean difference -0.01 mg/dL, 95% CI -0.08 to 0.05, P = .69) when iodixanol was compared with iopromide. But iodixanol was associated with a statistically significant reduction in cardiovascular adverse events when compared with iopromide (OR 0.47, 95% CI 0.30-0.73, P = .0009). CONCLUSIONS Analysis of pooled data from 8 randomized controlled trials of iodixanol against iopromide in patients with renal insufficiency undergoing coronary angiography with or without PCI showed that iodixanol nonsignificantly reduced the incidence of CIN, but was associated with a significantly reduced risk of cardiovascular adverse events when compared with iopromide.
Collapse
|
57
|
Heyman SN, Khamaisi M, Abassi Z. Interacting hypoxia and endothelin in the diabetic kidney: therapeutic options. Am J Physiol Renal Physiol 2018; 314:F699-F701. [DOI: 10.1152/ajprenal.00598.2017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Samuel N. Heyman
- Department of Medicine, Hadassah Hebrew University Hospital, Mt. Scopus, Jerusalem, Israel
| | - Mogher Khamaisi
- Department of Medicine D, Rambam Health Campus and The Bruce and Ruth Rapapport Faculty of Medicine, Technion, Haifa, Israel
| | - Zaid Abassi
- Department of Physiology, The Bruce and Ruth Rapapport Faculty of Medicine, Technion, Haifa, Israel
- Department of Laboratory Medicine, Rambam Health Campus, Haifa, Israel
| |
Collapse
|
58
|
He L, Wei Q, Liu J, Yi M, Liu Y, Liu H, Sun L, Peng Y, Liu F, Venkatachalam MA, Dong Z. AKI on CKD: heightened injury, suppressed repair, and the underlying mechanisms. Kidney Int 2017; 92:1071-1083. [PMID: 28890325 DOI: 10.1016/j.kint.2017.06.030] [Citation(s) in RCA: 263] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 06/13/2017] [Accepted: 06/19/2017] [Indexed: 02/07/2023]
Abstract
Acute kidney injury (AKI) and chronic kidney disease (CKD) are interconnected. Although AKI-to-CKD transition has been intensively studied, the information of AKI on CKD is very limited. Nonetheless, AKI, when occurring in patients with CKD, is known to be more severe and difficult to recover. CKD is associated with significant changes in cell signaling in kidney tissues, including the activation of transforming growth factor-β, p53, hypoxia-inducible factor, and major developmental pathways. At the cellular level, CKD is characterized by mitochondrial dysfunction, oxidative stress, and aberrant autophagy. At the tissue level, CKD is characterized by chronic inflammation and vascular dysfunction. These pathologic changes may contribute to the heightened sensitivity of, and nonrecovery from, AKI in patients with CKD.
Collapse
Affiliation(s)
- Liyu He
- Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qingqing Wei
- Department of Cellular Biology and Anatomy, Medical College of Georgia at Augusta University and Charlie Norwood VA Medical Center, Augusta, Georgia, USA
| | - Jing Liu
- Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Department of Cellular Biology and Anatomy, Medical College of Georgia at Augusta University and Charlie Norwood VA Medical Center, Augusta, Georgia, USA
| | - Mixuan Yi
- Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Department of Cellular Biology and Anatomy, Medical College of Georgia at Augusta University and Charlie Norwood VA Medical Center, Augusta, Georgia, USA
| | - Yu Liu
- Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hong Liu
- Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lin Sun
- Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Youming Peng
- Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Fuyou Liu
- Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Manjeri A Venkatachalam
- Department of Pathology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Zheng Dong
- Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Department of Cellular Biology and Anatomy, Medical College of Georgia at Augusta University and Charlie Norwood VA Medical Center, Augusta, Georgia, USA.
