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Aydin S, Aydin OC, Yazar MF, Aydemir H, Kantarci M, Barun S. Assessment of the potential interactions between favipiravir and radiocontrast agents. World J Radiol 2024; 16:128-135. [PMID: 38845605 PMCID: PMC11151898 DOI: 10.4329/wjr.v16.i5.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/23/2024] [Accepted: 05/08/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND In cases of coronavirus disease 2019 (COVID-19), favipiravir is commonly included to the therapy regimen. Drug interactions between favipiravir and other COVID-19 therapy drugs are frequently researched. However, no research on possible drug interactions between Favipiravir and radiocontrast agents, which have become almost crucial in diagnostic processes while not being part of the treatment, has been found. AIM To determine potential medication interactions between Favipiravir and radiocontrast agents. METHODS The study comprised patients who were taking Favipiravir for COVID-19 therapy and underwent a contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) test while taking the medicine. The computerized patient files of the cases included in the study, as well as the pharmacovigilance forms in the designated hospital, were evaluated for this purpose. RESULTS The study included the evaluation of data from 1046 patients. The study sample's mean age was 47.23 ± 9.48 years. The mean age of cases with drug interactions was statistically significant greater than that of cases with no drug interactions (P = 0.003). When evaluated with logistic regression analysis, a 1-year raises in age increases the risk of developing drug interactions by 1.63 times (P = 0.023). There was no statistically significant difference in the occurrence of medication interactions between the sexes (P = 0.090). Possible medication interactions were discovered in 42 cases (4%). CONCLUSION The findings of this study revealed that the most notable findings as a result of the combined use of contrast agents and favipiravir were increased creatinine and transaminase values, as well as an increase in the frequency of nausea and vomiting. The majority of drug interactions discovered were modest enough that they were not reflected in the clinic. Drug interactions become more common as people get older.
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Affiliation(s)
- Sonay Aydin
- Department of Radiology, Erzincan Binali Yıldırım University, Faculty of Medicine, Erzincan 24100, Türkiye
| | - Ozlem Celik Aydin
- Department of Pharmacology, Gazi University, Faculty of Medicine, Erzincan 24100, Türkiye
| | - Mesut Furkan Yazar
- Department of Radiology, Bilecik Education and Reseach Hospital, Bilecik 11230, Türkiye
| | - Huseyin Aydemir
- Department of Radiology, Erzincan Binali Yıldırım University, Faculty of Medicine, Erzincan 24100, Türkiye
| | - Mecit Kantarci
- Department of Radiology, Erzincan Binali Yıldırım University, Faculty of Medicine, Erzincan 24100, Türkiye
- Department of Radiology, Atatürk University, Faculty of Medicine, Erzurum 25030, Türkiye
| | - Sureyya Barun
- Department of Pharmacology, Gazi University, Faculty of Medicine, Erzincan 24100, Türkiye
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Chang W, Liu CC, Huang YT, Wu JY, Tsai WW, Hung K, Chen I, Feng PH. Diagnostic efficacy of the triglyceride-glucose index in the prediction of contrast-induced nephropathy following percutaneous coronary intervention. Front Endocrinol (Lausanne) 2023; 14:1282675. [PMID: 38075076 PMCID: PMC10703478 DOI: 10.3389/fendo.2023.1282675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/09/2023] [Indexed: 12/18/2023] Open
Abstract
Introduction Contrast-induced nephropathy (CIN) is a common complication of percutaneous coronary intervention (PCI). Identifying patients at high CIN risk remains challenging. The triglyceride-glucose (TyG) index may help predict CIN but evidence is limited. We conducted a meta-analysis to evaluate the diagnostic value of TyG index for CIN after PCI. Methods A systematic literature search was performed in MEDLINE, Cochrane, and EMBASE until August 2023 (PROSPERO registration: CRD42023452257). Observational studies examining TyG index for predicting CIN risk in PCI patients were included. This diagnostic meta-analysis aimed to evaluate the accuracy of the TyG index in predicting the likelihood of CIN. Secondary outcomes aimed to assess the pooled incidence of CIN and the association between an elevated TyG index and the risk of CIN. Results Five studies (Turkey, n=2; China, n=3) with 3518 patients (age range: 57.6 to 68.22 years) were included. The pooled incidence of CIN was 15.3% [95% confidence interval (CI) 11-20.8%]. A high TyG index associated with increased CIN risk (odds ratio: 2.25, 95% CI 1.82-2.77). Pooled sensitivity and specificity were 0.77 (95% CI 0.59-0.88) and 0.55 (95% CI 0.43-0.68) respectively. Analysis of the summary receiver operating characteristic (sROC) curve revealed an area under the curve of 0.69 (95% CI 0.65-0.73). There was a low risk of publication bias (p = 0.81). Conclusion The TyG index displayed a noteworthy correlation with the risk of CIN subsequent to PCI. However, its overall diagnostic accuracy was found to be moderate in nature. While promising, the TyG index should not be used in isolation for CIN screening given the heterogeneity between studies. In addition, the findings cannot be considered conclusive given the scarcity of data. Further large-scale studies are warranted to validate TyG cutoffs and determine how to optimally incorporate it into current risk prediction models. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023452257, identifier CRD42023452257.
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Affiliation(s)
- Wei−Ting Chang
- School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung, Taiwan
- Division of Cardiology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Chien-Cheng Liu
- Department of Anesthesiology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
- Department of Nursing, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Yen-Ta Huang
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jheng-Yan Wu
- Department of Nutrition, Chi Mei Medical Center, Tainan, Taiwan
| | - Wen-Wen Tsai
- Department of Neurology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Kuo−Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - I−Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Ping-Hsun Feng
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan, Taiwan
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Cheng L, Wang L, Chen B, Wang C, Wang M, Li J, Gao X, Zhang Z, Han L. A multiple-metabolites model to predict preliminary renal injury induced by iodixanol based on UHPLC/Q-Orbitrap-MS and 1H-NMR. Metabolomics 2022; 18:85. [PMID: 36307737 DOI: 10.1007/s11306-022-01942-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/11/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND & AIMS There are some problems, such as unclear pathological mechanism, delayed diagnosis, and inaccurate therapeutic target of Contrast-induced acute kidney injury (CI-AKI). It is significantly important to find biomarkers and therapeutic targets that can indicate renal injury in the early stage of CI-AKI. This study aims to establish a multiple-metabolites model to predict preliminary renal injury induced by iodixanol and explore its pathogenesis. METHODS Both UHPLC/Q-Orbitrap-MS and 1H-NMR methods were applied for urine metabolomics studies on two independent cohorts who suffered from a preliminary renal injury caused by iodixanol, and the multivariate statistical analysis and random forest (RF) algorithm were used to process the related date. RESULTS In the discovery cohort (n = 169), 6 metabolic markers (leucine, indole, 5-hydroxy-L-tryptophan, N-acetylvaline, hydroxyhexanoycarnine, and kynurenic acid) were obtained by the cross-validation between the RF and liquid chromatography-mass spectrometry (LC-MS). Secondly, the 6 differential metabolites were confirmed by comparison of standard substance and structural identification of 1H-NMR. Subsequently, the multiple-metabolites model composed of the 6 biomarkers was validated in a validation cohort (n = 165). CONCLUSIONS The concentrations of leucine, indole, N-acetylvaline, 5-hydroxy-L-tryptophan, hydroxyhexanoycarnitine and kynurenic acid in urine were proven to be positively correlated with the degree of renal injury induced by iodixanol. The multiple-metabolites model based on these 6 biomarkers has a good predictive ability to predict early renal injury caused by iodixanol, provides treatment direction for injury intervention and a reference for reducing the incidence of clinical CI-AKI further.
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Affiliation(s)
- Liying Cheng
- State Key Laboratory of Component-Based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, People's Republic of China
| | - Liming Wang
- State Key Laboratory of Component-Based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, People's Republic of China
| | - Biying Chen
- State Key Laboratory of Component-Based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, People's Republic of China
| | - Chenxi Wang
- State Key Laboratory of Component-Based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, People's Republic of China
| | - Mengxi Wang
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, 210000, People's Republic of China
| | - Jie Li
- Tianjin Key Laboratory of Clinical Multi-Omics, Airport Economy Zone, Tianjin, 300308, People's Republic of China
| | - Xiumei Gao
- State Key Laboratory of Component-Based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, People's Republic of China.
| | - Zhu Zhang
- Department of Nephrology, Fuwai Huazhong Cardiovascular Hospital, Zhengzhou, 451464, People's Republic of China.
| | - Lifeng Han
- State Key Laboratory of Component-Based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, People's Republic of China.
