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Lyu L, Miao Y, Liu X, Dong H, Chu H, Wang X. Effect of Serum Bilirubin Levels on Contrast-induced Acute Kidney Injury: A Systematic Evaluation and Meta-analysis. Angiology 2024; 75:605-624. [PMID: 37379462 DOI: 10.1177/00033197231186493] [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: 06/30/2023]
Abstract
Contrast-induced acute kidney injury (CI-AKI) is an important complication following the use of iodinated contrast media. Bilirubin has a protective effect but may also aggravate CI-AKI. The purpose of this systematic review was to assess whether bilirubin is a risk factor for CI-AKI. We searched the databases PubMed, Embase, Web of Science, Cochrane Library, Scopus, Ovid Medline, CNKI (China National Knowledge Infrastructure), VPCS (Vip Paper Check System), Wanfang, and CBM (Chinese BioMedical Literature Database) from the initial date to May 6, 2023. We summarized the results by directly combining the effect-size odds ratio (OR) and 95% confidence interval (CI) and identified sources of heterogeneity through subgroup analysis, sensitivity analysis, and meta-regression analysis. A total of 10 studies (14 data sets) were included: 7 retrospective studies (10 data sets) and 3 prospective studies (4 data sets), involving 12776 participants. The incidence of CI-AKI of 16% (95% CI: 14-19%). Total bilirubin was positively associated with the occurrence of CI-AKI (OR = 1.80; 95% CI: 1.36-2.38). Both low and high bilirubin concentrations were risk factors for CI-AKI. The incidence of CI-AKI was higher in the low bilirubin group than in the high bilirubin group.
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Affiliation(s)
- Lin Lyu
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yuxin Miao
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xuequan Liu
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - He Dong
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Haichen Chu
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaoyu Wang
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, China
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2
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Zoccali C, Mallamaci F. Inorganic nitrate: a game changer in preventing contrast-associated acute kidney injury. Eur Heart J 2024; 45:1659-1661. [PMID: 38591523 DOI: 10.1093/eurheartj/ehae094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Affiliation(s)
- Carmine Zoccali
- Renal Research Institute, New York, USA
- Institute of Molecular Biology and Genetics (Biogem), Ariano Irpino, Italy
- Associazione Ipertensione Nefrologia Trapianto Renale (IPNET), Grande Ospedale Metropolitano, c/o Nefrologia, 89124 Reggio Calabria, Italy
| | - Francesca Mallamaci
- Nephrology, Dialysis and Transplantation Unit, Grande Ospedale Metropolitano, 89124 Reggio Calabria, Italy
- CNR-IFC, Research Unit of Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Institute of Clinical Physiology, Reggio Calabria, Italy
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Li Y, Wang J. Contrast-induced acute kidney injury: a review of definition, pathogenesis, risk factors, prevention and treatment. BMC Nephrol 2024; 25:140. [PMID: 38649939 PMCID: PMC11034108 DOI: 10.1186/s12882-024-03570-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/02/2024] [Indexed: 04/25/2024] Open
Abstract
Contrast-induced acute kidney injury (CI-AKI) has become the third leading cause of hospital-acquired AKI, which seriously threatens the health of patients. To date, the precise pathogenesis of CI-AKI has remained not clear and may be related to the direct cytotoxicity, hypoxia and ischemia of medulla, and oxidative stress caused by iodine contrast medium, which have diverse physicochemical properties, including cytotoxicity, permeability and viscosity. The latest research shows that microRNAs (miRNAs) are also involved in apoptosis, pyroptosis, and autophagy which caused by iodine contrast medium (ICM), which may be implicated in the pathogenesis of CI-AKI. Unfortunately, effective therapy of CI-AKI is very limited at present. Therefore, effective prevention of CI-AKI is of great significance, and several preventive options, including hydration, antagonistic vasoconstriction, and antioxidant drugs, have been developed. Here, we review current knowledge about the features of iodine contrast medium, the definition, pathogenesis, molecular mechanism, risk factors, prevention and treatment of CI-AKI.
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Affiliation(s)
- Yanyan Li
- Department of Pharmacy, Chongqing Traditional Chinese Medicine Hospital, 400021, Chongqing, P.R. China
| | - Junda Wang
- Department of Radiology, Chongqing Traditional Chinese Medicine Hospital, No. 6 Panxi 7 Branch Road, 400021, Chongqing, P.R. China.
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4
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Yildiz C, Yuksel Y, Efe SC, Altintas MS, Katkat F, Ayca B, Karabulut D, Çağlar FNT, Köse S. Value of systemic inflammation-response index in predicting contrast-induced nephropathy in patients with ST-elevation myocardial infarction. Acta Cardiol 2023; 78:930-936. [PMID: 37293996 DOI: 10.1080/00015385.2023.2218020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/19/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Contrast induced nephropathy (CIN) is one of the feared complications of contrast medium-using procedures. Present study was conducted in order to evaluate the value of systemic inflammatory-response index (SIRI) for development of CIN among patients who underwent primary percutaneous intervention. METHODS Six hundred seventy-six patients with the diagnosis of ST elevation myocardial infarction were included. The patients were divided into two groups according to the presence of CIN. Patients without (n = 530) and with (n = 146) CIN constituted group 0 and group 1, respectively. Clinical and biochemical features of the patients were recorded. Calculation of SIRI was made for each patient. RESULT CIN patients were older, had higher prevalence of hyperlipidaemia, higher values of pre- and post-procedural creatinine levels, neutrophil and monocyte counts, neutrophil/lymphocyte ratio (NLR) and monocyte/lymphocyte ratio (MLR) and SIRI. They had lower values of left ventricular ejection fraction (LVEF), haemoglobin and high-density lipoprotein-cholesterol levels. SIRI had the highest area under the curve (AUC) for prediction of CIN. Pairwise analyses of the AUC's demonstrated that SIRI had statistically significantly higher AUC compared to NLR and MLR. Multivariate logistic regression analysis showed that besides from LVEF and pre-procedural creatinine, NLR and SIRI were the independent predictors of CIN. SIRI had a higher odds ratio compared to NLR. CONCLUSION SIRI had greater diagnostic power than NLR and MLR and it can easily be used by physicians for the identification of high-risk patients for the occurrence of CIN.
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Affiliation(s)
- Cennet Yildiz
- Cardiology Department, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Yasin Yuksel
- Cardiology Department, Private Reyap Hospital, Istanbul, Turkey
| | - Suleyman Cagan Efe
- Cardiology Department, Kosuyolu High Specialization Education and Research Hospital, Istanbul, Turkey
| | - Mehmet Sait Altintas
- Cardiology Department, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Fahrettin Katkat
- Cardiology Department, Mehmet Akif Ersoy Training and Research Hospital, Istanbul, Turkey
| | - Burak Ayca
- Cardiology Department, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Dilay Karabulut
- Cardiology Department, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | | | - Sennur Köse
- Department of Nephrology, Istanbul Training and Education Hospital, Istanbul, Turkey
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5
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Ma M, Wan X, Chen Y, Lu Z, Guo D, Kong H, Pan B, Zhang H, Chen D, Xu D, Sun D, Lang H, Zhou C, Li T, Cao C. A novel explainable online calculator for contrast-induced AKI in diabetics: a multi-centre validation and prospective evaluation study. J Transl Med 2023; 21:517. [PMID: 37525240 PMCID: PMC10391987 DOI: 10.1186/s12967-023-04387-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 07/24/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND In patients undergoing percutaneous coronary intervention (PCI), contrast-induced acute kidney injury (CIAKI) is a frequent complication, especially in diabetics, and is connected with severe mortality and morbidity in the short and long term. Therefore, we aimed to develop a CIAKI predictive model for diabetic patients. METHODS 3514 patients with diabetes from four hospitals were separated into three cohorts: training, internal validation, and external validation. We developed six machine learning (ML) algorithms models: random forest (RF), gradient-boosted decision trees (GBDT), logistic regression (LR), least absolute shrinkage and selection operator with LR, extreme gradient boosting trees (XGBT), and support vector machine (SVM). The area under the receiver operating characteristic curve (AUC) of ML models was compared to the prior score model, and developed a brief CIAKI prediction model for diabetes (BCPMD). We also validated BCPMD model on the prospective cohort of 172 patients from one of the hospitals. To explain the prediction model, the shapley additive explanations (SHAP) approach was used. RESULTS In the six ML models, XGBT performed best in the cohort of internal (AUC: 0.816 (95% CI 0.777-0.853)) and external validation (AUC: 0.816 (95% CI 0.770-0.861)), and we determined the top 15 important predictors in XGBT model as BCPMD model variables. The features of BCPMD included acute coronary syndromes (ACS), urine protein level, diuretics, left ventricular ejection fraction (LVEF) (%), hemoglobin (g/L), congestive heart failure (CHF), stable Angina, uric acid (umol/L), preoperative diastolic blood pressure (DBP) (mmHg), contrast volumes (mL), albumin (g/L), baseline creatinine (umol/L), vessels of coronary artery disease, glucose (mmol/L) and diabetes history (yrs). Then, we validated BCPMD in the cohort of internal validation (AUC: 0.819 (95% CI 0.783-0.855)), the cohort of external validation (AUC: 0.805 (95% CI 0.755-0.850)) and the cohort of prospective validation (AUC: 0.801 (95% CI 0.688-0.887)). SHAP was constructed to provide personalized interpretation for each patient. Our model also has been developed into an online web risk calculator. MissForest was used to handle the missing values of the calculator. CONCLUSION We developed a novel risk calculator for CIAKI in diabetes based on the ML model, which can help clinicians achieve real-time prediction and explainable clinical decisions.