| |
Collapse
|
59
|
Mamoulakis C, Tsarouhas K, Fragkiadoulaki I, Heretis I, Wilks MF, Spandidos DA, Tsitsimpikou C, Tsatsakis A. Contrast-induced nephropathy: Basic concepts, pathophysiological implications and prevention strategies. Pharmacol Ther 2017. [PMID: 28642116 DOI: 10.1016/j.pharmthera.2017.06.009] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Contrast-induced nephropathy (CIN) is reversible acute renal failure observed following administration of iodinated contrast media (CM) during angiographic or other medical procedures such as urography. There are various mechanisms through which CM develop their nephrotoxic effects, including oxidative stress and apoptosis. CIN is a real-life, albeit not very rare, entity. Exact pathophysiology remains obscure and no standard diagnostic criteria apply. The Acute Kidney Injury Network criteria was recently employed but its incidence/clinical significance warrants further clarification based on recent methodological advancements, because most published studies to date were contaminated by bias. The current study is a comprehensive review conducted to provide an overview of the basic concepts of CIN and summarize recent knowledge on its pathophysiology and the evidence supporting potential prevention strategies. CIN is expected to increase morbidity, hospital stay and mortality, while all patients scheduled to receive CM should undergo risk assessment for CIN and high-risk patients may be considered candidates for prevention strategies. The value of using compounds with antioxidant properties other than sodium bicarbonate, remains controversial, warranting further clinical investigation.
Collapse
Affiliation(s)
- Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece.
| | | | - Irini Fragkiadoulaki
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, Heraklion 71003, Greece
| | - Ioannis Heretis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece
| | - Martin F Wilks
- Swiss Centre for Applied Human Toxicology, University of Basel, CH-4055 Basel, Switzerland
| | - Demetrios A Spandidos
- Department of Virology, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Christina Tsitsimpikou
- Department of Hazardous Substances, Mixtures and Articles, General Chemical State Laboratory of Greece, Ampelokipi, Athens, Greece
| | - Aristides Tsatsakis
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, Heraklion 71003, Greece
| |
Collapse
|
60
|
Heyman SN, Khamaisi M, Rosen S, Rosenberger C, Abassi Z. Potential Hypoxic Renal Injury in Patients With Diabetes on SGLT2 Inhibitors: Caution Regarding Concomitant Use of NSAIDs and Iodinated Contrast Media. Diabetes Care 2017; 40:e40-e41. [PMID: 28130255 DOI: 10.2337/dc16-2200] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 12/26/2016] [Indexed: 02/03/2023]
Affiliation(s)
- Samuel N Heyman
- Division of Medicine, Hadassah Hebrew University Hospitals, Jerusalem, Israel
| | - Mogher Khamaisi
- Division of Internal Medicine, Rambam Health Care Campus, Haifa, Israel
| | - Seymour Rosen
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA
| | | | - Zaid Abassi
- Department of Physiology, Biophysics and Systems Biology, The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
61
|
Predictive Value of CHA2DS2-VASC Score for Contrast-Induced Nephropathy After Percutaneous Coronary Intervention for Acute Coronary Syndrome. Am J Cardiol 2017; 119:819-825. [PMID: 28040187 DOI: 10.1016/j.amjcard.2016.11.033] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 11/14/2016] [Accepted: 11/14/2016] [Indexed: 01/18/2023]
Abstract
The CHA2DS2-VASC score, used for embolic risk stratification in atrial fibrillation (AF), has been reported recently to predict adverse clinical outcomes in patients with acute coronary syndrome (ACS), regardless of having AF. We investigated the correlation between the CHA2DS2-VASC score and contrast-induced nephropathy (CIN) in patients with ACS who underwent urgent percutaneous coronary intervention (PCI). A total of 1,408 patients were enrolled in the study. The CHA2DS2-VASC score was calculated for each patient. Based on the receiver operating characteristic analysis, the study population was divided into 2 groups: CHA2DS2-VASC score ≤3 group (n = 944) and CHA2DS2-VASC score ≥4 group (n = 464). Patients were then reallocated to 2 groups according to the presence or absence of CIN. CIN was defined as a rise in serum creatinine >0.5 mg/dl or >25% increase in baseline within 72 hours after PCI. Overall, 159 cases (11.3%) of CIN were diagnosed. Receiver operating characteristic curve analysis revealed good diagnostic value of CHA2DS2-VASC score in predicting CIN (area under the curve 0.769, 95% confidence interval 0.733 to 0.805; p <0.001). When patients with a CHA2DS2-VASC score of ≥4 were compared with those with a CHA2DS2-VASC score of ≤3, patients with high score had a higher frequency of CIN (23.9% vs 5.1%; p <0.001), and multivariate analysis identified the CHA2DS2-VASC score of ≥4 as an independent predictor of CIN. In conclusion, CHA2DS2-VASC score can be used as a new, simple, and reliable tool to predict CIN in patients with ACS who underwent urgent PCI.