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Valimukhametova AR, Zub OS, Lee BH, Fannon O, Nguyen S, Gonzalez-Rodriguez R, Akkaraju GR, Naumov AV. Dual-Mode Fluorescence/Ultrasound Imaging with Biocompatible Metal-Doped Graphene Quantum Dots. ACS Biomater Sci Eng 2022; 8:4965-4975. [PMID: 36179254 DOI: 10.1021/acsbiomaterials.2c00794] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Sonography offers many advantages over standard methods of diagnostic imaging due to its non-invasiveness, substantial tissue penetration depth, and low cost. The benefits of ultrasound imaging call for the development of ultrasound-trackable drug delivery vehicles that can address a variety of therapeutic targets. One disadvantage of the technique is the lack of high-precision imaging, which can be circumvented by complementing ultrasound contrast agents with visible and, especially, near-infrared (NIR) fluorophores. In this work, we, for the first time, develop a variety of lightly metal-doped (iron oxide, silver, thulium, neodymium, cerium oxide, cerium chloride, and molybdenum disulfide) nitrogen-containing graphene quantum dots (NGQDs) that demonstrate high-contrast properties in the ultrasound brightness mode and exhibit visible and/or near-infrared fluorescence imaging capabilities. NGQDs synthesized from glucosamine precursors with only a few percent metal doping do not introduce additional toxicity in vitro, yielding over 80% cell viability up to 2 mg/mL doses. Their small (<50 nm) sizes warrant effective cell internalization, while oxygen-containing surface functional groups decorating their surfaces render NGQDs water soluble and allow for the attachment of therapeutics and targeting agents. Utilizing visible and/or NIR fluorescence, we demonstrate that metal-doped NGQDs experience maximum accumulation within the HEK-293 cells 6-12 h after treatment. The successful 10-fold ultrasound signal enhancement is observed at 0.5-1.6 mg/mL for most metal-doped NGQDs in the vascular phantom, agarose gel, and animal tissue. A combination of non-invasive ultrasound imaging with capabilities of high-precision fluorescence tracking makes these metal-doped NGQDs a viable agent for a variety of theragnostic applications.
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Affiliation(s)
- Alina R Valimukhametova
- Department of Physics and Astronomy, Texas Christian University, Fort Worth, Texas 76129, United States
| | - Olga S Zub
- Alfa Radiology Management, Inc, Plano, Texas 75023, United States
| | - Bong Han Lee
- Department of Physics and Astronomy, Texas Christian University, Fort Worth, Texas 76129, United States
| | - Olivia Fannon
- Department of Physics and Astronomy, Texas Christian University, Fort Worth, Texas 76129, United States
| | - Steven Nguyen
- Department of Physics and Astronomy, Texas Christian University, Fort Worth, Texas 76129, United States
| | - Roberto Gonzalez-Rodriguez
- Department of Chemistry and Biochemistry, Texas Christian University, Fort Worth, Texas 76129, United States
| | - Giridhar R Akkaraju
- Department of Biology, Texas Christian University, Fort Worth, Texas 76129, United States
| | - Anton V Naumov
- Department of Physics and Astronomy, Texas Christian University, Fort Worth, Texas 76129, United States
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Xu Z, Qian L, Niu R, Wang Y, Yang Y, Liu C, Lin X. Mechanism of Abelmoschus manihot L. in the Treatment of Contrast-Induced Nephropathy on the Basis of Network Pharmacology Analysis. FRONTIERS IN NEPHROLOGY 2022; 2:834513. [PMID: 37675022 PMCID: PMC10479589 DOI: 10.3389/fneph.2022.834513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/21/2022] [Indexed: 09/08/2023]
Abstract
Background Contrast-induced nephropathy (CIN) is increasingly seen in patients receiving contrast medium. Abelmoschus manihot (L.) Medik. (Malvaceae) and its preparations are widely used and effective in the treatment of various chronic kidney diseases and CIN in China. It is supposed to be an important adjuvant therapy for CIN. Methods PubMed and CNKI were searched for the main compounds of A. manihot L. The Swiss target prediction platform, OMIM, GeneCards, DisGeNET, and DrugBank databases were mined for information relevant to the prediction of targets that A. manihot L. in the treatment of CIN. Subsequently, STRING database was applied for the construction of the PPI protein interaction network, meanwhile, the core targets were screened. DAVID database was used to perform the GO function and Kegg signal pathway enrichment analysis. AutoDockTools and PYMOAL were used for molecular docking. Vitro experiments were used to verify the effect of TFA, the main active component of A. manihot L., in the intervention of iopromide-induced cells injury. Results A total of 17 chemical components and 133 potential targets in A. manihot L. were obtained. The top 15 proteins with higher degree value were selected from the PPI network model, AKT1, PIK3R1, EGFR, SRC,AR, APP, TNF, GAPDH, MMP9, and PTPN1, etc. may be core targets. The enrichment analysis indicated that A. manihot L. was involved in the regulation of PI3K/AKT signaling pathway, FoxO signaling pathway, VEGF signaling pathway, HIF-1, TNF signaling pathway, melanoma, hepatitis B, and other signaling pathways which were mainly associated with the regulation of transcription and apoptosis, protein phosphorylation, inflammatory response, aging, and cell proliferation. Molecular docking indicated that the key components and core targets had a good binding ability. The vitro experiments illustrated that TFA reduces iopromide induced renal tubular cell injury and apoptosis, which may be related to regulating the phosphorylation of AKT. Conclusion The study preliminarily revealed the multi-component, multi-target, and multi-pathway synergistic effects of A. manihot L. on CIN, which provide theoretical reference and basis for the study of the pharmacological mechanism of A. manihot L. in the treatment of CIN.
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Affiliation(s)
- Zhongchi Xu
- Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Lichao Qian
- Nanjing Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Ruge Niu
- Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Yibei Wang
- Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Ying Yang
- Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Chunling Liu
- Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xin Lin
- Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
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6
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Moisi MI, Bungau SG, Vesa CM, Diaconu CC, Behl T, Stoicescu M, Toma MM, Bustea C, Sava C, Popescu MI. Framing Cause-Effect Relationship of Acute Coronary Syndrome in Patients with Chronic Kidney Disease. Diagnostics (Basel) 2021; 11:diagnostics11081518. [PMID: 34441451 PMCID: PMC8391570 DOI: 10.3390/diagnostics11081518] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/15/2021] [Accepted: 08/16/2021] [Indexed: 02/06/2023] Open
Abstract
The main causes of death in patients with chronic kidney disease (CKD) are of cardiovascular nature. The interaction between traditional cardiovascular risk factors (CVRF) and non-traditional risk factors (RF) triggers various complex pathophysiological mechanisms that will lead to accelerated atherosclerosis in the context of decreased renal function. In terms of mortality, CKD should be considered equivalent to ischemic coronary artery disease (CAD) and properly monitored. Vascular calcification, endothelial dysfunction, oxidative stress, anemia, and inflammatory syndrome represents the main uremic RF triggered by accumulation of the uremic toxins in CKD subjects. Proteinuria that appears due to kidney function decline may initiate an inflammatory status and alteration of the coagulation—fibrinolysis systems, favorizing acute coronary syndromes (ACS) occurrence. All these factors represent potential targets for future therapy that may improve CKD patient’s survival and prevention of CV events. Once installed, the CAD in CKD population is associated with negative outcome and increased mortality rate, that is the reason why discovering the complex pathophysiological connections between the two conditions and a proper control of the uremic RF are crucial and may represent the solutions for influencing the prognostic. Exclusion of CKD subjects from the important trials dealing with ACS and improper use of the therapeutical options because of the declined kidney functioned are issues that need to be surpassed. New ongoing trials with CKD subjects and platelets reactivity studies offers new perspectives for a better clinical approach and the expected results will clarify many aspects.
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Affiliation(s)
- Mădălina Ioana Moisi
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (M.I.M.); (C.B.)
| | - Simona Gabriela Bungau
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania;
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410087 Oradea, Romania
- Correspondence: (S.B.); (C.M.V)
| | - Cosmin Mihai Vesa
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (M.I.M.); (C.B.)
- Correspondence: (S.B.); (C.M.V)
| | - Camelia Cristina Diaconu
- Department 5, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania
| | - Tapan Behl
- Department of Pharmacology, Chitkara College of Pharmacy, Chitkara University, Punjab 140401, India;
| | - Manuela Stoicescu
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (M.S.); (C.S.); (M.I.P.)
| | - Mirela Mărioara Toma
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania;
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410087 Oradea, Romania
| | - Cristiana Bustea
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (M.I.M.); (C.B.)
| | - Cristian Sava
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (M.S.); (C.S.); (M.I.P.)
| | - Mircea Ioachim Popescu
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410087 Oradea, Romania
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (M.S.); (C.S.); (M.I.P.)