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Affiliation(s)
- Mengqing Ma
- Department of Nephrology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, 211166, Jiangsu, China
| | - Xin Wan
- Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, Jiangsu, China
| | - Yuyang Chen
- Department of Nephrology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, 211166, Jiangsu, China
| | - Zhichao Lu
- Department of Computer Science and Technology, Nanjing University, Nanjing, 210023, Jiangsu, China
| | - Danning Guo
- Department of Nephrology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, 211166, Jiangsu, China
| | - Huiping Kong
- Department of Nephrology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, 211166, Jiangsu, China
| | - Binbin Pan
- Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, Jiangsu, China
| | - Hao Zhang
- Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, Jiangsu, China
| | - Dawei Chen
- Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, Jiangsu, China
| | - Dongxu Xu
- Department of Cardiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, 211166, Jiangsu, China
| | - Dong Sun
- Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Hong Lang
- Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Changgao Zhou
- Department of Cardiology, Affiliated Shu Yang Hospital of Nanjing University of Chinese Medicine, Shuyang, 223600, Jiangsu, China
| | - Tao Li
- Department of Cardiology, Affiliated Shu Yang Hospital of Nanjing University of Chinese Medicine, Shuyang, 223600, Jiangsu, China
| | - Changchun Cao
- Department of Nephrology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, 211166, Jiangsu, China.
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Ling Y, He Y, Guo W, Zhang R, Zhao Y, Yu S, Huang Z, Li Q, Huang H, Liu J, Liu Y, Chen J. Association of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and acute kidney disease in patients undergoing coronary angiography: a cohort study. Int Urol Nephrol 2023:10.1007/s11255-023-03491-7. [PMID: 36820946 DOI: 10.1007/s11255-023-03491-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 01/25/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Acute kidney disease (AKD) following coronary angiography (CAG) indicates a higher risk of chronic kidney disease and follow-up cardiovascular comorbidities. However, the predictive risk factor of AKD is not clear. We sought to verify whether preoperative N-terminal pro-B-type natriuretic peptide (NT-proBNP) level was associated with AKD in patients undergoing CAG. METHOD We analyzed 7602 patients underwent CAG in this multi-center registry cohort study. Cardiorenal ImprovemeNt II (CIN-II) in five Chinese tertiary hospitals from 2007 to 2020. The primary outcome was AKD, defined as a ≥ 50% increase of serum creatinine within 7-90 days. Multivariable logistic regressions were used to assess the association between NT-proBNP and AKD. RESULT 1009 patients (13.27%) eventually developed AKD, who were more likely to be female, older, and with comorbidities of chronic heart failure and anemia. After adjusting to the potential confounders, the NT-proBNP level remained an independent predictor of AKD (lnNT-proBNP OR: 1.20, 95% CI 1.13-1.28, p < 0.005). Restricted cubic spline analysis demonstrated a linear relationship between elevated NT-proBNP and AKD (p for trend < 0.001). In the subgroup analysis, elevated NT-proBNP level in patients with percutaneous coronary intervention (p for interaction < 0.001) or without previous congestive heart failure (p for interaction = 0.0346) has a more significant value of AKD prediction. CONCLUSION Pre-operative NT-proBNP level was independently associated with the risk of AKD in patients following CAG. Perioperative strategies are warranted to prevent AKD in patients with elevated NT-proBNP levels.
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Affiliation(s)
- Yihang Ling
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.,Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Yibo He
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Wei Guo
- Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Rongting Zhang
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China
| | - Yukun Zhao
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China
| | - Sijia Yu
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Zhidong Huang
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Qiang Li
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Haozhang Huang
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Jin Liu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Yong Liu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China. .,Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
| | - Jiyan Chen
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China. .,Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China. .,Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
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Wang B, Wang Y, Tan Y, Guo J, Chen H, Wu PY, Wang X, Zhang H. Assessment of Fasudil on Contrast-Associated Acute Kidney Injury Using Multiparametric Renal MRI. Front Pharmacol 2022; 13:905547. [PMID: 35784704 PMCID: PMC9242620 DOI: 10.3389/fphar.2022.905547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 05/31/2022] [Indexed: 11/25/2022] Open
Abstract
Aims: To evaluate the utility of fasudil in a rat model of contrast-associated acute kidney injury (CA-AKI) and explore its underlying mechanism through multiparametric renal magnetic resonance imaging (mpMRI). Methods: Experimental rats (n = 72) were grouped as follows: controls (n = 24), CA-AKI (n = 24), or CA-AKI + Fasudil (n = 24). All animals underwent two mpMRI studies (arterial spin labeling, T1 and T2 mapping) at baseline and post iopromide/fasudil injection (Days 1, 3, 7, and 13 respectively). Relative change in renal blood flow (ΔRBF), T1 (ΔT1) and T2 (ΔT2) values were assessed at specified time points. Serum levels of cystatin C (CysC) and interleukin-1β (IL-1β), and urinary neutrophil gelatinase-associated lipocalin (NGAL) concentrations were tested as laboratory biomarkers, in addition to examining renal histology and expression levels of various proteins (Rho-kinase [ROCK], α-smooth muscle actin [α-SMA]), hypoxia-inducible factor-1α (HIF-1α), and transforming growth factor-β1 (TGF-β1) that regulate renal fibrosis and hypoxia. Results: Compared with the control group, serum levels of CysC and IL-1β, and urinary NGAL concentrations were clearly increased from Day 1 to Day 13 in the CA-AKI group (all p < 0.05). There were significant reductions in ΔT2 values on Days 1 and 3, and ΔT1 reductions were significantly more pronounced at all time points (Days 1–13) in the CA-AKI + Fasudil group (vs. CA-AKI) (all p < 0.05). Fasudil treatment lowered expression levels of ROCK-1, and p-MYPT1/MYPT1 proteins induced by iopromide, decreasing TGF-β1 expression and suppressing both extracellular matrix accumulation and α-SMA expression relative to untreated status (all p < 0.05). Fasudil also enhanced PHD2 transcription and inhibition of HIF-1α expression after CA-AKI. Conclusions: In the context of CA-AKI, fasudil appears to reduce renal hypoxia, fibrosis, and dysfunction by activating (Rho/ROCK) or inhibiting (TGF-β1, HIF-1α) certain signaling pathways and reducing α-SMA expression. Multiparametric MRI may be a viable noninvasive tool for monitoring CA-AKI pathophysiology during fasudil therapy.
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Affiliation(s)
- Bin Wang
- Department of Medical Imaging, First Hospital of Shanxi Medical University, Taiyuan, China
- Department of Medical Imaging, Shanxi Medical University, Taiyuan, China
| | - Yongfang Wang
- Department of Medical Imaging, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yan Tan
- Department of Medical Imaging, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Jinxia Guo
- GE Healthcare MR Research China, Beijing, China
| | - Haoyuan Chen
- Department of Medical Imaging, Shanxi Medical University, Taiyuan, China
| | - Pu-Yeh Wu
- GE Healthcare MR Research China, Beijing, China
| | - Xiaochun Wang
- Department of Medical Imaging, First Hospital of Shanxi Medical University, Taiyuan, China
- *Correspondence: Xiaochun Wang, ; Hui Zhang,
| | - Hui Zhang
- Department of Medical Imaging, First Hospital of Shanxi Medical University, Taiyuan, China
- *Correspondence: Xiaochun Wang, ; Hui Zhang,
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Malpani R, Petty CW, Bhatt N, Staib LH, Chapiro J. Use of Artificial Intelligence in Non-Oncologic Interventional Radiology: Current State and Future Directions. DIGESTIVE DISEASE INTERVENTIONS 2021; 5:331-337. [PMID: 35005333 PMCID: PMC8740955 DOI: 10.1055/s-0041-1726300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The future of radiology is disproportionately linked to the applications of artificial intelligence (AI). Recent exponential advancements in AI are already beginning to augment the clinical practice of radiology. Driven by a paucity of review articles in the area, this article aims to discuss applications of AI in non-oncologic IR across procedural planning, execution, and follow-up along with a discussion on the future directions of the field. Applications in vascular imaging, radiomics, touchless software interactions, robotics, natural language processing, post-procedural outcome prediction, device navigation, and image acquisition are included. Familiarity with AI study analysis will help open the current 'black box' of AI research and help bridge the gap between the research laboratory and clinical practice.