Collapse
|
62
|
Wang Y, Ren K, Liu Y, Sun WG, Wang JH, Zhang X, Wu CH. Application of BOLD MRI and DTI for the evaluation of renal effect related to viscosity of iodinated contrast agent in a rat model. J Magn Reson Imaging 2017; 46:1320-1331. [PMID: 28248433 DOI: 10.1002/jmri.25683] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 02/06/2017] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To evaluate the effects of viscosity of contrast agent (CA) on intrarenal oxygenation and diffusion as measured by blood oxygenation level-dependent (BOLD) magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) in a rat model. MATERIALS AND METHODS Radiocontrast iodixanol formulated in three viscosities were designated 270, 320, and 350 (mg iodine/mL). Sixty-three male Wistar rats were divided into four groups. Saline and iodixanol (4 g iodine/kg) were administered. MR images were acquired on a 3.0T scanner at baseline and at 1 hour, 24 hours, 48 hours, and 72 hours postinjection of solutions. BOLD-MRI was performed with a multiple gradient-recalled-echo sequence. The changes in R2*, apparent diffusion coefficient (ADC), fractional anisotropy (FA), histology, and hypoxia-inducible factor-1α (HIF-1α) immunoexpression were evaluated. The R2*, ADC, and FA values were normalized to baseline to calculate ΔR2*, ΔADC, and ΔFA. RESULTS Compared with baseline levels, distinct elevation of ΔR2* (P < 0.05) and obvious decrease in ΔADC (P < 0.01) and ΔFA (P < 0.05) were observed in all the anatomical compartments at 1 hour after administration of CA. The absolute values in ΔR2*, ΔADC, and ΔFA increased with increases in CA viscosity, and differed significantly between the CA groups in renal cortex (CO), outer stripe of outer medulla (OSOM), and inner stripe of outer medulla (ISOM) (all P < 0.05). A significant positive correlation was observed between ΔR2* and HIF-1α expression (P < 0.001, r = 0.75). Significant negative correlations were observed between ΔADC, ΔFA, and pathologies in CO, OSOM, ISOM (all P < 0.001, r = -0.68-0.87; all P < 0.001, r = -0.60-0.66). CONCLUSION The effect of CA viscosity on intrarenal oxygenation and diffusion was viscosity-dependent, and was identified using BOLD-MRI and DTI. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017;46:1320-1331.
Collapse
Affiliation(s)
- Yi Wang
- Department of Radiology, First Hospital of China Medical University, Shenyang, P.R. China.,Key Laboratory of Imaging Diagnosis and Interventional Radiology of Liaoning Province, Shenyang, P.R. China
| | - Ke Ren
- Department of Radiology, First Hospital of China Medical University, Shenyang, P.R. China
| | - Yi Liu
- Department of Radiology, First Hospital of China Medical University, Shenyang, P.R. China
| | - Wen-Ge Sun
- Department of Radiology, First Hospital of China Medical University, Shenyang, P.R. China
| | - Jia-Huan Wang
- Department of Radiology, First Hospital of China Medical University, Shenyang, P.R. China
| | - Xin Zhang
- Department of Radiology, First Hospital of China Medical University, Shenyang, P.R. China.,Key Laboratory of Imaging Diagnosis and Interventional Radiology of Liaoning Province, Shenyang, P.R. China
| | - Cheng-Hua Wu
- Department of Radiology, First Hospital of China Medical University, Shenyang, P.R. China.,Key Laboratory of Imaging Diagnosis and Interventional Radiology of Liaoning Province, Shenyang, P.R. China
| |
Collapse
|
63
|