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Serra R, Bracale UM, Ielapi N, Del Guercio L, Di Taranto MD, Sodo M, Michael A, Faga T, Bevacqua E, Jiritano F, Serraino GF, Mastroroberto P, Provenzano M, Andreucci M. The Impact of Chronic Kidney Disease on Peripheral Artery Disease and Peripheral Revascularization. Int J Gen Med 2021; 14:3749-3759. [PMID: 34326661 PMCID: PMC8315808 DOI: 10.2147/ijgm.s322417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 07/05/2021] [Indexed: 12/11/2022] Open
Abstract
Chronic kidney disease (CKD) is a clinical condition characterized by high morbidity and mortality. Globally, CKD is also increasing in prevalence and incidence. The two principal kidney measures namely estimated glomerular filtration rate (eGFR) and albuminuria have been found to be predictors of renal and cardiovascular (CV) endpoints including peripheral artery disease (PAD). The prevalence of PAD was increased in CKD patients and, particularly, in patients with more severe CKD stages. Despite the fact that revascularization strategies are suitable in CKD patients in similar fashion to non-CKD patients, few CKD patients underwent these procedures. In fact, if it is true that revascularization improves prognosis in PAD patients irrespective of baseline eGFR, it was also demonstrated that CKD patients, who underwent revascularization, were at higher risk for amputations, mortality, re-intervention and perioperative complications. With the present review article, we have examined the association between CKD, PAD and peripheral revascularization highlighting data about epidemiology, pathophysiologic mechanisms, and results from previous observational and intervention studies. We have also examined the future perspectives and challenges of research around the association between CKD and PAD.
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Affiliation(s)
- Raffaele Serra
- Interuniversity Center of Phlebolymphology (CIFL), "Magna Graecia" University, Catanzaro, Italy.,Department of Surgical and Medical Sciences, University Magna Graecia of Catanzaro, Viale Europa, Catanzaro, 88100, Italy
| | | | - Nicola Ielapi
- Department of Public Health and Infectious Disease, "Sapienza" University of Rome, Roma, 00185, Italy
| | - Luca Del Guercio
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Maria Donata Di Taranto
- Department of Molecular Medicine and Medical Biotechnology, University Federico II of Naples, Naples, Italy
| | - Maurizio Sodo
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Ashour Michael
- Department of Health Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Teresa Faga
- Department of Health Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Egidio Bevacqua
- Department of Experimental and Clinical Medicine, University of Catanzaro, Catanzaro, 88100, Italy
| | - Federica Jiritano
- Department of Experimental and Clinical Medicine, University of Catanzaro, Catanzaro, 88100, Italy
| | | | - Pasquale Mastroroberto
- Department of Experimental and Clinical Medicine, University of Catanzaro, Catanzaro, 88100, Italy
| | - Michele Provenzano
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Viale Europa, Catanzaro, 88100, Italy
| | - Michele Andreucci
- Department of Health Sciences, "Magna Graecia" University, Catanzaro, Italy
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Raffort J, Lareyre F, Katsiki N, Mikhailidis DP. Contrast-induced nephropathy in non-cardiac vascular procedures, a narrative review: Part 1. Curr Vasc Pharmacol 2021; 20:3-15. [PMID: 34238194 DOI: 10.2174/1570161119666210708165119] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/30/2021] [Accepted: 06/03/2021] [Indexed: 11/22/2022]
Abstract
Contrast-induced nephropathy (CIN) is an important complication of iodinated contrast medium (CM) administration, which is associated with both short- and long-term adverse outcomes (e.g., cardiorenal events, longer hospital stay, and mortality). CIN has been mainly studied in relation to cardiac procedures, but it can also occur following non-cardiac vascular interventions. This is Part 1 of a narrative review summarizing the available literature on CIN after non-cardiac vascular diagnostic or therapeutic procedures for aortic aneurysm and carotid stenosis. We discuss the definition, pathophysiology, incidence, risk factors, biomarkers, and consequences of CIN in these settings, as well as preventive strategies and alternatives to limit iodinated CM use. Physicians and vascular surgeons should be aware of CM-related adverse events and the potential strategies to avoid them. Clearly, more research in this important field is required.
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Affiliation(s)
- Juliette Raffort
- Clinical Chemistry Laboratory, University Hospital of Nice. France
| | - Fabien Lareyre
- Université Côte d'Azur, CHU, Inserm U1065, C3M, Nice. France
| | - Niki Katsiki
- First Department of Internal Medicine, Diabetes Center, Division of Endocrinology and Metabolism, AHEPA University Hospital, Thessaloniki, Greece
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, United Kingdom
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Ariete V, Barnert N, Gómez M, Mieres M, Pérez B, Gutierrez JC. Morphometrical Study of the Lumbar Segment of the Internal Vertebral Venous Plexus in Dogs: A Contrast CT-Based Study. Animals (Basel) 2021; 11:ani11061502. [PMID: 34067340 PMCID: PMC8224572 DOI: 10.3390/ani11061502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/09/2021] [Accepted: 05/19/2021] [Indexed: 01/10/2023] Open
Abstract
Simple Summary The internal vertebral venous plexus (IVVP) is a valveless venous network running inside the vertebral canal. The objective of this study was to morphometrically describe the IVVP, dural sac, epidural space and vertebral canal of the lumbar segment in dogs with enhanced computerized tomography. Six clinically healthy adult dogs were used for the study. Dorsal reconstructed computed tomography (CT) images showed a continuous rhomboidal morphological pattern for the IVVP. The dural sac was observed as an isodense structure with a rounded shape throughout the vertebral canal. The average percentage area occupied by the IVVP between L1 and L7 vertebrae ranged between 6.3% and 8.9% of the area of the vertebral canal, and the dural sac ranged between 13.8% and 72.2% of the vertebral canal. The epidural space accounted between 27.08% and 86.2% of the lumbar vertebral canal. CT venography is a safe technique that allows adequate visualization and evaluation of the lumbar IVVP and adjacent structures in dogs. Abstract The internal vertebral venous plexus (IVVP) is a thin-walled, valveless venous network that is located inside the vertebral canal, communicating with the cerebral venous sinuses. The objective of this study was to perform a morphometric analysis of the IVVP, dural sac, epidural space and vertebral canal between the L1 and L7 vertebrae with contrast-enhanced computed tomography (CT). Six clinically healthy adult dogs weighing between 12 kg to 28 kg were used in the study. The CT venographic protocol consisted of a manual injection of 880 mgI/kg of contrast agent (587 mgI/kg in a bolus and 293 mgI/mL by continuous infusion). In all CT images, the dimensions of the IVVP, dural sac, and vertebral canal were collected. Dorsal reconstruction CT images showed a continuous rhomboidal morphological pattern for the IVVP. The dural sac was observed as a rounded isodense structure throughout the vertebral canal. The average area of the IVVP ranged from 0.61 to 0.74 mm2 between L1 and L7 vertebrae (6.3–8.9% of the vertebral canal), and the area of the dural sac was between 1.22 and 7.42 mm2 (13.8–72.2% of the vertebral canal). The area of the epidural space between L1 and L7 ranged from 2.85 to 7.78 mm2 (27.8–86.2% of the vertebral canal). This CT venography protocol is a safe method that allows adequate visualization and morphometric evaluation of the IVVP and adjacent structures.
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Affiliation(s)
- Valeria Ariete
- Institute of Pharmacology and Morphophysiology, Austral University of Chile, Valdivia 5090000, Chile; (V.A.); (N.B.); (B.P.)
| | - Natalia Barnert
- Institute of Pharmacology and Morphophysiology, Austral University of Chile, Valdivia 5090000, Chile; (V.A.); (N.B.); (B.P.)
| | - Marcelo Gómez
- Institute of Pharmacology and Morphophysiology, Austral University of Chile, Valdivia 5090000, Chile; (V.A.); (N.B.); (B.P.)
- Correspondence: ; Tel.: +56-632221216 or +56-984437732
| | - Marcelo Mieres
- Institute of Veterinary Clinical Sciences, Austral University of Chile, Valdivia 5090000, Chile;
| | - Bárbara Pérez
- Institute of Pharmacology and Morphophysiology, Austral University of Chile, Valdivia 5090000, Chile; (V.A.); (N.B.); (B.P.)
| | - Juan Claudio Gutierrez
- Department of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, University of California, Davis, CA 95616, USA;
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10
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Zhou F, Luo Q, Han L, Shen G, Huang L, Ye H. Proteomics reveals urine apolipoprotein A-I as a potential biomarker of acute kidney injury following percutaneous coronary intervention in elderly patients. Exp Ther Med 2021; 22:745. [PMID: 34046095 PMCID: PMC8141962 DOI: 10.3892/etm.2021.10177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/14/2021] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to investigate how changes in the lipid composition are involved in early stages of acute kidney injury (AKI) following percutaneous coronary intervention (PCI-AKI) in elderly patients. A prospective nested case-control study was performed. Alterations in the urine protein accumulation were investigated in patients with and without PCI-AKI using isobaric tags for relative and absolute quantitation (iTRAQ). In addition, differentially expressed proteins (DEPs) related to lipids were confirmed using parallel reaction monitoring (PRM)-based targeted proteomics. From the cohort of elderly patients (>60 years of age), 14 (12.28%) developed AKI within 48 h after PCI. No significant differences were detected between the AKI and control (CON) groups for serum creatinine at 24 h following treatment (P=0.27). Among the DEPs that overlapped in both the AKI-24 h/AKI-Pre (AKI group at 24 h post-PCI vs. pre-PCI) and AKI-24 h/CON-24 h groups (AKI group vs. CON group at 24 h post-PCI), only apolipoprotein A-I (apoA-I) was related to lipids, which displayed a significant upregulation in expression levels. The protein expression levels of apoA-I displayed a 5.98-fold increase at 24 h after PCI from the baseline and a 2.09-fold increase compared with the control group as determined using PRM, which exhibited a similar trend to the iTRAQ results. Using protein-protein interaction analyses, apoA-I was determined to be functionally linked to the complement and coagulation cascades, the renin-angiotensin system and the hypoxia-inducible factor-1 signaling pathway. Using the pathway analysis tool from the Kyoto Encyclopedia of Genes and Genomes, several pathways were identified to be associated with apoA-I, including fat digestion and absorption, vitamin digestion and absorption, as well as the peroxisome proliferator activated receptor signaling pathway. In conclusion, apoA-I may be a promising biomarker for the early diagnosis of PCI-AKI in elderly patients. The role of apoA-I in the pathobiology of PCI-AKI requires further exploration.