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Affiliation(s)
- Rohil Malpani
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar Street, New Haven, CT 06520, USA
| | - Christopher W. Petty
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar Street, New Haven, CT 06520, USA
| | - Neha Bhatt
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar Street, New Haven, CT 06520, USA
| | - Lawrence H. Staib
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar Street, New Haven, CT 06520, USA
| | - Julius Chapiro
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar Street, New Haven, CT 06520, USA
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Abstract
The nephrotoxicity of iodinated contrast agent/media is defined by acute renal failure occurring within 48 to 72 hours after injection of iodized contrast product, in the absence of other etiology. The risk factors for contrast agent renal injury must systematically be sought before the exam. The presence of risk factors, including the existence of a renal failure defined by a creatinine clearance (eGFR) of less than 60 mL/min/1.73 m2, requires to take prevention measures including hydration. If eGFR is less than 30 mL/min/1.73 m2, the advice of a nephrologist is necessary.
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Affiliation(s)
- Évangeline Pillebout
- Service de néphrologie-transplantation, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France.
| | - Frank Martinez
- Service de transplantation, hôpital Necker, 149, rue de Sèvre, 75015 Paris, France
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10
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Abstract
Radiological procedures utilizing intravenous iodinated contrast agents are being widely utilized for both therapeutic and diagnostic purposes. This has resulted in an increasing incidence of procedure-related, contrast-induced nephropathy (CIN). CIN is commonly defined as a decline in kidney function occurring in a narrow time window after administration of iodinated contrast agents. Although self-limiting in most cases, CIN carries a risk of more permanent renal insufficiency, dialysis, and death. It remains a common and serious complication among at-risk patients after exposure of contrast agents. Therefore, it is important to identify patients who are at risk during early stages to implement preventative strategies to decrease the incidence of CIN. Minimizing the amount of contrast administered and providing adequate hydration are the cornerstones of an effective preventative approach. This review focuses on the basic concepts of CIN and summarizes the current understanding of its pathophysiology. In addition, it provides practical recommendations with respect to CIN prevention and management.
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Affiliation(s)
- Elham Shams
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | - Harvey N Mayrovitz
- Medical Education, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Davie, USA
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11
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Kord A, Park SJ, Rao A, Eppurath A, Lipnik A, Ray CE. Postcontrast Acute Kidney Injury After Transarterial Chemoembolization. Semin Intervent Radiol 2021; 38:139-143. [PMID: 33883811 PMCID: PMC8049752 DOI: 10.1055/s-0041-1724016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Ali Kord
- Division of Interventional Radiology, Department of Radiology, University of Illinois College of Medicine, Chicago, Illinois
| | - Simon J. Park
- Division of Interventional Radiology, Department of Radiology, University of Illinois College of Medicine, Chicago, Illinois
| | - Amith Rao
- Division of Interventional Radiology, Department of Radiology, University of Illinois College of Medicine, Chicago, Illinois
| | - Atul Eppurath
- Division of Interventional Radiology, Department of Radiology, University of Illinois College of Medicine, Chicago, Illinois
| | - Andrew Lipnik
- Division of Interventional Radiology, Department of Radiology, University of Illinois College of Medicine, Chicago, Illinois
| | - Charles E. Ray
- Division of Interventional Radiology, Department of Radiology, University of Illinois College of Medicine, Chicago, Illinois
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12
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Kusirisin P, Chattipakorn SC, Chattipakorn N. Contrast-induced nephropathy and oxidative stress: mechanistic insights for better interventional approaches. J Transl Med 2020; 18:400. [PMID: 33081797 PMCID: PMC7576747 DOI: 10.1186/s12967-020-02574-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/14/2020] [Indexed: 12/17/2022] Open
Abstract
Contrast-induced nephropathy (CIN) or contrast-induced acute kidney injury (CI-AKI) is an iatrogenic acute kidney injury observed after intravascular administration of contrast media for intravascular diagnostic procedures or therapeutic angiographic intervention. High risk patients including those with chronic kidney disease (CKD), diabetes mellitus with impaired renal function, congestive heart failure, intraarterial intervention, higher volume of contrast, volume depletion, old age, multiple myeloma, hypertension, and hyperuricemia had increased prevalence of CIN. Although CIN is reversible by itself, some patients suffer this condition without renal recovery leading to CKD or even end-stage renal disease which required long term renal replacement therapy. In addition, both CIN and CKD have been associated with increasing of mortality. Three pathophysiological mechanisms have been proposed including direct tubular toxicity, intrarenal vasoconstriction, and excessive production of reactive oxygen species (ROS), all of which lead to impaired renal function. Reports from basic and clinical studies showing potential preventive strategies for CIN pathophysiology including low- or iso-osmolar contrast media are summarized and discussed. In addition, reports on pharmacological interventions to reduce ROS and attenuate CIN are summarized, highlighting potential for use in clinical practice. Understanding this contributory mechanism could pave ways to improve therapeutic strategies in combating CIN.
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Affiliation(s)
- Prit Kusirisin
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
| | - Siriporn C Chattipakorn
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
| | - Nipon Chattipakorn
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand.
- Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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13
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Wei W, Ma N, Fan X, Yu Q, Ci X. The role of Nrf2 in acute kidney injury: Novel molecular mechanisms and therapeutic approaches. Free Radic Biol Med 2020; 158:1-12. [PMID: 32663513 DOI: 10.1016/j.freeradbiomed.2020.06.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/24/2020] [Accepted: 06/11/2020] [Indexed: 12/13/2022]
Abstract
Acute kidney injury (AKI) is a common clinical syndrome that is related to high morbidity and mortality. Oxidative stress, including the production of reactive oxygen species (ROS), appears to be the main element in the occurrence of AKI and the cause of the progression of chronic kidney disease (CKD) into end-stage renal disease (ESRD). Nuclear factor erythroid 2 related factor 2 (Nrf2) is a significant regulator of redox balance that has been shown to improve kidney disease by eliminating ROS. To date, researchers have found that the use of Nrf2-activated compounds can effectively reduce ROS, thereby preventing or retarding the progression of various types of AKI. In this review, we summarized the molecular mechanisms of Nrf2 and ROS in AKI and described the latest findings on the therapeutic potential of Nrf2 activators in various types of AKI.
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Affiliation(s)
- Wei Wei
- Department of Urology, The First Hospital, Jilin University, Changchun, China
| | - Ning Ma
- Department of Urology, The First Hospital, Jilin University, Changchun, China
| | - Xiaoye Fan
- Institute of Translational Medicine, The First Hospital of Jilin University, Changchun, China
| | - Qinlei Yu
- Jilin Provincial Animal Disease Control Center, 4510 Xi'an Road, Changchun, 130062, China
| | - Xinxin Ci
- Institute of Translational Medicine, The First Hospital of Jilin University, Changchun, China.