Histopathological Evaluation of Contrast-Induced Acute Kidney Injury Rodent Models. BIOMED RESEARCH INTERNATIONAL 2016; 2016:3763250. [PMID: 27975052 PMCID: PMC5128699 DOI: 10.1155/2016/3763250] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/06/2016] [Accepted: 10/19/2016] [Indexed: 12/20/2022]
Abstract
Contrast-induced acute kidney injury (CI-AKI) can occur in 3–25% of patients receiving radiocontrast material (RCM) despite appropriate preventive measures. Often patients with an atherosclerotic vasculature have to receive large doses of RCM. Thus, animal studies to uncover the exact pathomechanism of CI-AKI are needed. Sensitive and specific histologic end-points are lacking; thus in the present review we summarize the histologic appearance of different rodent models of CI-AKI. Single injection of RCM causes overt renal damage only in rabbits. Rats and mice need an additional insult to the kidney to establish a clinically manifest CI-AKI. In this review we demonstrate that the concentrating ability of the kidney may be responsible for species differences in sensitivity to CI-AKI. The most commonly held theory about the pathomechanism of CI-AKI is tubular cell injury due to medullary hypoxia. Thus, the most common additional insult in rats and mice is some kind of ischemia. The histologic appearance is tubular epithelial cell (TEC) damage; however severe TEC damage is only seen if RCM is combined by additional ischemia. TEC vacuolization is the first sign of CI-AKI, as it is a consequence of RCM pinocytosis and lysosomal fusion; however it is not sensitive as it does not correlate with renal function and is not specific as other forms of TEC damage also cause vacuolization. In conclusion, histopathology alone is insufficient and functional parameters and molecular biomarkers are needed to closely monitor CI-AKI in rodent experiments.
Collapse
|
64
|
Safi W, Rauscher I, Umgelter A. Contrast-induced acute kidney injury in cirrhotic patients. A retrospective analysis. Ann Hepatol 2016; 14:895-901. [PMID: 26436362 DOI: 10.5604/16652681.1171779] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The nephrotoxic potential of intravenous iodinated contrast (IC) is controversial. Cirrhotic patients are often submitted to imaging procedures involving IC and small changes in renal function may have detrimental effects. MATERIAL AND METHODS Retrospective analysis of hospitalized patients with elective imaging by either contrast-enhanced CT or MRI. Contrast induced acute kidney injury (CI-AKI) was diagnosed if there was either an increase of SCr by 25% or by 44 μmol/L or a decrease of estimated glomerular filtration rate by 25% by day 3. RESULTS Between 2004 and 2012 152 patients (female: 30.3%, age: 60 ± 10.8 years, MELD 13 ± 6) were included in this study of which 84 (55.3%) had received IC and 68 (44,7%), who served as controls, MRI with gadolinium based contrast (non-IC). Baseline parameters were well matched except for age (61.7 vs. 56.9) years in the IC vs. non-IC groups, p = 0.005). 15 patients (17.9%) receiving IC and 4 patients (5.9%) not receiving IC (p = 0.026) reached the composite end-point for CI-AKI. In multivariable regression analysis INR [B = 0.252 (95% CI: 0.108-0.397), p = 0.001]; IC [B = 0.136 (95% CI: 0.023-0.248), p = 0.019] and serum sodium [B = 0.011 (95% CI: 0.001-0.023); p = 0.080] were independently associated with changes of SCr. In conclusion IC may cause renal dysfunction in cirrhotic patients. Patients subjected to imaging using IC should be closely monitored.