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Affiliation(s)
- Fangfang Zhou
- Department of Nephrology, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang 315010, P.R. China
| | - Qun Luo
- Department of Nephrology, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang 315010, P.R. China
| | - Lina Han
- Department of Nephrology, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang 315010, P.R. China
| | - Gen Shen
- Department of Cardiology, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang 315010, P.R. China
| | - Lulu Huang
- Department of Nephrology, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang 315010, P.R. China
| | - Honghua Ye
- Department of Cardiology, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang 315010, P.R. China
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11
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Apelt K, Bijkerk R, Lebrin F, Rabelink TJ. Imaging the Renal Microcirculation in Cell Therapy. Cells 2021; 10:cells10051087. [PMID: 34063200 PMCID: PMC8147454 DOI: 10.3390/cells10051087] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/23/2021] [Accepted: 04/30/2021] [Indexed: 12/12/2022] Open
Abstract
Renal microvascular rarefaction plays a pivotal role in progressive kidney disease. Therefore, modalities to visualize the microcirculation of the kidney will increase our understanding of disease mechanisms and consequently may provide new approaches for evaluating cell-based therapy. At the moment, however, clinical practice is lacking non-invasive, safe, and efficient imaging modalities to monitor renal microvascular changes over time in patients suffering from renal disease. To emphasize the importance, we summarize current knowledge of the renal microcirculation and discussed the involvement in progressive kidney disease. Moreover, an overview of available imaging techniques to uncover renal microvascular morphology, function, and behavior is presented with the associated benefits and limitations. Ultimately, the necessity to assess and investigate renal disease based on in vivo readouts with a resolution up to capillary level may provide a paradigm shift for diagnosis and therapy in the field of nephrology.
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Affiliation(s)
- Katerina Apelt
- Department of Internal Medicine-Nephrology, Leiden University Medical Center, 2333ZA Leiden, The Netherlands; (K.A.); (R.B.); (F.L.)
- Einthoven Laboratory of Vascular and Regenerative Medicine, Leiden University Medical Center, 2333ZA Leiden, The Netherlands
| | - Roel Bijkerk
- Department of Internal Medicine-Nephrology, Leiden University Medical Center, 2333ZA Leiden, The Netherlands; (K.A.); (R.B.); (F.L.)
- Einthoven Laboratory of Vascular and Regenerative Medicine, Leiden University Medical Center, 2333ZA Leiden, The Netherlands
| | - Franck Lebrin
- Department of Internal Medicine-Nephrology, Leiden University Medical Center, 2333ZA Leiden, The Netherlands; (K.A.); (R.B.); (F.L.)
- Einthoven Laboratory of Vascular and Regenerative Medicine, Leiden University Medical Center, 2333ZA Leiden, The Netherlands
- Physics for Medicine Paris, Inserm, CNRS, ESPCI Paris, Paris Sciences et Lettres University, 75005 Paris, France
| | - Ton J. Rabelink
- Department of Internal Medicine-Nephrology, Leiden University Medical Center, 2333ZA Leiden, The Netherlands; (K.A.); (R.B.); (F.L.)
- Einthoven Laboratory of Vascular and Regenerative Medicine, Leiden University Medical Center, 2333ZA Leiden, The Netherlands
- Correspondence:
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12
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Yan G, Tang C, Ma G. The Predictive Value of Myeloperoxidase for Contrast-Induced Nephropathy After Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction. Int J Gen Med 2021; 14:1621-1629. [PMID: 33958892 PMCID: PMC8096440 DOI: 10.2147/ijgm.s303678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/12/2021] [Indexed: 11/23/2022] Open
Abstract
Background Higher serum myeloperoxidase (MPO) in patients with acute coronary syndrome is associated with adverse cardiovascular outcomes. Contrast-induced nephropathy (CIN) is associated with worse prognosis in patients with coronary artery disease following angiography. We have no idea whether patients with higher serum myeloperoxidase have a higher risk of CIN in acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). Methods This study involved 436 consecutive patients with AMI who had received PCI. Serum MPO levels were determined using enzyme-linked immunosorbent assay before administration of contrast media. Multivariate logistic regression analysis was used to analyze the independent risk factors for CIN after univariate analysis. The receiver operator characteristic (ROC) analysis was performed to evaluate the predictive value of MPO for CIN. Results Among the 436 patients, 79 individuals (18.1%) suffered CIN after the PCI procedure. Patients who developed CIN had significantly higher MPO levels compared to those who did not ([203.8 (150.6–276.2)] versus [138.5 (129.9–149.2)]; p<0.001). Multivariate logistic regression analysis revealed that MPO level (OR 1.023, 95% CI: 1.017–1.029, p<0.001) was an independent risk factor for the incidence of CIN after adjusting for the baseline information, blood indicators and angiography procedural parameters. The area under the ROC curve for predicting CIN of MPO was 0.848, and the optimum cutoff point of MPO was 147.38ug/L; the sensitivity and specificity were 82.3% and 72.3%, respectively. Conclusion The results show that MPO is independently associated with an increased risk of CIN with AMI patients undergoing PCI. Further studies are needed to verify these results.
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Affiliation(s)
- Gaoliang Yan
- Department of Cardiology, Zhongda Hospital of Southeast University Medical School, Nanjing, 210009, People's Republic of China
| | - Chengchun Tang
- Department of Cardiology, Zhongda Hospital of Southeast University Medical School, Nanjing, 210009, People's Republic of China
| | - Genshan Ma
- Department of Cardiology, Zhongda Hospital of Southeast University Medical School, Nanjing, 210009, People's Republic of China
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13
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Zdziechowska M, Gluba-Brzózka A, Franczyk B, Rysz J. Biochemical Markers in the Prediction of Contrast-induced Acute Kidney Injury. Curr Med Chem 2021; 28:1234-1250. [PMID: 32357810 DOI: 10.2174/0929867327666200502015749] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 03/21/2020] [Accepted: 03/29/2020] [Indexed: 11/22/2022]
Abstract
For many years clinicians have been searching for "kidney troponin"- a simple diagnostic tool to assess the risk of acute kidney injury (AKI). Recently, the rise in the variety of contrast-related procedures (contrast computed tomography (CT), percutaneous coronary intervention (PCI) and angiography) has resulted in the increased number of contrast-induced acute kidney injuries (CI-AKI). CIAKI remains an important cause of overall mortality, prolonged hospitalisation and it increases the total costs of therapy. The consequences of kidney dysfunction affect the quality of life and they may lead to disability as well. Despite extensive worldwide research, there are no sensitive and reliable methods of CI-AKI prediction. Kidney Injury Molecule 1 (KIM-1) and Neutrophil Gelatinase Lipocalin (NGAL) have been considered as kidney-specific molecules. High concentrations of these substances before the implementation of contrast-related procedures have been suggested to enable the estimation of kidney vulnerability to CI-AKI and they seem to have the predictive potential for cardiovascular events and overall mortality. According to other authors, routine determination of known inflammation factors (e.g., CRP, WBC, and neutrophil count) may be helpful in the prediction of CIAKI. However, the results of clinical trials provide contrasting results. The pathomechanism of contrast- induced nephropathy remains unclear. Due to its prevalence, the evaluation of the risk of acute kidney injury remains a serious problem to be solved. This paper reviews pathophysiology and suggested optimal markers facilitating the prediction of contrast-induced acute kidney injury.
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Affiliation(s)
- Magdalena Zdziechowska
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Zeromskiego 113, 90-549 Lodz, Poland
| | - Anna Gluba-Brzózka
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Zeromskiego 113, 90-549 Lodz, Poland
| | - Beata Franczyk
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Zeromskiego 113, 90-549 Lodz, Poland
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Zeromskiego 113, 90-549 Lodz, Poland
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14
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Andreucci M, Provenzano M, Faga T, Gagliardi I, Pisani A, Perticone M, Coppolino G, De Sarro G, Serra R, Michael A. Darbepoetin alfa reduces cell death due to radiocontrast media in human renal proximal tubular cells. Toxicol Rep 2021; 8:816-821. [PMID: 33868961 PMCID: PMC8044868 DOI: 10.1016/j.toxrep.2021.03.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/17/2021] [Accepted: 03/27/2021] [Indexed: 01/19/2023] Open
Abstract
Radiocontrast medium, sodium diatrizoate, reduces renal cell viability in vitro. Effect of darbepoetin on diatrizoate-treated cells was studied. Pre-treatment of renal cells with darbepoetin could reduce diatrizoate toxicity. Darbepoetin caused changes in the activation state of signaling molecules.