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14
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Javanbakht M, Hemami MR, Mashayekhi A, Branagan-Harris M, Zaman A, Al-Najjar Y, O'Donoghue D, Fath-Ordoubadi F, Wheatcroft S. DyeVert™ PLUS EZ System for Preventing Contrast-Induced Acute Kidney Injury in Patients Undergoing Diagnostic Coronary Angiography and/or Percutaneous Coronary Intervention: A UK-Based Cost-Utility Analysis. PHARMACOECONOMICS - OPEN 2020; 4:459-472. [PMID: 31989464 PMCID: PMC7426357 DOI: 10.1007/s41669-020-00195-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Contrast-induced acute kidney injury (CI-AKI) is a complication commonly associated with invasive angiographic procedures and is considered the leading cause of hospital-acquired acute kidney injury. CI-AKI can lead to a prolonged hospital stay, with a substantial economic impact, and increased mortality. The DyeVert™ PLUS EZ system (FDA approved and CE marked) is a device that has been developed to divert a portion of the theoretical injected contrast media volume (CMV), reducing the overall volume of contrast media injected and aortic reflux, and potentially improving long-term health outcomes. OBJECTIVES To assess the long-term costs and health outcomes associated with the introduction of the DyeVert™ PLUS EZ system into the UK health care service for the prevention of CI-AKI in a cohort of patients with chronic kidney disease (CKD) stage 3-4 undergoing diagnostic coronary angiography (DAG) and/or percutaneous coronary intervention (PCI), and to compare these costs and outcomes with those of the current practice. METHODS A de novo economic model was developed based on the current pathway of managing patients undergoing DAG and/or PCI and on evidence related to the clinical effectiveness of DyeVert™ in terms of its impact on relevant clinical outcomes and health service resource use. Clinical data used to populate the model were derived from the literature or were based on assumptions informed by expert clinical input. Costs included in the model were from the NHS and personal social services perspective and obtained from the literature and UK-based routine sources. Probabilistic distributions were assigned to the majority of model parameters so that a probabilistic analysis could be undertaken, while deterministic sensitivity analyses were also carried out to explore the impact of key parameter variation on the model results. RESULTS Base-case results indicate that the intervention leads to cost savings (- £435) and improved effectiveness (+ 0.028 QALYs) over the patient's lifetime compared with current practice. Output from the probabilistic analysis points to a high likelihood of the intervention being cost-effective across presented willingness-to-pay (WTP) thresholds. The overall long-term cost saving for the NHS associated with the introduction of the DyeVert™ PLUS EZ system is over £19.7 million for each annual cohort of patients. The cost savings are mainly driven by a lower risk of subsequent diseases and their associated costs. CONCLUSIONS The introduction of the DyeVert™ PLUS EZ system has the potential to reduce costs for the health care service and yield improved clinical outcomes for patients with CKD stage 3-4 undergoing angiographic procedures.
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Affiliation(s)
- Mehdi Javanbakht
- Optimax Access UK Ltd, Market Access Consultancy, Southampton, UK.
- Device Access UK Ltd, Market Access Consultancy, University of Southampton Science Park, Kenneth Dibben House, Enterprise Rd, Southampton Science Park, Southampton, Hampshire, SO16 7NS, UK.
| | | | - Atefeh Mashayekhi
- Optimax Access UK Ltd, Market Access Consultancy, Southampton, UK
- Device Access UK Ltd, Market Access Consultancy, University of Southampton Science Park, Kenneth Dibben House, Enterprise Rd, Southampton Science Park, Southampton, Hampshire, SO16 7NS, UK
| | - Michael Branagan-Harris
- Device Access UK Ltd, Market Access Consultancy, University of Southampton Science Park, Kenneth Dibben House, Enterprise Rd, Southampton Science Park, Southampton, Hampshire, SO16 7NS, UK
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15
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Cardoso PMM, Mazuco RA, Macedo LSD, Polese AAV, Barroso MEDS, Baratella WG, Andrade TUD, Lenz D, Pereira TDMC, Endringer DC. Nephroprotective activity of the enriched polyphenol extract of Euterpe edulis Martius. BRAZ J PHARM SCI 2020. [DOI: 10.1590/s2175-97902019000318051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | - Thiago de Melo Costa Pereira
- Universidade Vila Velha, Brazil; Federal Institute of Education, Science and Technology of Espírito Santo, Brazil
| | - Denise Coutinho Endringer
- Universidade Vila Velha, Brazil; Federal Institute of Education, Science and Technology of Espírito Santo, Brazil
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16
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Xia Q, Liu C, Zheng X. N-acetylcysteine ameliorates contrast‑induced kidney injury in rats with unilateral hydronephrosis. Mol Med Rep 2017; 17:2203-2210. [PMID: 29207099 PMCID: PMC5783464 DOI: 10.3892/mmr.2017.8122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 09/21/2017] [Indexed: 12/15/2022] Open
Abstract
The aim of the present study was to investigate the protective effects of N-acetylcysteine (NAC) on contrast-induced acute kidney injury in rats with unilateral hyronephrosis. Eighty-two male Sprague Dawley rats were randomized to undergo sham operation (n=14) or unilateral ureteral obstruction (UUO) (n=68). After 3 weeks, the UUO animals were randomized to three groups: NAC gastric perfusion, UUO+iohexol+NAC (n=24); normal saline perfusion, UUO+iohexol (n=24); and controls, UUO (n=20). After 3 days, UUO+iohexol+NAC and UUO+iohexol rats were injected with iohexol. One day after contrast, half of the rats were sacrificed to assess the pathological changes to the kidneys, serum creatinine, serum neutrophil gelatinase-associated lipocalin (NGAL), renal cell apoptosis rate and expression of apoptosis regulators Bcl-2/Bax. The remaining rats underwent obstruction relief and were analyzed 3 weeks later. Compared with the controls, serum NGAL levels were high in UUO+iohexol rats 1 day following injection and 3 weeks after obstruction relief, but UUO+iohexol+NAC rats exhibited lower serum NGAL levels compared with UUO+iohexol rats (all P<0.05). Following modeling, UUO+iohexol rats exhibited a significantly higher apoptosis rate of renal tubular cells, higher expression of Bax mRNA, and lower ratio of Bcl-2/Bax (all P<0.05). Three weeks after obstruction relief, UUO+iohexol+NAC rats exhibited a lower apoptosis rate, lower Bax mRNA expression, higher expression of Bcl-2 mRNA and higher ratio of Bcl-2/Bax (all P<0.05) compared with day 1 following drug administration. The prophylactic use of NAC reduced the apoptotic rate of renal tubular cells following contrast exposition, which was accompanied by changes in the expression of Bcl-2/Bax mRNA.
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Affiliation(s)
- Qiang Xia
- Department of Urology, Wuxi Ninth People's Hospital, Wuxi, Jiangsu 214062, P.R. China
| | - Chunxiao Liu
- Department of Urology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong 510280, P.R. China
| | - Xia Zheng
- Department of Comparative Medicine, Guangdong Medical Laboratory Animal Center, Foshan, Guangdong 528248, P.R. China
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17
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Mattathil S, Ghumman S, Weinerman J, Prasad A. Use of the RenalGuard system to prevent contrast-induced AKI: A meta-analysis. J Interv Cardiol 2017; 30:480-487. [DOI: 10.1111/joic.12417] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 07/19/2017] [Accepted: 07/19/2017] [Indexed: 01/09/2023] Open
Affiliation(s)
- Stephanie Mattathil
- Department of Medicine; Division of Cardiology; University of Texas Health Science Center at San Antonio; San Antonio Texas
| | - Saad Ghumman
- Department of Medicine; Division of Cardiology; University of Texas Health Science Center at San Antonio; San Antonio Texas
| | - Jonathan Weinerman
- Department of Medicine; Division of Cardiology; University of Texas Health Science Center at San Antonio; San Antonio Texas
| | - Anand Prasad
- Department of Medicine; Division of Cardiology; University of Texas Health Science Center at San Antonio; San Antonio Texas
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18
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Cho MH, Kim SN, Park HW, Chung S, Kim KS. Could Vitamin E Prevent Contrast-Induced Acute Kidney Injury? A Systematic Review and Meta-Analysis. J Korean Med Sci 2017; 32:1468-1473. [PMID: 28776342 PMCID: PMC5546966 DOI: 10.3346/jkms.2017.32.9.1468] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 06/03/2017] [Indexed: 11/20/2022] Open
Abstract
Several clinical studies have proposed a protective role for vitamin E (α-tocopherol) against contrast-induced acute kidney injury (CIAKI). The aim of study was to assess the effects of vitamin E for the prevention of CIAKI. A systematic review and meta-analysis was conducted using MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials. Randomized controlled trials (RCTs) reporting the effects of vitamin E on CIAKI development and measurements of renal function were included. Four trials including 623 participants were analyzed in the meta-analysis. All participants received intravenous hydration in addition to vitamin E or placebo. The incidence of the vitamin E group (5.8%) was lower than that of the control group (15.4%). Compared with the control, vitamin E significantly reduced the risk ratio (RR) of CIAKI by 62% (0.38; 95% confidence interval [CI], 0.22, 0.63; P < 0.010). In addition, vitamin E reduced serum creatinine (SCr) increase after contrast administration (standardized mean difference [SMD], -0.27; 95% CI, -0.49, -0.06; P = 0.010). However, changes in glomerular filtration rate (GFR) after contrast administration were not significantly different between vitamin E and the control group (SMD, 0.21; 95% CI, -0.01, 0.43; P = 0.060). Heterogeneity within the available trials was not observed. Our meta-analysis provides evidence that vitamin E plus hydration significantly reduced the risk of CIAKI in patients with renal impairment compared with hydration alone.