Collapse
Affiliation(s)
- Wajima Safi
- Medizinische Klinik, Klinikum rechts der Isar der Technischen Universität München
| | - Isabel Rauscher
- Nuklearmedizinische Klinik. Klinikum rechts der Isar der Technischen Universität München
| | - Andreas Umgelter
- Medizinische Klinik, Klinikum rechts der Isar der Technischen Universität München
| |
Collapse
|
65
|
Impact of Iodinated Contrast on Renal Function and Hemodynamics in Rats with Chronic Hyperglycemia and Chronic Kidney Disease. BIOMED RESEARCH INTERNATIONAL 2016; 2016:3019410. [PMID: 27034930 PMCID: PMC4789389 DOI: 10.1155/2016/3019410] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 01/26/2016] [Accepted: 02/04/2016] [Indexed: 12/19/2022]
Abstract
Iodinated contrast (IC) is clinically used in diagnostic and interventional procedures, but its use can result in contrast-induced acute kidney injury (CI-AKI). Chronic kidney disease (CKD) and chronic hyperglycemia (CH) are important predisposing factors to CI-AKI. The aim of this study was to investigate the impact of iodinated contrast on the renal function and hemodynamics in rats with chronic hyperglycemia and chronic kidney disease. A total of 30 rats were divided into six groups; Sham: control of chronic renal disease; Citrate: control of chronic hyperglycemia (CH); Nx5/6: rats with 5/6 nephrectomy; Chronic Hyperglycemia: rats receiving Streptozotocin 65 mg/kg; Nx5/6 + IC: rats Nx5/6 received 6 mL/kg of IC; CH + IC: Chronic hyperglycemia rats receiving 6 mL/kg of IC. Renal function (inulin clearance; urinary neutrophil gelatinase-associated lipocalin, NGAL) and hemodynamics (arterial blood pressure; renal blood flow; renal vascular resistance) were evaluated. Iodinated contrast significantly increased urinary NGAL and reduced inulin clearance, while the hemodynamics parameters showed changes in arterial blood pressure, renal blood flow, and renal vascular resistance in both CKD and CH groups. The results suggest that the iodinated contrast in risk factors models has important impact on renal function and hemodynamics. NGAL was confirmed to play a role of highlight in diagnosis of CI-AKI.
Collapse
|
66
|
Effect of iodinated contrast medium in diabetic rat kidneys as evaluated by blood-oxygenation-level-dependent magnetic resonance imaging and urinary neutrophil gelatinase-associated lipocalin. Invest Radiol 2016; 50:392-6. [PMID: 25668748 DOI: 10.1097/rli.0000000000000141] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The objective of this study was to assess whether streptozotocin (STZ)-induced diabetic rats develop iodinated contrast-induced acute kidney injury. The intrarenal R2* (=1/T2*) was evaluated continuously before, during, and after contrast administration. Renal injury was confirmed using urinary neutrophil gelatinase-associated lipocalin measurements. MATERIALS AND METHODS Six Sprague-Dawley rats were administered with STZ to induce diabetes (group 1). R2* was measured before, during, and after administration of iodixanol. R2* readings were sampled from 4 renal regions: inner medulla, inner stripe of outer medulla (ISOM), outer stripe of outer medulla, and cortex. Peak R2* and initial upslope of R2* increase after iodinated contrast were calculated. Data from 12 nondiabetic rats pretreated with nitric oxide synthase and prostaglandin inhibitors to induce susceptibility to contrast-induced acute kidney injury (pretreatment model) from a previous study were reanalyzed for peak R2* and initial upslope of R2* increase after contrast. Six of these animals received saline (group 2), and the other 6 received furosemide (group 3) before iodixanol. RESULTS Peak R2* and initial upslope of R2* increase were used as blood-oxygenation-level-dependent response parameters. R2* in ISOM was comparable in all 3 groups before administration of furosemide/saline. Except for the furosemide group, ISOM showed a rapid increase in R2* immediately after contrast administration. Unlike the L-NAME- and indomethacin-treated groups, the diabetic group showed a quick reversal of R2* toward baseline measurements after contrast administration. Urinary neutrophil gelatinase-associated lipocalin indicated significant increase in diabetic rats 4 hours after contrast administration. The observed trends with peak R2* and initial upslope of R2* increase in renal ISOM were in agreement with those of urinary neutrophil gelatinase-associated lipocalin. CONCLUSIONS The STZ-induced diabetic rat may be suitable for studying the effects of iodinated contrast on renal oxygenation status and may mimic human condition closer than the pretreatment model described before. The peak R2* value and initial upslope of R2* in ISOM appear to be effective magnetic resonance imaging markers to predict renal injury after administration of an iodinated contrast agent.