The hypersialylated erythropoiesis stimulating agent (ESA) darbepoetin alfa was developed for the treatment of anemia, and has also been reported to have other nonerythropoietic effects. This study outlines one such effect against the toxicity of the radiocontrast medium (RCM) sodium diatrizoate (NaD) in human renal proximal tubular (HK-2) cells in vitro. Using a standard cell viability assay, we observed that pre-incubation of HK-2 cells with darbepoetin (at concentrations of 0.25and 1.0 μg/mL) for 2.5 h prior to addition of NaD (75 mg I/mL, for 2 h) reduced the decrease in cell viability due to the RCM, assayed 22 h after removal of the NaD, whilst maintaining the cells incubated with darbepoetin. Western blot analysis showed that darbepoetin reduced the phosphorylation of c-Jun N-terminal kinases (JNK)1/2 over a period of 1 h incubation with NaD, but did not have an obvious effect on several other targets associated with cell death/survival. However, incubation of HK-2 cells with darbepoetin for a further 22 h after prior exposure to NaD (75 mg I/mL, for 2 h) and subsequent immunoblotting showed that darbepoetin: caused recovery of the activity (phosphorylation) of pro-proliferative/survival signalling molecules, such as Akt (Ser473), STAT (signal transducer and activator of transcription)3(Tyr705); decreased activation of the pro-apoptotic transcription factor FOXO3a by increasing its phosphorylation at Thr32; decreased phosphorylation (activation) of p38 Mitogen activated protein kinase; and reduced poly(ADP-ribose)polymerase (PARP)-1 cleavage. In summary, we present here a beneficial nonerythropoietic effect of darbepoetin alfa against radiocontrast-induced toxicity together with modulation of signalling molecules that play a crucial role in determining cell fate.
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Affiliation(s)
- Michele Andreucci
- Department of "Health Sciences", Nephrology Unit, "Magna Graecia" University, I-88100, Catanzaro, Italy
| | - Michele Provenzano
- Department of "Health Sciences", Nephrology Unit, "Magna Graecia" University, I-88100, Catanzaro, Italy
| | - Teresa Faga
- Department of "Health Sciences", Nephrology Unit, "Magna Graecia" University, I-88100, Catanzaro, Italy
| | - Ida Gagliardi
- Department of "Health Sciences", Nephrology Unit, "Magna Graecia" University, I-88100, Catanzaro, Italy
| | - Antonio Pisani
- Department of "Public Health", Nephrology Unit, "Federico II" University, I-80131, Naples, Italy
| | - Maria Perticone
- Department of Experimental and Clinical Medicine, "Magna Græcia" University, I-88100, Catanzaro, Italy
| | - Giuseppe Coppolino
- Department of "Health Sciences", Nephrology Unit, "Magna Graecia" University, I-88100, Catanzaro, Italy
| | - Giovambattista De Sarro
- Department of "Health Sciences", Pharmacology Unit, "Magna Graecia" University, I-88100, Catanzaro, Italy
| | - Raffaele Serra
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, Headquarters: "Magna Graecia" University, I-88100, Catanzaro, Italy
| | - Ashour Michael
- Department of "Health Sciences", Nephrology Unit, "Magna Graecia" University, I-88100, Catanzaro, Italy
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15
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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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Alshogran OY, Nusair SD, El-Elimat T, Alzoubi KH, Obeidat A, Sweidan M. Evaluation of coenzyme Q10 combined with or without N-acetyl cysteine or atorvastatin for preventing contrast-induced kidney injury in diabetic rats. Naunyn Schmiedebergs Arch Pharmacol 2021; 394:1403-1410. [PMID: 33630121 DOI: 10.1007/s00210-021-02070-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/16/2021] [Indexed: 10/22/2022]
Abstract
Combined antioxidants effect for prevention of contrast-induced nephropathy (CIN) remains unclear. This study assessed the potential protective effects of coenzyme Q10 (CoQ10) alone or combined with N-acetyl cysteine (NAC) or atorvastatin against CIN in diabetic rats. Animals were randomly divided into five groups, including control and four disease groups with CIN and diabetes. Group 2 included diabetic rats with CIN. Groups 3-5 included diabetic rats that received CoQ10, CoQ10 and NAC, or CoQ10 and atorvastatin, respectively, before CIN induction. Serum, urine, and tissue were collected to evaluate renal protective effects of tested agents. Renal biomarkers, oxidative stress, and histopathological alterations were investigated. Rats with CIN showed significant renal impairment as revealed by the deleterious effects on kidney function and histology. While induction of CIN did not affect the renal levels of catalase, glutathione peroxidase (GPx), and thiobarbituric acid reactive substances, pretreatment of animals with CoQ10/NAC showed significant increase in GPx and catalase levels versus controls. Lastly, pretreatment with CoQ10/atorvastatin showed regenerative effect on distal tubules with mild kidney histology alterations relative to CIN rats. The combined use of CoQ10/atorvastatin could be a potential strategy to prevent CIN. However, future studies are warranted to test different combinations for longer prophylactic periods.
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Affiliation(s)
- Osama Y Alshogran
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan.
| | - Shreen D Nusair
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Tamam El-Elimat
- Department of Medicinal Chemistry and Pharmacognosy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Karem H Alzoubi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Abdullah Obeidat
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Maya Sweidan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan
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Guo Y, Li W, Qian M, Jiang T, Guo P, Du Q, Lin N, Xie X, Wu Z, Lin D, Liu D. D-4F Ameliorates Contrast Media-Induced Oxidative Injuries in Endothelial Cells via the AMPK/PKC Pathway. Front Pharmacol 2021; 11:556074. [PMID: 33658920 PMCID: PMC7917283 DOI: 10.3389/fphar.2020.556074] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 11/30/2020] [Indexed: 01/23/2023] Open
Abstract
Endothelial dysfunction is involved in the pathophysiological processes of contrast media (CM)–induced acute kidney injury (CI-AKI) after vascular angiography or intervention. Previous study found that apolipoprotein A-I (apoA-I) mimetic peptide, D-4F, alleviates endothelial impairments via upregulating heme oxygenase-1 (HO-1) expression and scavenging excessively generated reactive oxygen species (ROS). However, whether D-4F could ameliorate oxidative injuries in endothelial cells through suppressing ROS production remains unclear. In this study, a representative nonionic iodinated CM, iodixanol, was chosen for the in vitro and in vivo studies. Endothelial cell viability was assayed using micrographs, lactate dehydrogenase (LDH) activity, and cell counting kit-8 (CCK-8). Apoptosis was detected using flow cytometry analysis and caspase-3 activation. Endothelial inflammation was tested using monocyte adhesion assay and adhesion molecule expression. ROS production was detected by measuring the formation of lipid peroxidation malondialdehyde (MDA) through the thiobarbituric acid reactive substance (TBARS) assay. Peroxynitrite (ONOO⁻) formation was tested using the 3-nitrotyrosine ELISA kit. Iodixanol impaired cell viability, promoted vascular cell adhesion molecule-1 (VCAM-1) and intercellular cell adhesion molecule-1 (ICAM-1) expression, and induced cell apoptosis in human umbilical vein endothelial cells (HUVECs). However, D-4F mitigated these injuries. Furthermore, iodixanol induced the phosphorylation of protein kinase C (PKC) beta II, p47, Rac1, and endothelial nitric oxide synthase (eNOS) at Thr495, which elicited ROS release and ONOO⁻ generation. D-4F inhibited NADPH oxidase (NOX) activation, ROS production, and ONOO⁻ formation via the AMP-activated protein kinase (AMPK)/PKC pathway. Additionally, after an intravascular injection of iodixanol in Sprague Dawley rats, iodixanol induced a remarkable inflammatory response in arterial endothelial cells, although significant apoptosis and morphological changes were not observed. D-4F alleviated the vessel inflammation resulting from iodixanol in vivo. Collectively, besides scavenging ROS, D-4F could also suppress ROS production and ONOO⁻ formation through the AMPK/PKC pathway, which ameliorated oxidative injuries in endothelial cells. Hence, D-4F might serve as a potential agent in preventing CI-AKI.