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Affiliation(s)
- Myung Hyun Cho
- Department of Pediatrics, Konkuk University Medical Center, Seoul, Korea
| | - Soo Nyung Kim
- Department of Obstetrics and Gynecology, Konkuk University Medical Center, Seoul, Korea
- Department of Pediatrics, Konkuk University School of Medicine, Seoul, Korea
| | - Hye Won Park
- Department of Pediatrics, Konkuk University Medical Center, Seoul, Korea
- Department of Pediatrics, Konkuk University School of Medicine, Seoul, Korea
| | - Sochung Chung
- Department of Pediatrics, Konkuk University Medical Center, Seoul, Korea
- Department of Pediatrics, Konkuk University School of Medicine, Seoul, Korea
| | - Kyo Sun Kim
- Department of Pediatrics, Konkuk University Medical Center, Seoul, Korea
- Department of Pediatrics, Konkuk University School of Medicine, Seoul, Korea.
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19
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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.
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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
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20
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Relaxin Attenuates Contrast-Induced Human Proximal Tubular Epithelial Cell Apoptosis by Activation of the PI3K/Akt Signaling Pathway In Vitro. BIOMED RESEARCH INTERNATIONAL 2017; 2017:2869405. [PMID: 28540295 PMCID: PMC5429925 DOI: 10.1155/2017/2869405] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/22/2017] [Accepted: 03/26/2017] [Indexed: 12/29/2022]
Abstract
Background. Contrast-induced acute kidney injury (CI-AKI) is one of the main causes of iatrogenic acute kidney injury (AKI); however, therapeutic strategies for AKI remain limited. This study aims to explore the effect of relaxin (RLX) on contrast-induced HK-2 apoptosis and its underlying mechanisms. Methods. Renal tubular epithelial cells (HK-2) were incubated either with or without ioversol, human H2 relaxin, and LY294002 (the inhibitor of the PI3K/Akt signal pathway). Cell viability was evaluated with a CCK-8 assay. Apoptotic morphologic alterations were observed using the Hoechst 33342 staining method. Apoptosis was detected with Annexin V staining. Western blot analysis was employed to measure the expression of pAkt (S473), Akt, cleaved caspase-3, Bcl-2, Bax, and actin proteins. Results. Ioversol reduced the viability of HK-2 cells. Western blotting results revealed decreased expression of phosphorylated Akt in cells treated with ioversol. The activities of caspase-3 and Bax protein increased, while the expression of Bcl-2 protein decreased. As a result, the Bax/Bcl-2 ratio increased after treatment with ioversol. These effects were reversed when HK-2 cells were cotreated with RLX. However, with preadministration of PI3K/Akt pathway inhibitor LY294002, the effect of RLX was blocked. Conclusion. Our study demonstrates that relaxin attenuates ioversol induced cell apoptosis via activation of the PI3K/Akt signaling pathway, suggesting that RLX might play a protective role in the treatment of CI-AKI.
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21
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Ichai C, Vinsonneau C, Souweine B, Armando F, Canet E, Clec’h C, Constantin JM, Darmon M, Duranteau J, Gaillot T, Garnier A, Jacob L, Joannes-Boyau O, Juillard L, Journois D, Lautrette A, Muller L, Legrand M, Lerolle N, Rimmelé T, Rondeau E, Tamion F, Walrave Y, Velly L. Acute kidney injury in the perioperative period and in intensive care units (excluding renal replacement therapies). Ann Intensive Care 2016; 6:48. [PMID: 27230984 PMCID: PMC4882312 DOI: 10.1186/s13613-016-0145-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 04/19/2016] [Indexed: 12/17/2022] Open
Abstract
Acute kidney injury (AKI) is a syndrome that has progressed a great deal over the last 20 years. The decrease in urine output and the increase in classical renal biomarkers, such as blood urea nitrogen and serum creatinine, have largely been used as surrogate markers for decreased glomerular filtration rate (GFR), which defines AKI. However, using such markers of GFR as criteria for diagnosing AKI has several limits including the difficult diagnosis of non-organic AKI, also called "functional renal insufficiency" or "pre-renal insufficiency". This situation is characterized by an oliguria and an increase in creatininemia as a consequence of a reduction in renal blood flow related to systemic haemodynamic abnormalities. In this situation, "renal insufficiency" seems rather inappropriate as kidney function is not impaired. On the contrary, the kidney delivers an appropriate response aiming to recover optimal systemic physiological haemodynamic conditions. Considering the kidney as insufficient is erroneous because this suggests that it does not work correctly, whereas the opposite is occurring, because the kidney is healthy even in a threatening situation. With current definitions of AKI, normalization of volaemia is needed before defining AKI in order to avoid this pitfall.
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Affiliation(s)
- Carole Ichai
- />Service de Réanimation Polyvalente, IRCAN (Inserm U1081, CNRS UMR7284 et CHU de Nice, Hôpital Pasteur 2, 30 Voie Romaine, CHU de Nice, 06000 Nice, France
| | | | - Bertrand Souweine
- />Service de Réanimation Polyvalente, CHU de Nice, 30 Voie Romaine, 06000 Nice, France
| | - Fabien Armando
- />Service de Réanimation médicale, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Emmanuel Canet
- />Service de Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France
| | - Christophe Clec’h
- />Service de Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital d’Avicenne, 125 rue de Stalingrad, 93000 Bobigny, France
| | - Jean-Michel Constantin
- />Département de Médecine périopératoire, Hôpital Estaing, CHU de Clermont-Ferrand, 1 place Louis Aubrac, 63000 Clermont-Ferrand, France
| | - Michaël Darmon
- />Service de réanimation, hôpital de la Charité, CHU de Saint-Etienne, 44 rue Pointe Cadet, 42100 Saint-Etienne, France
| | - Jacques Duranteau
- />Département d’anesthésie-réanimation, Assistance Publique-Hôpitaux de Paris, hôpital Kremlin-Bicêtre, 78, rue de la division du général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Théophille Gaillot
- />Service de Pédiatrie, hôpital Sud, CHU de Rennes, 16 Bd Bulgarie, 35203 Rennes, France
| | - Arnaud Garnier
- />Service de Pédiatrie, Néphrologie, hôpital des Enfants, CHU de Toulouse, 330 avenue de Grande-Bretagne, 31059 Toulouse Cedex, France
| | - Laurent Jacob
- />Service d’anesthésie-réanimation, Assistance Publique-Hôpitaux de Paris, hôpital Saint-Louis, 1, Avenue Claude-Vellefaux, 75010 Paris, France
| | - Olivier Joannes-Boyau
- />Service d’Anesthésie Réanimation II, Hôpital du Haut-Lévêque, CHU de Bordeaux, 33600 Pessac, France
| | - Laurent Juillard
- />Service de néphrologie-dialyse, hôpital Édouard-Herriot, Hospices Civils de Lyon, 5, Place d’Arsonval, 69003 Lyon, France
| | - Didier Journois
- />Service de réanimation, Assistance Publique-Hôpitaux de Paris, hôpital Européen Georges Pompidou, 20, rue Leblanc, 75908 Paris, France
| | - Alexandre Lautrette
- />Service de réanimation, hôpital Gabriel Montpied, CHU de Clermont-Ferrand, 58 rue Montalemberg, 63003 Clermont-Ferrand, France
| | - Laurent Muller
- />Service de réanimation, hôpital Carémeau, CHU de Nîmes, 4 rue du Professeur Robert-Debré, 30029 Nîmes, France
| | - Matthieu Legrand
- />Service d’anesthésie-réanimation, hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, 1, Avenue Claude-Vellefaux, 75010 Paris, France
| | - Nicolas Lerolle
- />Service de réanimation, centre hospitalier universitaire, CHU d’Angers, 4 rue Larrey, 49100 Angers, France
| | - Thomas Rimmelé
- />Service d’anesthésie réanimation, hôpital Édouard-Herriot, Hospices Civils de Lyon, 5, Place d’Arsonval, 69003 Lyon, France