Collapse
|
67
|
Type 1 and type 2 diabetes mellitus and risk of acute kidney injury after coronary artery bypass grafting. Am Heart J 2015; 170:895-902. [PMID: 26542497 DOI: 10.1016/j.ahj.2015.08.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 08/14/2015] [Indexed: 01/28/2023]
Abstract
BACKGROUND Our objective was to investigate the association between type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), and acute kidney injury (AKI) in patients who underwent coronary artery bypass grafting (CABG). METHODS We included all patients (n = 36,106) from the SWEDEHEART register who underwent primary isolated CABG in Sweden from 2003 to 2013. Information on type of diabetes was retrieved from the Swedish National Diabetes Register. Acute kidney injury was defined as an absolute increase by 0.3 mg/dL (26 μmol/L) or a relative increase by at least 50% in postoperative serum creatinine compared with preoperative levels. Odds ratios with 95% CIs for AKI in patients with T1DM and T2DM were compared with those patients without diabetes using logistic regression. RESULTS In total, there were 457 patients (1.3%) with T1DM and 5124 (14%) with T2DM. Among patients with T1DM and T2DM, 145 (32%) and 1037 (20%), respectively, developed AKI, compared with 4017 (13%) in patients without diabetes. The adjusted odds ratio for AKI was 4.89 (95% CI 3.82-6.25) in patients with T1DM and 1.27 (95% CI 1.16-1.40) in patients with T2DM, in comparison with patients without diabetes. CONCLUSIONS Both T1DM and T2DM were associated with an increased risk of AKI after CABG. The risk was markedly higher in patients with T1DM than in those with T2DM and was independent of preoperative renal function.
Collapse
|
68
|
Sai Varsha M, Raman T, Manikandan R, Dhanasekaran G. Hypoglycemic action of vitamin K1 protects against early-onset diabetic nephropathy in streptozotocin-induced rats. Nutrition 2015; 31:1284-92. [DOI: 10.1016/j.nut.2015.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 04/30/2015] [Accepted: 05/09/2015] [Indexed: 01/18/2023]
|
69
|
Deng J, Wu G, Yang C, Li Y, Jing Q, Han Y. Rosuvastatin attenuates contrast-induced nephropathy through modulation of nitric oxide, inflammatory responses, oxidative stress and apoptosis in diabetic male rats. J Transl Med 2015; 13:53. [PMID: 25880311 PMCID: PMC4329210 DOI: 10.1186/s12967-015-0416-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 01/22/2015] [Indexed: 12/12/2022] Open
Abstract
Background Contrast-induced nephropathy (CIN) is an important cause of acute renal failure. We observe the effect of rosuvastatin on preventing CIN in diabetic rats in current study. Methods Diabetic rats were then divided into five groups: 1 diabetic rats (D), 2 diabetic rats + contrast media (DCM), 3 diabetic rats + rosuvastatin (DR), 4 diabetic rats + contrast media + rosuvastatin (DRCM), 5 non-diabetic rat control (NDCM). Contrast-induced nephropathy was induced by intravenous injection a single dose of indomethacin (10 mg/kg), double doses of N-nitro-L-arginine methyl ester (10 mg/kg) and a single dose of high-osmolar contrast medium meglumine amidotrizoate (6 ml/kg). DR and DRCM group rats were treated with rosuvastatin (10 mg/kg/day) by gavage for 5 days. At the end of treatment, the experimental groups were sacrificed, and their renal tissues were investigated histopathologically beside assessments of functional activities, nitric oxide metabolites, and oxidative stress and apoptic markers. Results After 6 days, serum creatinine and urine microprotein were increased, and creatinine clearance, kidney nitrite were decreased in DCM rats compared with NDCM, D, DR and DRCM groups. Histopathology scores in group DCM were increased compared with groups NDCM, D and DR, but lower in group DRCM than in group DCM (p < 0.01). Kidney thiobarbituric acid-reacting substances (TBARS), serum malondialdehyde (MDA), and serum protein carbonyl content (PCC) were increased, and serum thiol was decreased in the DCM group compared with groups NDCM, D and DR; however, these results were reversed in group DRCM compared with group DCM. Both expression of IL-6, TNF-α and the percentage of apoptotic cells were increased in group DCM than in groups NDCM, D and DR, but they were decreased in group DRCM than in group DCM. The expression of phospho-p38, cleaved capase-3, and the Bax/Bcl-2 ratio, were increased in group DCM than in groups NDCM, D and DR, but were decreased in group DRCM than in group DCM. Conclusions Our study demonstrated that rosuvastatin treatment attenuated both inflammatory processes and apoptosis and inhibited oxidative stress and the p38 MAPK pathway in a diabetic rat model in the setting of CIN.