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Affiliation(s)
- Yansong Guo
- Department of Cardiology, Fujian Provincial Hospital, Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Provincial Clinical Medicine College of Fujian Medical University, Fuzhou, China
| | - Wei Li
- Department of Cardiology, the Affiliated Xiamen Cardiovascular Hospital of Xiamen University, Medical College of Xiamen University, Xiamen, China
| | - Mingming Qian
- Department of Cardiology, the Affiliated Xiamen Cardiovascular Hospital of Xiamen University, Medical College of Xiamen University, Xiamen, China
| | - Ting Jiang
- MOE Key Laboratory of Spectrochemical Analysis & Instrumentation, High-field NMR Research Center, College of Chemistry and Chemical Engineering, Xiamen University, Xiamen, China
| | - Ping Guo
- Department of Cardiology, the Affiliated Xiamen Cardiovascular Hospital of Xiamen University, Medical College of Xiamen University, Xiamen, China
| | - Qian Du
- Department of Cardiology, the Affiliated Xiamen Cardiovascular Hospital of Xiamen University, Medical College of Xiamen University, Xiamen, China
| | - Na Lin
- Department of Cardiology, Fujian Provincial Hospital, Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Provincial Clinical Medicine College of Fujian Medical University, Fuzhou, China
| | - Xianwei Xie
- Department of Cardiology, Fujian Provincial Hospital, Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Provincial Clinical Medicine College of Fujian Medical University, Fuzhou, China
| | - Zhiyong Wu
- Department of Cardiology, Fujian Provincial Hospital, Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Provincial Clinical Medicine College of Fujian Medical University, Fuzhou, China
| | - Donghai Lin
- MOE Key Laboratory of Spectrochemical Analysis & Instrumentation, High-field NMR Research Center, College of Chemistry and Chemical Engineering, Xiamen University, Xiamen, China
| | - Donghui Liu
- Department of Cardiology, Fujian Provincial Hospital, Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Provincial Clinical Medicine College of Fujian Medical University, Fuzhou, China.,Department of Cardiology, the Affiliated Xiamen Cardiovascular Hospital of Xiamen University, Medical College of Xiamen University, Xiamen, China
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18
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Zhang D, Zhou X, Zhang H, Fan X, Lin Z, Xue H, Wang Y, Jin Z, Chen Y. Quick evaluation of lower leg ischemia in patients with peripheral arterial disease by time maximum intensity projection CT angiography: a pilot study. BMC Med Imaging 2021; 21:7. [PMID: 33407186 PMCID: PMC7789570 DOI: 10.1186/s12880-020-00537-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/13/2020] [Indexed: 01/05/2023] Open
Abstract
Background The purpose of this study is to evaluate a new method involving time maximum intensity projection (t-MIP) postprocessed from dynamic computed tomographic angiography (dyn-CTA) in diagnosing peripheral arterial disease (PAD). Methods A population of 34 patients with known PAD was examined with a combined CTA protocol consisting of a standard CTA (s-CTA) scan of the lower extremities and a dyn-CTA scan of the calves. For each lower leg, t-MIP images consisting of the MIP0 (sagittal MIP), MIP+θ (45° lateral MIP), and MIP−θ (− 45° lateral MIP) were automatically generated from dyn-CTA. An objective evaluation of the vascular CT attenuation of the best enhancement phase of dyn-CTA and t-MIP was measured; a subjective evaluation of vessel stenosis and occlusion was performed, assigning a score for t-MIP and s-CTA. The CT attenuation of t-MIP and dyn-CTA was compared, as were the runoff scores of t-MIP and s-CTA. Results The CT attenuation of t-MIP CTA of three vascular segments from 68 lower extremities was higher than that of the best enhancement phase of dyn-CTA and s-CTA, with statistically significant differences at the posterior tibial artery and fibular artery (all p < 0.05). There were strong correlations (r ≥ 0.75, p < 0.05) of the runoff scores between t-MIP and s-CTA. Conclusions There is potential clinical applicability of t-MIP in assisting with the diagnosis of lower leg vascular stenosis in dyn-CTA with reliable diagnostic accuracy and convenient immediacy.
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Affiliation(s)
- Daming Zhang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xueyan Zhou
- School of Technology, Harbin University, Harbin, China
| | - Haiping Zhang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiaobing Fan
- Department of Radiology, The University of Chicago, Chicago, IL, 60637, USA
| | - Zehong Lin
- School of Technology, Harbin University, Harbin, China
| | - Huadan Xue
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yining Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Yuexin Chen
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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19
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Huang S, Tang Y, Liu T, Zhang N, Yang X, Yang D, Hong G. A Novel Antioxidant Protects Against Contrast Medium-Induced Acute Kidney Injury in Rats. Front Pharmacol 2020; 11:599577. [PMID: 33329004 PMCID: PMC7729082 DOI: 10.3389/fphar.2020.599577] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/23/2020] [Indexed: 12/29/2022] Open
Abstract
Many studies proposed that oxidative stress and apoptosis are key mechanisms in the pathogenesis of contrast-induced acute kidney injury (CI-AKI). Xylose-pyrogallol conjugate (XP) is an original effective antioxidant that showed decent antioxidant and anti-apoptosis effect before. Thus the therapeutic effect and mechanism of XP in preventing CI-AKI in the short and long term were investigated in this research. Renal function and histological grade were evaluated to determine the severity of renal injury. Kidney samples were then collected for the measurement of oxidative stress markers and the detection of apoptosis. Transmission electron microscopy (TEM) and western blot of mitochondrial protein were utilized for the analysis of the mitochondrial conditions. The results demonstrated that the CI-AKI rats caused a significant decrease in renal function accompanied by a remarkable increase in Malondialdehyde (MDA), bax, caspase-3, cytochrome c (Cyt C) level, TdT-mediated dUTP nick end labeling (TUNEL) positive apoptotic cells, and damaged mitochondria, while a decline in antioxidase activities and mitochondrial superoxide dismutase 2 (SOD2) expression compared with the control rats. However, when XP (50 or 100 or 200 mg/kg/day) was given orally for consecutive 7 days before CI-AKI modeling, XP (200 mg/kg) showed a better capability to restore renal dysfunction, histopathological appearance, the level of apoptosis, mitochondrial damage, oxidative stress, and fibrosis generation without interference in computed tomographic imaging. Our study indicated that antioxidant XP played a nephroprotective role probably via antiapoptotic and antioxidant mechanisms. Besides, XP may regulate the mitochondria pathway via decreasing the ratio of bax/bcl-2, inhibiting caspase-3 expression, cytochrome c release, and superoxide dismutase 2 activity. Overall, XP as a high-efficient antioxidant may have the potentials to prevent CI-AKI.
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Affiliation(s)
- Shuo Huang
- Clinical College of Orthopedics, Tianjin Medical University, Tianjin Hospital, Tianjin, China
| | - Yanyan Tang
- Clinical College of Orthopedics, Tianjin Medical University, Tianjin Hospital, Tianjin, China
| | - Tianjun Liu
- Tianjin Key Laboratory of Biomedical Materials, Institute of Biomedical Engineering, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China
| | - Ning Zhang
- School of Chemical Engineering, Anhui University of Science and Technology, Huainan, China
| | - Xueyan Yang
- Clinical College of Orthopedics, Tianjin Medical University, Tianjin Hospital, Tianjin, China
| | - Dingwei Yang
- Department of Nephrology, Tianjin Hospital, Tianjin, China
| | - Ge Hong
- Tianjin Key Laboratory of Biomedical Materials, Institute of Biomedical Engineering, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China
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20
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Mathur N, Lu ZX, MacKay L, Lau T, Kuganesan A, Lau KK. Is point of care renal function testing reliable screening pre-IV contrast administration? Emerg Radiol 2020; 28:77-82. [PMID: 32725604 DOI: 10.1007/s10140-020-01829-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 07/22/2020] [Indexed: 01/12/2023]
Abstract
PURPOSE Intravenous iodinated contrast is a commonly used diagnostic aid to improve image quality on computed tomography. There exists a small risk of post-contrast acute kidney injury in patients receiving IV contrast. One of the biggest risk factors for developing PC-AKI is the presence of pre-existing renal dysfunction, making it important to measure the renal function prior to contrast administration. Point of care (POC) devices offer a quick estimation of renal function, potentially improving workflows in radiology departments. METHOD Two POC devices were evaluated, the Nova StatSensor and Abbott iSTAT. Patients undergoing routine radiological investigations had blood collected and analysed by a POC method and the laboratory method (Beckman AU5800). The two values were analysed and compared. Renal function was calculated using eGFR via the CKD-EPI result. eGFR values were stratified as high risk (eGFR < 30), moderate risk (eGFR 30-59) and low risk (eGFR ≥ 60). RESULTS One hundred eighty-six patients were included in the study. One hundred one patients underwent the Abbott iSTAT analysis, 139 patients underwent Nova StatSensor analysis, and 53 had both. Statistical analysis revealed that the StatSensor R2 value was 0.77, and coefficient variation was 10.65%. iSTAT had a R2 value of 0.83 and coefficient variation of 7.36%. The POC devices did not miss any high-risk patients but underreported eGFR values in certain patients. CONCLUSION POC devices are moderately accurate at detecting renal impairment in patients undergoing radiological investigations. They seem to be a good screening tool; however, any low eGFR values should be further examined.