| | - Eric Rondeau
- />Service de néphrologie, hôpital Tenon, Assistance Publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France
| | - Fabienne Tamion
- />Service de réanimation médicale, hôpital Charles-Nicolle, CHU de Rouen, 1 rue de Germont, 76031 Rouen, France
| | - Yannick Walrave
- />Service de Réanimation Polyvalente, CHU de Nice, 30 Voie Romaine, 06000 Nice, France
| | - Lionel Velly
- />Service d’anesthésie-réanimation, hôpital de la Timone, Assistance Publique-Hôpitaux de Marseille, 13385 Marseille Cedex 5, France
| | - Société française d’anesthésie et de réanimation (Sfar)
- />Service de Réanimation Polyvalente, IRCAN (Inserm U1081, CNRS UMR7284 et CHU de Nice, Hôpital Pasteur 2, 30 Voie Romaine, CHU de Nice, 06000 Nice, France
- />Service de Réanimation, Hôpital Marc Jacquet, 77000 Melun, France
- />Service de Réanimation Polyvalente, CHU de Nice, 30 Voie Romaine, 06000 Nice, France
- />Service de Réanimation médicale, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
- />Service de Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France
- />Service de Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital d’Avicenne, 125 rue de Stalingrad, 93000 Bobigny, France
- />Département de Médecine périopératoire, Hôpital Estaing, CHU de Clermont-Ferrand, 1 place Louis Aubrac, 63000 Clermont-Ferrand, France
- />Service de réanimation, hôpital de la Charité, CHU de Saint-Etienne, 44 rue Pointe Cadet, 42100 Saint-Etienne, France
- />Département d’anesthésie-réanimation, Assistance Publique-Hôpitaux de Paris, hôpital Kremlin-Bicêtre, 78, rue de la division du général Leclerc, 94270 Le Kremlin-Bicêtre, France
- />Service de Pédiatrie, hôpital Sud, CHU de Rennes, 16 Bd Bulgarie, 35203 Rennes, France
- />Service de Pédiatrie, Néphrologie, hôpital des Enfants, CHU de Toulouse, 330 avenue de Grande-Bretagne, 31059 Toulouse Cedex, France
- />Service d’anesthésie-réanimation, Assistance Publique-Hôpitaux de Paris, hôpital Saint-Louis, 1, Avenue Claude-Vellefaux, 75010 Paris, France
- />Service d’Anesthésie Réanimation II, Hôpital du Haut-Lévêque, CHU de Bordeaux, 33600 Pessac, France
- />Service de néphrologie-dialyse, hôpital Édouard-Herriot, Hospices Civils de Lyon, 5, Place d’Arsonval, 69003 Lyon, France
- />Service de réanimation, Assistance Publique-Hôpitaux de Paris, hôpital Européen Georges Pompidou, 20, rue Leblanc, 75908 Paris, France
- />Service de réanimation, hôpital Gabriel Montpied, CHU de Clermont-Ferrand, 58 rue Montalemberg, 63003 Clermont-Ferrand, France
- />Service de réanimation, hôpital Carémeau, CHU de Nîmes, 4 rue du Professeur Robert-Debré, 30029 Nîmes, France
- />Service d’anesthésie-réanimation, hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, 1, Avenue Claude-Vellefaux, 75010 Paris, France
- />Service de réanimation, centre hospitalier universitaire, CHU d’Angers, 4 rue Larrey, 49100 Angers, France
- />Service d’anesthésie réanimation, hôpital Édouard-Herriot, Hospices Civils de Lyon, 5, Place d’Arsonval, 69003 Lyon, France
- />Service de néphrologie, hôpital Tenon, Assistance Publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France
- />Service de réanimation médicale, hôpital Charles-Nicolle, CHU de Rouen, 1 rue de Germont, 76031 Rouen, France
- />Service d’anesthésie-réanimation, hôpital de la Timone, Assistance Publique-Hôpitaux de Marseille, 13385 Marseille Cedex 5, France
| | - Société de réanimation de langue française (SRLF)
- />Service de Réanimation Polyvalente, IRCAN (Inserm U1081, CNRS UMR7284 et CHU de Nice, Hôpital Pasteur 2, 30 Voie Romaine, CHU de Nice, 06000 Nice, France
- />Service de Réanimation, Hôpital Marc Jacquet, 77000 Melun, France
- />Service de Réanimation Polyvalente, CHU de Nice, 30 Voie Romaine, 06000 Nice, France
- />Service de Réanimation médicale, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
- />Service de Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France
- />Service de Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital d’Avicenne, 125 rue de Stalingrad, 93000 Bobigny, France
- />Département de Médecine périopératoire, Hôpital Estaing, CHU de Clermont-Ferrand, 1 place Louis Aubrac, 63000 Clermont-Ferrand, France
- />Service de réanimation, hôpital de la Charité, CHU de Saint-Etienne, 44 rue Pointe Cadet, 42100 Saint-Etienne, France
- />Département d’anesthésie-réanimation, Assistance Publique-Hôpitaux de Paris, hôpital Kremlin-Bicêtre, 78, rue de la division du général Leclerc, 94270 Le Kremlin-Bicêtre, France
- />Service de Pédiatrie, hôpital Sud, CHU de Rennes, 16 Bd Bulgarie, 35203 Rennes, France
- />Service de Pédiatrie, Néphrologie, hôpital des Enfants, CHU de Toulouse, 330 avenue de Grande-Bretagne, 31059 Toulouse Cedex, France
- />Service d’anesthésie-réanimation, Assistance Publique-Hôpitaux de Paris, hôpital Saint-Louis, 1, Avenue Claude-Vellefaux, 75010 Paris, France
- />Service d’Anesthésie Réanimation II, Hôpital du Haut-Lévêque, CHU de Bordeaux, 33600 Pessac, France
- />Service de néphrologie-dialyse, hôpital Édouard-Herriot, Hospices Civils de Lyon, 5, Place d’Arsonval, 69003 Lyon, France
- />Service de réanimation, Assistance Publique-Hôpitaux de Paris, hôpital Européen Georges Pompidou, 20, rue Leblanc, 75908 Paris, France
- />Service de réanimation, hôpital Gabriel Montpied, CHU de Clermont-Ferrand, 58 rue Montalemberg, 63003 Clermont-Ferrand, France
- />Service de réanimation, hôpital Carémeau, CHU de Nîmes, 4 rue du Professeur Robert-Debré, 30029 Nîmes, France
- />Service d’anesthésie-réanimation, hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, 1, Avenue Claude-Vellefaux, 75010 Paris, France
- />Service de réanimation, centre hospitalier universitaire, CHU d’Angers, 4 rue Larrey, 49100 Angers, France
- />Service d’anesthésie réanimation, hôpital Édouard-Herriot, Hospices Civils de Lyon, 5, Place d’Arsonval, 69003 Lyon, France
- />Service de néphrologie, hôpital Tenon, Assistance Publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France
- />Service de réanimation médicale, hôpital Charles-Nicolle, CHU de Rouen, 1 rue de Germont, 76031 Rouen, France
- />Service d’anesthésie-réanimation, hôpital de la Timone, Assistance Publique-Hôpitaux de Marseille, 13385 Marseille Cedex 5, France
| | - Groupe francophone de réanimation et urgences pédiatriques (GFRUP)
- />Service de Réanimation Polyvalente, IRCAN (Inserm U1081, CNRS UMR7284 et CHU de Nice, Hôpital Pasteur 2, 30 Voie Romaine, CHU de Nice, 06000 Nice, France
- />Service de Réanimation, Hôpital Marc Jacquet, 77000 Melun, France
- />Service de Réanimation Polyvalente, CHU de Nice, 30 Voie Romaine, 06000 Nice, France
- />Service de Réanimation médicale, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
- />Service de Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France
- />Service de Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital d’Avicenne, 125 rue de Stalingrad, 93000 Bobigny, France
- />Département de Médecine périopératoire, Hôpital Estaing, CHU de Clermont-Ferrand, 1 place Louis Aubrac, 63000 Clermont-Ferrand, France
- />Service de réanimation, hôpital de la Charité, CHU de Saint-Etienne, 44 rue Pointe Cadet, 42100 Saint-Etienne, France
- />Département d’anesthésie-réanimation, Assistance Publique-Hôpitaux de Paris, hôpital Kremlin-Bicêtre, 78, rue de la division du général Leclerc, 94270 Le Kremlin-Bicêtre, France
- />Service de Pédiatrie, hôpital Sud, CHU de Rennes, 16 Bd Bulgarie, 35203 Rennes, France
- />Service de Pédiatrie, Néphrologie, hôpital des Enfants, CHU de Toulouse, 330 avenue de Grande-Bretagne, 31059 Toulouse Cedex, France
- />Service d’anesthésie-réanimation, Assistance Publique-Hôpitaux de Paris, hôpital Saint-Louis, 1, Avenue Claude-Vellefaux, 75010 Paris, France
- />Service d’Anesthésie Réanimation II, Hôpital du Haut-Lévêque, CHU de Bordeaux, 33600 Pessac, France
- />Service de néphrologie-dialyse, hôpital Édouard-Herriot, Hospices Civils de Lyon, 5, Place d’Arsonval, 69003 Lyon, France