Collapse
Affiliation(s)
- Jie Deng
- Department of Cardiology, the General Hospital of Shenyang Military Region, Chinese People's Liberation Army, Shenyang, Liaoing, China.
| | - Guijun Wu
- Department of Cardiology, the General Hospital of Shenyang Military Region, Chinese People's Liberation Army, Shenyang, Liaoing, China.
| | - Chen Yang
- Department of Cardiology, the General Hospital of Shenyang Military Region, Chinese People's Liberation Army, Shenyang, Liaoing, China.
| | - Yi Li
- Department of Cardiology, the General Hospital of Shenyang Military Region, Chinese People's Liberation Army, Shenyang, Liaoing, China.
| | - Quanmin Jing
- Department of Cardiology, the General Hospital of Shenyang Military Region, Chinese People's Liberation Army, Shenyang, Liaoing, China.
| | - Yaling Han
- Department of Cardiology, the General Hospital of Shenyang Military Region, Chinese People's Liberation Army, Shenyang, Liaoing, China.
| |
Collapse
|
70
|
Freitas SCF, Harthmann ÂD, Rodrigues B, Irigoyen MC, De Angelis K. Effect of aerobic exercise training on regional blood flow and vascular resistance in diabetic rats. Diabetol Metab Syndr 2015; 7:115. [PMID: 26697119 PMCID: PMC4687277 DOI: 10.1186/s13098-015-0109-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 12/01/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Hyperglycemia has been associated with decreased blood flow in various organs, leading to tissue damage and dysfunctions. Exercise training (ET) is known to promote beneficial changes in the autonomic nervous system and may have effects on circulation. The aim of this study was to evaluate coronary and renal blood flows and vascular resistances after ET in diabetic rats. METHODS Thirty-two rats were divided into four groups (n = 8): sedentary control (SC), trained control (TC), sedentary diabetic (SD), trained diabetic (TD). Diabetes was induced by an injection of streptozotocin (STZ, 50 mg/kg). The ET was performed on a treadmill for 10 weeks. The blood flows were measured using colored microspheres. RESULTS The diabetic groups presented hyperglycemia (blood glucose >350 mg/dL) and ET did not change this parameter. The SD group showed reduced renal blood flow when compared to SC group, and ET was able to normalize this parameter in TD rats (SC: 4.3 ± 0.5; TC: 2.9 ± 0.3; SD: 1.9 ± 0.4; TD: 3.2 ± 0.4 mL/min/g). TD group presented increased coronary blood flow in relation to SD group (SC: 2.3 ± 0.23; TC: 2.8 ± 0.5; SD: 1.2 ± 0.4; TD: 3.0 ± 0.4 mL/min/g). The heart and kidneys vascular resistance were increased in SD group when compared to SC group, and ET was able to reverse these changes. CONCLUSIONS Given the relevance of cardiomyopathy and nephropathy in mortality of diabetics, our results demonstrated that ET is effective in improving coronary and renal blood flows and vascular resistances in STZ-diabetic rats, reinforcing the positive role of this approach in preventing hyperglycemia-induced long-term organ damage.