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Affiliation(s)
- Namit Mathur
- Emergency Department, Monash Health, Clayton, Victoria, Australia.
| | - Zhong X Lu
- Monash Pathology, Monash Health, Clayton, Victoria, Australia.,Department of Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Lisa MacKay
- Monash Pathology, Monash Health, Clayton, Victoria, Australia
| | - Theodore Lau
- Monash Imaging, Monash Health, Clayton, Victoria, Australia
| | | | - Kenneth K Lau
- Department of Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.,Monash Imaging, Monash Health, Clayton, Victoria, Australia
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21
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Chen Q, Yu J, Rush BM, Stocker SD, Tan RJ, Kim K. Ultrasound super-resolution imaging provides a noninvasive assessment of renal microvasculature changes during mouse acute kidney injury. Kidney Int 2020; 98:355-365. [PMID: 32600826 DOI: 10.1016/j.kint.2020.02.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 01/22/2020] [Accepted: 02/06/2020] [Indexed: 12/26/2022]
Abstract
Acute kidney injury (AKI) is a risk factor for the development of chronic kidney disease (CKD). One mechanism for this phenomenon is renal microvascular rarefaction and subsequent chronic impairment in perfusion. However, diagnostic tools to monitor the renal microvasculature in a noninvasive and quantitative manner are still lacking. Ultrasound super-resolution imaging is an emerging technology that can identify microvessels with unprecedented resolution. Here, we applied this imaging technique to identify microvessels in the unilateral ischemia-reperfusion injury mouse model of AKI-to-CKD progression in vivo. Kidneys from 21 and 42 day post- ischemia-reperfusion injury, the contralateral uninjured kidneys, and kidneys from sham-operated mice were examined by ultrasound super-resolution and histology. Renal microvessels were successfully identified by this imaging modality with a resolution down to 32 μm. Renal fibrosis was observed in all kidneys with ischemia-reperfusion injury and was associated with a significant reduction in kidney size, cortical thickness, relative blood volume, and microvascular density as assessed by this imaging. Tortuosity of the cortical microvasculature was also significantly increased at 42 days compared to sham. These vessel density measurements correlated significantly with CD31 immunohistochemistry (R2=0.77). Thus, ultrasound super-resolution imaging provides unprecedented resolution and is capable of noninvasive quantification of renal vasculature changes associated with AKI-to-CKD progression in mice. Hence, this technique could be a promising diagnostic tool for monitoring progressive kidney disease.
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Affiliation(s)
- Qiyang Chen
- Department of Bioengineering, University of Pittsburgh School of Engineering, Pittsburgh, Pennsylvania, USA; Center for Ultrasound Molecular Imaging and Therapeutics, Department of Medicine, Heart and Vascular Institute, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jaesok Yu
- Department of Bioengineering, University of Pittsburgh School of Engineering, Pittsburgh, Pennsylvania, USA; Center for Ultrasound Molecular Imaging and Therapeutics, Department of Medicine, Heart and Vascular Institute, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Brittney M Rush
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Sean D Stocker
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Roderick J Tan
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
| | - Kang Kim
- Department of Bioengineering, University of Pittsburgh School of Engineering, Pittsburgh, Pennsylvania, USA; Center for Ultrasound Molecular Imaging and Therapeutics, Department of Medicine, Heart and Vascular Institute, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; McGowan Institute of Regenerative Medicine, University of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; Department of Mechanical Engineering and Materials Science, University of Pittsburgh School of Engineering, Pittsburgh, Pennsylvania, USA.
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22
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Quercetin, a Promising Clinical Candidate for The Prevention of Contrast-Induced Nephropathy. Int J Mol Sci 2019; 20:ijms20194961. [PMID: 31597315 PMCID: PMC6801677 DOI: 10.3390/ijms20194961] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/02/2019] [Accepted: 10/04/2019] [Indexed: 01/09/2023] Open
Abstract
Iodinated contrast media (CM) are the leading cause of acute renal failure of toxic origin. Between 21% and 50% of patients that receive them develop contrast-induced nephropathy (CIN). All prophylactic measures used so far have failed to provide effective prevention. Since oxidative stress is involved in the damage, a possible preventive strategy could be the administration of antioxidant substances, such as quercetin. This compound has shown renoprotective effects in experimental studies. The aim of this study was to evaluate whether quercetin may be helpful in preventing CIN in patients undergoing coronary catheterization. A clinical phase II study was conducted. Patients were distributed in two groups, namely, CM (patients who only received contrast media) and CM+Q (patients who were pretreated with quercetin orally for 3-5 days). Results showed less incidence of CIN in the CM+Q group, possibly due to glomerular protection, evidenced by a lower increase in serum creatinine and albuminuria; and a lower decrease in the glomerular filtration rate (GFR). Furthermore, in this group, the relative risk of developing CIN observed in patients that received a high dose of contrast media was inferior. In conclusion, this is the first study that demonstrates that quercetin is a promising safe candidate in preventing CIN.
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23
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Demir MC, Akkas M. Awareness of Risks Associated with the Use of Plain X-Ray, Computed Tomography, and Magnetic Resonance Imaging Among Emergency Physicians and Comparison with that of Other Physicians: A Survey from Turkey. MEDICAL SCIENCE MONITOR : INTERNATIONAL MEDICAL JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2019; 25:6587-6597. [PMID: 31476197 PMCID: PMC6738011 DOI: 10.12659/msm.918381] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Increased use of radiological imaging in all departments of medicine, especially in the Emergency Department, requires that physicians have a high level of knowledge regarding commonly used imaging methods and high awareness of the risks of examinations. MATERIAL AND METHODS The physicians were divided into 5 groups according to their specialties as emergency medicine physicians (EMPs), physicians from any specialty of internal sciences, physicians from any specialty of surgical sciences, general practitioners (GPs), and radiologists. A total of 700 physicians answered the questionnaire via email. RESULTS 15.7% of EMPs reported that they did not routinely perform any risk assessment before requesting computed tomography (CT); the rate was 17.9% for direct radiography and 29.3% for magnetic resonance imaging (MRI). The proportions of physicians who do not routinely perform risk assessments for direct radiography, CT, and MRI were as follows: 16.4%, 8.6%, and 19.3% in physicians from medical sciences, respectively; 25%, 22.9%, and 35% in physicians from surgical sciences, respectively; 24.3%, 14.3%, and 37.1% in GPs, respectively; and 27.1%, 22.1% and 37.1% in radiologists, respectively. In all radiological examinations, 1.4% of EMPs and ≤1.4% of other physicians routinely explain the risks associated with the imaging method to the patients, and discuss the risks and benefits of the imaging with the patients. CONCLUSIONS All physicians, including EMPs, need to undergo urgent training to increase their knowledge on risks of imaging methods and discussion of existing risks with patients.
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Affiliation(s)
- Mehmet Cihat Demir
- Department of Emergency Medicine, Sinop Atatürk State Hospital, Sinop, Turkey
| | - Meltem Akkas
- Department of Emergency Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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24
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Wang Y, Wang B, Qi X, Zhang X, Ren K. Resveratrol Protects Against Post-Contrast Acute Kidney Injury in Rabbits With Diabetic Nephropathy. Front Pharmacol 2019; 10:833. [PMID: 31402864 PMCID: PMC6675867 DOI: 10.3389/fphar.2019.00833] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 06/28/2019] [Indexed: 12/31/2022] Open
Abstract
Resveratrol (Res) is a multi-functional polyphenol compound that has protective functions in acute kidney diseases. Here, we examined whether the resveratrol could ameliorate post-contrast acute kidney injury (PC-AKI) following diabetic nephropathy (DN), and explored any underlying mechanism(s) in vivo and in vitro. Twenty-four rabbits with DN were randomly divided into four groups: control (Cont), resveratrol (Res), iohexol (PC-AKI), and resveratrol plus iohexol (Res+PC-AKI) groups. Functional magnetic resonance imaging, renal histology, blood and urinary biomarkers, silent information regulator l (SIRT1), peroxisome proliferator-activated receptor gamma coactivator-1 alpha (PGC-1α), hypoxia-inducible transcription factor-1α (HIF-1α), and apoptosis-associated protein expression were assessed ex vivo. For in vitro experiments, renal tubular epithelial (HK-2) cells subjected to high glucose conditions were treated with resveratrol, Ex527, an SIRT1 inhibitor, or 2-methoxyestradiol (2-MeOE2), HIF-1α inhibitor, before treatment with iohexol. With regard to the rabbit model of acute renal injury in DN, compared to the PC-AKI group, the Res+PC-AKI group showed decreased levels of cystatin C and urinary neutrophil gelatinase-associated lipocalin, increased pure molecular diffusion (D) and the fraction of water flowing in capillaries (f), a decreased apparent relaxation rate (R2*), renal injury score and apoptosis rate, increased protein expression levels of SIRT1 and PGC-1α, and decreased levels of HIF-1α and apoptosis-associated protein. In addition, iohexol decreased HK-2 cell survival and increased the cell apoptosis rate; results were reversed after treating cells with resveratrol. Resveratrol reduced renal hypoxia, mitochondrial dysfunction and renal tubular cell apoptosis by activating SIRT1-PGC-1α-HIF-1α signaling pathways in PC-AKI with DN.