- />Service de réanimation, Assistance Publique-Hôpitaux de Paris, hôpital Européen Georges Pompidou, 20, rue Leblanc, 75908 Paris, France
- />Service de réanimation, hôpital Gabriel Montpied, CHU de Clermont-Ferrand, 58 rue Montalemberg, 63003 Clermont-Ferrand, France
- />Service de réanimation, hôpital Carémeau, CHU de Nîmes, 4 rue du Professeur Robert-Debré, 30029 Nîmes, France
- />Service d’anesthésie-réanimation, hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, 1, Avenue Claude-Vellefaux, 75010 Paris, France
- />Service de réanimation, centre hospitalier universitaire, CHU d’Angers, 4 rue Larrey, 49100 Angers, France
- />Service d’anesthésie réanimation, hôpital Édouard-Herriot, Hospices Civils de Lyon, 5, Place d’Arsonval, 69003 Lyon, France
- />Service de néphrologie, hôpital Tenon, Assistance Publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France
- />Service de réanimation médicale, hôpital Charles-Nicolle, CHU de Rouen, 1 rue de Germont, 76031 Rouen, France
- />Service d’anesthésie-réanimation, hôpital de la Timone, Assistance Publique-Hôpitaux de Marseille, 13385 Marseille Cedex 5, France
| | - Société française de néphrologie (SFN)
- />Service de Réanimation Polyvalente, IRCAN (Inserm U1081, CNRS UMR7284 et CHU de Nice, Hôpital Pasteur 2, 30 Voie Romaine, CHU de Nice, 06000 Nice, France
- />Service de Réanimation, Hôpital Marc Jacquet, 77000 Melun, France
- />Service de Réanimation Polyvalente, CHU de Nice, 30 Voie Romaine, 06000 Nice, France
- />Service de Réanimation médicale, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
- />Service de Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France
- />Service de Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital d’Avicenne, 125 rue de Stalingrad, 93000 Bobigny, France
- />Département de Médecine périopératoire, Hôpital Estaing, CHU de Clermont-Ferrand, 1 place Louis Aubrac, 63000 Clermont-Ferrand, France
- />Service de réanimation, hôpital de la Charité, CHU de Saint-Etienne, 44 rue Pointe Cadet, 42100 Saint-Etienne, France
- />Département d’anesthésie-réanimation, Assistance Publique-Hôpitaux de Paris, hôpital Kremlin-Bicêtre, 78, rue de la division du général Leclerc, 94270 Le Kremlin-Bicêtre, France
- />Service de Pédiatrie, hôpital Sud, CHU de Rennes, 16 Bd Bulgarie, 35203 Rennes, France
- />Service de Pédiatrie, Néphrologie, hôpital des Enfants, CHU de Toulouse, 330 avenue de Grande-Bretagne, 31059 Toulouse Cedex, France
- />Service d’anesthésie-réanimation, Assistance Publique-Hôpitaux de Paris, hôpital Saint-Louis, 1, Avenue Claude-Vellefaux, 75010 Paris, France
- />Service d’Anesthésie Réanimation II, Hôpital du Haut-Lévêque, CHU de Bordeaux, 33600 Pessac, France
- />Service de néphrologie-dialyse, hôpital Édouard-Herriot, Hospices Civils de Lyon, 5, Place d’Arsonval, 69003 Lyon, France
- />Service de réanimation, Assistance Publique-Hôpitaux de Paris, hôpital Européen Georges Pompidou, 20, rue Leblanc, 75908 Paris, France
- />Service de réanimation, hôpital Gabriel Montpied, CHU de Clermont-Ferrand, 58 rue Montalemberg, 63003 Clermont-Ferrand, France
- />Service de réanimation, hôpital Carémeau, CHU de Nîmes, 4 rue du Professeur Robert-Debré, 30029 Nîmes, France
- />Service d’anesthésie-réanimation, hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, 1, Avenue Claude-Vellefaux, 75010 Paris, France
- />Service de réanimation, centre hospitalier universitaire, CHU d’Angers, 4 rue Larrey, 49100 Angers, France
- />Service d’anesthésie réanimation, hôpital Édouard-Herriot, Hospices Civils de Lyon, 5, Place d’Arsonval, 69003 Lyon, France
- />Service de néphrologie, hôpital Tenon, Assistance Publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France
- />Service de réanimation médicale, hôpital Charles-Nicolle, CHU de Rouen, 1 rue de Germont, 76031 Rouen, France
- />Service d’anesthésie-réanimation, hôpital de la Timone, Assistance Publique-Hôpitaux de Marseille, 13385 Marseille Cedex 5, France
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22
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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.
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23
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Prasad A, Sohn A, Morales J, Williams K, Bailey SR, Levin D, McCullough PA, Mehran R, Lopez-Cruz G, Harder J. Contemporary practice patterns related to the risk of acute kidney injury in the catheterization laboratory: Results from a survey of Society of Cardiovascular Angiography and Intervention (SCAI) cardiologists. Catheter Cardiovasc Interv 2016; 89:383-392. [DOI: 10.1002/ccd.26628] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 05/01/2016] [Accepted: 05/23/2016] [Indexed: 12/22/2022]
Affiliation(s)
- Anand Prasad
- Department of Medicine, Division of Cardiology; The University of Texas Health Science Center San Antonio; San Antonio Texas
| | - Aaron Sohn
- Department of Medicine, Division of Cardiology; The University of Texas Health Science Center San Antonio; San Antonio Texas
| | - Jonathan Morales
- Department of Medicine, Division of Cardiology; The University of Texas Health Science Center San Antonio; San Antonio Texas
| | - Ken Williams
- Department of Medicine, Division of Cardiology; The University of Texas Health Science Center San Antonio; San Antonio Texas
| | - Steven R. Bailey
- Department of Medicine, Division of Cardiology; The University of Texas Health Science Center San Antonio; San Antonio Texas
| | - Daniel Levin
- Department of Medicine, Division of Cardiology; The University of Texas Health Science Center San Antonio; San Antonio Texas
| | | | - Roxana Mehran
- Department of Medicine, Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute at the Icahn School of Medicine at Mount Sinai; Mount Sinai
| | | | - Joel Harder
- The Society of Cardiovascular Angiography and Interventions; Washington, DC
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24
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Acute kidney injury in the perioperative period and in intensive care units (excluding renal replacement therapies). Anaesth Crit Care Pain Med 2016; 35:151-65. [PMID: 27235292 DOI: 10.1016/j.accpm.2016.03.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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25
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Shamekhi Amiri F. Recent advances in the treatment of renal diseases with nebivolol: A literature review. Nephrol Ther 2016; 12:140-8. [PMID: 27117765 DOI: 10.1016/j.nephro.2016.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 01/03/2016] [Accepted: 01/04/2016] [Indexed: 11/25/2022]
Abstract
Reactive oxygen species play an important role in both acute and chronic kidney diseases. Chronic kidney disease is associated with various consequences to the cardiovascular system and metabolic profiles. Nebivolol, a highly cardioselective third-generation β-blocker, has nitric oxide (NO) induced vasodilation and antioxidant properties. Nebivolol affects the endothelial NO pathway in two complementary ways: it increases endothelial mediated NO expression and has antioxidant action, which leads to a decrease in degradation. Central blood pressure can be effectively lowered by nebivolol in the prehypertension phase. Clinically nebivolol's ability to modulate endothelial dysfunction may offer additional vascular protection in treating hypertension. As well, pre-treatment with 5mg nebivolol every 24 hours for 4 days is protective against nephrotoxic effects of contrast media. The aim of this study is to review the current literature on the efficacy and safety of nebivolol in the treatment of various states of renal diseases.
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Affiliation(s)
- Fateme Shamekhi Amiri
- Faculty of medicine (poursina), Tehran University of Medical Sciences, Tehran, Iran.