Collapse
Affiliation(s)
- Sarah Cristina Ferreira Freitas
- />Translational Physiology Laboratory, Universidade Nove de Julho, Rua Vergueiro 235/249, 2º subsolo, São Paulo, SP 01504 001 Brazil
| | - Ângela d’Avila Harthmann
- />Hypertension Unit, Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Bruno Rodrigues
- />Departament of Adapted Physical Education, Faculty of Physical Education (FEF), University of Campinas (UNICAMP), Campinas, SP Brazil
| | - Maria-Cláudia Irigoyen
- />Hypertension Unit, Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Kátia De Angelis
- />Translational Physiology Laboratory, Universidade Nove de Julho, Rua Vergueiro 235/249, 2º subsolo, São Paulo, SP 01504 001 Brazil
| |
Collapse
|
71
|
Heung M, Koyner JL. Entanglement of Sepsis, Chronic Kidney Disease, and Other Comorbidities in Patients Who Develop Acute Kidney Injury. Semin Nephrol 2015; 35:23-37. [DOI: 10.1016/j.semnephrol.2015.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
72
|
Prevention of contrast-induced nephropathy through a knowledge of its pathogenesis and risk factors. ScientificWorldJournal 2014; 2014:823169. [PMID: 25525625 PMCID: PMC4266998 DOI: 10.1155/2014/823169] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 09/30/2014] [Indexed: 12/13/2022] Open
Abstract
Contrast-induced nephropathy (CIN) is an iatrogenic acute renal failure (ARF) occurring after the intravascular injection of iodinated radiographic contrast media. During the past several years, in many patients undergoing computed tomography, iodinated contrast media have not been used for the fear of ARF, thereby compromising the diagnostic procedure. But recent studies have demonstrated that CIN is rarely occurring in patients with normal renal function and that preexisting chronic renal failure and/or diabetes mellitus represent(s) predisposing condition(s) for its occurrence. After the description of CIN and its epidemiology and pathophysiology, underlying the important role played by dehydration and salt depletion, precautions for prevention of CIN are listed, suggested, and discussed. Maximum priority has to be given to adequate hydration and volume expansion prior to radiographic procedures. Other important precautions include the need for monitoring renal function before, during, and after contrast media injection, discontinuation of potentially nephrotoxic drugs, use of either iodixanol or iopamidol at the lowest dosage possible, and administration of antioxidants. A long list of references is provided that will enable readers a deep evaluation of the topic.
Collapse
|
73
|
Kooiman J, Gurm HS. Predicting Contrast-induced Renal Complications in the Catheterization Laboratory. Interv Cardiol Clin 2014; 3:369-377. [PMID: 28582222 DOI: 10.1016/j.iccl.2014.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Risk scores should undergo 3 analytical phases before they are suitable for adoption in clinical practice, namely, derivation, external validation, and assessment of effect on clinical outcomes of use of the risk score in a so-called impact study. Major risk factors for renal complications after percutaneous coronary intervention are pre-existing chronic kidney disease, diabetes mellitus, use of a high contrast dose, and hemodynamic instability. Unfortunately, only 3 of these 10 risk scores have undergone external validation. As a result, there is a great need for further research on the already designed risk scores.
Collapse
Affiliation(s)
- Judith Kooiman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, South Holland, The Netherlands; Department of Nephrology, Leiden University Medical Center, Leiden, South Holland, The Netherlands.
| | - Hitinder S Gurm
- Division of Cardiovascular Medicine, Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan Health System, University of Michigan Cardiovascular Center, 2A394, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5853, USA
| |
Collapse
|
74
|
Mardani S, Nasri P, Tavakoli M. Contrast induced nephropathy; recent findings. J Nephropharmacol 2013; 2:27-30. [PMID: 28197441 PMCID: PMC5297549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 06/29/2013] [Indexed: 11/08/2022] Open
Abstract
Contrast induced nephropathy is one cause of acute renal failure. Contrast induced nephropathy is the third most common cause of hospital-acquired acute renal failure. The incidence of contrast induced nephropathy in the general population is 0.6% to 2.3%, but when focusing on specific high-risk patients the incidence can increase to more than 40%. Studies suggest that intravenous hydration is the most effective strategy to prevent contrast induced nephropathy. Hydration is inexpensive and is usually risk-free. Administration of optimal fluids before and after the contrast procedure allows for increased urine output and improved outcomes.
Collapse
Affiliation(s)
- Saeed Mardani
- 1Department of Internal Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Parto Nasri
- 2School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Tavakoli
- 3Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
,Corresponding author: Maryam Tavakoli, MD, Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| |
Collapse
|