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26
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Bôa ISF, Porto ML, Pereira ACH, Ramos JPL, Scherer R, Oliveira JP, Nogueira BV, Meyrelles SS, Vasquez EC, Endringer DC, Pereira TMC. Resin from Virola oleifera Protects Against Radiocontrast-Induced Nephropathy in Mice. PLoS One 2015; 10:e0144329. [PMID: 26674346 PMCID: PMC4684213 DOI: 10.1371/journal.pone.0144329] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 11/17/2015] [Indexed: 12/28/2022] Open
Abstract
Contrast-induced nephropathy (CIN) is an iatrogenic medical event for which there is not yet a successful therapy. Increasing evidence in rodents has suggested that this disease is associated with renal tubular and vascular injury that is triggered directly by oxidative stress. In the present study, we evaluated whether the antioxidant resin from Virola oleifera (RV) could attenuate renal damage in an experimental mouse model of CIN. Adult male Swiss mice were divided into six groups and pre-treated orally with RV (10, 100 and 300 mg/kg), N-acetylcysteine (200 mg/kg) or vehicle for 5 days before the induction of CIN and Control group. Renal function was assessed by measuring plasma creatinine and urea levels. Additionally, renal oxidative stress and apoptosis/cell viability were determined with flow cytometry. Finally, kidney tissues were sectioned for histopathological examination. In this CIN model, pre-treatment with RV improved renal function, lowered the mortality rate, and reduced oxidative stress and apoptosis in both the medulla and cortex renal cells in a dose-dependent manner. Moreover, the RV treatment had beneficial effects on kidney histopathology that were superior to the standard treatment with N-acetylcysteine. These data suggest that because of its antioxidative and antiapoptotic effects and its ability to preserve renal function, resin from Virola oleifera may have potential as a new therapeutic approach for preventing CIN.
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Affiliation(s)
- Igor Santos Fonte Bôa
- Pharmaceutical Sciences Graduate Program, Vila Velha University (UVV), Vila Velha, ES, Brazil
| | - Marcella Leite Porto
- Laboratory of Translational Physiology, Health Sciences Center, Federal University of Espirito Santo, Vitoria, Brazil
| | | | | | - Rodrigo Scherer
- Pharmaceutical Sciences Graduate Program, Vila Velha University (UVV), Vila Velha, ES, Brazil
| | - Jairo Pinto Oliveira
- Department of Morphology, Health Sciences Center, Federal University of Espirito Santo, Vitoria, Brazil
| | - Breno Valentim Nogueira
- Department of Morphology, Health Sciences Center, Federal University of Espirito Santo, Vitoria, Brazil
| | - Silvana Santos Meyrelles
- Laboratory of Translational Physiology, Health Sciences Center, Federal University of Espirito Santo, Vitoria, Brazil
| | - Elisardo Corral Vasquez
- Pharmaceutical Sciences Graduate Program, Vila Velha University (UVV), Vila Velha, ES, Brazil
- Laboratory of Translational Physiology, Health Sciences Center, Federal University of Espirito Santo, Vitoria, Brazil
| | - Denise Coutinho Endringer
- Pharmaceutical Sciences Graduate Program, Vila Velha University (UVV), Vila Velha, ES, Brazil
- Federal Institute of Education, Science and Technology (IFES), Vila Velha, ES, Brazil
| | - Thiago Melo Costa Pereira
- Pharmaceutical Sciences Graduate Program, Vila Velha University (UVV), Vila Velha, ES, Brazil
- Federal Institute of Education, Science and Technology (IFES), Vila Velha, ES, Brazil
- * E-mail:
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27
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Huang YT, Chen YY, Lai YH, Cheng CC, Lin TC, Su YS, Liu CH, Lai PC. Resveratrol alleviates the cytotoxicity induced by the radiocontrast agent, ioxitalamate, by reducing the production of reactive oxygen species in HK-2 human renal proximal tubule epithelial cells in vitro. Int J Mol Med 2015; 37:83-91. [PMID: 26573558 PMCID: PMC4687441 DOI: 10.3892/ijmm.2015.2404] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 11/04/2015] [Indexed: 12/18/2022] Open
Abstract
Radiocontrast-induced nephropathy (RIN) is one of the leading causes of hospital-acquired acute kidney injury (AKI). The clinical strategies currently available for the prevention of RIN are insufficient. In this study, we aimed to determine whether resveratrol, a polyphenol phytoalexin, can be used to prevent RIN. For this purpose, in vitro experiments were performed using a human renal proximal tubule epithelial cell line (HK-2 cells). Following treatment for 48 h, the highly toxic radiocontrast agent, ioxitalamate, exerted cytotoxic effects on the HK-2 cells in a concentration-dependent manner, as shown by MTT assay. The half maximal inhibitory concentration (IC50) was found to be approximately 30 mg/ml. Flow cytometry also revealed a marked increase in the number of apoptotic cells following exposure to ioxitalamate. In addition, the number of necrotic, but not necroptotic cells was increased. However, treatment with resveratrol (12.5 µM) for 48 h significantly alleviated ioxitalamate (30 mg/ml)-induced cytotoxicity, by reducing cytosolic DNA fragmentation, increasing the expression of the anti-apoptotic protein, Bcl-2 (B-cell lymphoma 2), and survivin, activating caspase-3, preventing autophagic death and suppressing the production of reactive oxygen species (ROS). Resveratrol also suppressed the ioxitalamate-induced formation of 8-hydroxy-2'-deoxyguanosine (8-OHdG), a biomarker of oxidative DNA damage. N-acetylcysteine (NAC), a ROS scavenger commonly used to prevent RIN, also reduced ioxitalamate-induced cytotoxicity, but at a high concentration of 1 mM. Sirtuin (SIRT)1 and SIRT3 were not found to play a role in these effects. Overall, our findings suggest that resveratrol may prove to be an effective adjuvant therapy for the prevention of RIN.
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Affiliation(s)
- Yen Ta Huang
- Surgical Intensive Care Unit, Buddhist Tzu Chi General Hospital, Tzu Chi University, Hualien, Taiwan, R.O.C
| | - Yi Ya Chen
- Master Program in Pharmacology and Toxicology, Tzu Chi University, Hualien, Taiwan, R.O.C
| | - Yu Hsien Lai
- PhD Program in Pharmacology and Toxicology, Tzu Chi University, Hualien, Taiwan, R.O.C
| | - Chuan Chu Cheng
- Department of Medical Research, Buddhist Tzu Chi General Hospital, Hualien, Taiwan, R.O.C
| | - Tzu Chun Lin
- Department of Medical Research, Buddhist Tzu Chi General Hospital, Hualien, Taiwan, R.O.C
| | - Ying Shih Su
- PhD Program in Pharmacology and Toxicology, Tzu Chi University, Hualien, Taiwan, R.O.C
| | - Chin Hung Liu
- Department of Pharmacology, College of Medicine, Tzu Chi University, Hualien, Taiwan, R.O.C
| | - Pei Chun Lai
- Department of Medicine, Tzu Chi University, Hualien, Taiwan, R.O.C
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28
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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.
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29
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Nicola R, Shaqdan KW, Aran K, Mansouri M, Singh A, Abujudeh HH. Contrast-Induced Nephropathy: Identifying the Risks, Choosing the Right Agent, and Reviewing Effective Prevention and Management Methods. Curr Probl Diagn Radiol 2015; 44:501-4. [PMID: 26072134 DOI: 10.1067/j.cpradiol.2015.04.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 04/08/2015] [Accepted: 04/09/2015] [Indexed: 12/14/2022]
Abstract
With the rise in the use of intravenous iodinated contrast media for both computed tomography scan and angiographic studies, there is a greater likelihood of complications. One of the most well-known adverse effects is contrast-induced media nephropathy, which is also called contrast-induced acute kidney injury. This is third most common cause of hospital acquired acute renal failure. It is associated with an increase in morbidity, mortality, and greater financial burden on healthcare system. Because of these factors, it is important for the radiologist to not only recognize risk factors, as well as the signs and symptoms, but also to know how to manage patients appropriately.
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Affiliation(s)
- Refky Nicola
- Division of Emergency Imaging, University of Rochester Medical Center, Rochester, NY
| | - Khalid W Shaqdan
- Division of Emergency Imaging, Massachusetts General Hospital, Boston, MA
| | - Khalid Aran
- Division of Emergency Imaging, Massachusetts General Hospital, Boston, MA
| | - Mohammad Mansouri
- Division of Emergency Imaging, Massachusetts General Hospital, Boston, MA
| | - Ajay Singh
- Division of Emergency Imaging, Massachusetts General Hospital, Boston, MA
| | - Hani H Abujudeh
- Division of Emergency Imaging, Massachusetts General Hospital, Boston, MA.
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30
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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.
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