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Affiliation(s)
- Yongfang Wang
- Department of Radiology, First Hospital of Shanxi Medical University, Taiyuan, China.,Department of Radiology, First Hospital of China Medical University, Shenyang, China
| | - Bin Wang
- Department of Radiology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xun Qi
- Department of Radiology, First Hospital of China Medical University, Shenyang, China
| | - Xin Zhang
- Department of Radiology, First Hospital of China Medical University, Shenyang, China
| | - Ke Ren
- Department of Radiology, Xiang' an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
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25
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Zhao F, Lei R, Yang SK, Luo M, Cheng W, Xiao YQ, Li XW, Guo J, Duan SB. Comparative effect of iso-osmolar versus low-osmolar contrast media on the incidence of contrast-induced acute kidney injury in diabetic patients: a systematic review and meta-analysis. Cancer Imaging 2019; 19:38. [PMID: 31215488 PMCID: PMC6580528 DOI: 10.1186/s40644-019-0224-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 06/04/2019] [Indexed: 01/19/2023] Open
Abstract
Background Contrast-induced acute kidney injury (CI-AKI) is a major adverse effect caused by intravascular administration of iodinated contrast medium. Whether there is a difference in CI-AKI incidence between iso-osmolar (IOCM) and low-osmolar contrast media (LOCM) among diabetic patients is controversial. Methods Randomized controlled trials comparing the nephrotoxic effects between IOCM and LOCM in diabetic patients with or without CKD (eGFR< 60 ml/min/1.73 m2) were included in the analysis. The incidence of CI-AKI was defined as an initial increase in serum creatinine (SCr) concentration of at least 0.5 mg/dl or a rise in creatinine of 25% from baseline. Results A total of 2190 patients were included, among whom 1122 patients received IOCM and 1068 received LOCM. When compared to LOCM, IOCM had no significant benefit in preventing CI-AKI (OR = 1.66, [CI: 0.97–2.84], P = 0.06, I2 = 54%). However, the difference between IOCM and LOCM was found when CI-AKI was defined as an absolute SCr increase (≥0.5 mg/dl) rather than a relative SCr increase (≥25%). Further analysis showed that LOCM resulted in more adverse events. Conclusions Whether there is a difference of CI-AKI incidence between IOCM and LOCM in diabetic patients was related to the selected diagnostic criteria. The incidence of adverse events was significantly lower with IOCM when compared with LOCM. Therefore, we suggest that IOCM may be used in diabetic and CKD (eGFR< 60 ml/min/1.73 m2) patients. Electronic supplementary material The online version of this article (10.1186/s40644-019-0224-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fei Zhao
- Department of Nephrology, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China
| | - Rong Lei
- Department of Nephrology, Changsha Central hospital, Changsha, 410004, Hunan, People's Republic of China
| | - Shi-Kun Yang
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, People's Republic of China
| | - Min Luo
- Department of Nephrology, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China
| | - Wei Cheng
- Department of Nephrology, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China
| | - Ye-Qing Xiao
- Department of Nephrology, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China
| | - Xu-Wei Li
- Department of Nephrology, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China
| | - Jun Guo
- Department of Nephrology, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China
| | - Shao-Bin Duan
- Department of Nephrology, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China.
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26
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Ward DB, Valentovic MA. Contrast Induced Acute Kidney Injury and Direct Cytotoxicity of Iodinated Radiocontrast Media on Renal Proximal Tubule Cells. J Pharmacol Exp Ther 2019; 370:160-171. [PMID: 31101680 DOI: 10.1124/jpet.119.257337] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 05/16/2019] [Indexed: 12/12/2022] Open
Abstract
The administration of intravenous iodinated radiocontrast media (RCM) to visualize internal structures during diagnostic procedures has increased exponentially since their first use in 1928. A serious side effect of RCM exposure is contrast-induced acute kidney injury (CI-AKI), which is defined as an abrupt and prolonged decline in renal function occurring 48-72 hours after injection. Multiple attempts have been made to decrease the toxicity of RCM by altering ionic strength and osmolarity, yet there is little evidence to substantiate that a specific RCM is superior in avoiding CI-AKI. RCM-associated kidney dysfunction is largely attributed to alterations in renal hemodynamics, specifically renal vasoconstriction; however, numerous studies indicate direct cytotoxicity as a source of epithelial damage. Exposure of in vitro renal proximal tubule cells to RCM has been shown to affect proximal tubule epithelium in the following manner: 1) changes to cellular morphology in the form of vacuolization; 2) increased production of reactive oxygen species, resulting in oxidative stress; 3) mitochondrial dysfunction, resulting in decreased efficiency of the electron transport chain and ATP production; 4) perturbation of the protein folding capacity of the endoplasmic reticulum (ER) (activating the unfolded protein response and inducing ER stress); and 5) decreased activity of cell survival kinases. The present review focuses on the direct cytotoxicity of RCM on proximal tubule cells in the absence of in vivo complications, such as alterations in renal hemodynamics or cytokine influence.
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Affiliation(s)
- Dakota B Ward
- Department of Biomedical Sciences, Toxicology Research Cluster, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia
| | - Monica A Valentovic
- Department of Biomedical Sciences, Toxicology Research Cluster, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia
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27
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Mamoulakis C, Fragkiadoulaki I, Karkala P, Georgiadis G, Zisis IE, Stivaktakis P, Kalogeraki A, Tsiaoussis I, Burykina T, Lazopoulos G, Tsarouhas K, Kouretas D, Tsatsakis A. Contrast-induced nephropathy in an animal model: Evaluation of novel biomarkers in blood and tissue samples. Toxicol Rep 2019; 6:395-400. [PMID: 31080747 PMCID: PMC6506864 DOI: 10.1016/j.toxrep.2019.04.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/19/2019] [Accepted: 04/28/2019] [Indexed: 12/26/2022] Open
Abstract
Identification of novel biomarkers of contrast-induced nephropathy (CIN) that may more accurately detect renal function changes; reflect kidney damage; assist monitoring; and elucidate pathophysiology attract considerable scientific attention nowadays. To evaluate novel biomarkers of nephrotoxicity in blood/tissue samples of a CIN model, 10 New Zealand white rabbits were divided into group 1 (n = 5; iopromide) and group 2 (n = 5; control). Blood was drawn at 0 h (immediately), 24 h and 48 h after contrast medium (CM) administration. Animals were euthanized at 48 h and kidneys were removed. Serum creatinine (sCr)/symmetric-asymmetric dimethylarginine (SDMA-ADMA) levels were measured. CM genotoxic/cytotoxic effect was investigated 48 h post-CM exposure using micronucleus assay in lymphocytes. Cytological examination was conducted using touch preparation technique (TPT). All animals in group 1 developed CIN: mean sCr levels increased by 68.2% within 48 h. Significant SDMA-ADMA level elevation was observed at 0 h and 24 h with insignificant drop at 48 h in group 1, remaining normal in group 2 at all time-points. Significant increase in bi-nucleated cells with micronuclei and micronuclei frequency was detected in group 1. Cytokinesis block proliferation index was reduced insignificantly in group 1. TPT revealed degenerative lesions/inflammation, cell degeneration, abnormal uterine tubular casts and rubella in kidneys of all animals in group 1. Group 2 presented normal cells.
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Key Words
- ADMA, asymmetric dimethylarginine
- AKI, acute kidney injury
- ANOVA, analysis of variance
- ARRIVE, animal research: reporting of in vivo experiments
- AVMA, American Veterinary Medical Association
- Animal
- Asymmetric dimethylarginine
- BNMN, Bi-nucleated cells with micronuclei
- CBPI, cytokinesis block proliferation index
- CIN, contrast-induced nephropathy
- CKD, chronic kidney disease
- CM, contrast medium
- Contrast media
- ESI, electrospray ionization
- GFR, glomerular filtration rate
- Iopromide
- KIM-1, kidney injury molecule-1
- Kidney
- LC–MS, liquid chromatography mass spectrometry
- MN, micronuclei
- Models
- NGAL, meutrophil gelatinase–associated lipocalin
- NO, nitric oxide
- Nephropathy
- Nephrotoxicity
- OECD, Organisation for Economic Co-operation and Development
- RBF, renal blood flow
- ROS, reactive oxygen species
- SCR, serum creatinine
- SD, standard deviation
- SDMA, symmetric dimethylarginine
- Symmetric dimethylarginine
- TPT, touch preparation technique
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Affiliation(s)
- Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece
| | - Irene Fragkiadoulaki
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, Heraklion, 71003, Greece
| | - Phaedra Karkala
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, Heraklion, 71003, Greece
| | - Georgios Georgiadis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece
| | - Ioannis-Erineos Zisis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, Heraklion, 71003, Greece
| | - Polychronis Stivaktakis
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, Heraklion, 71003, Greece
| | - Alexandra Kalogeraki
- Department of Pathology-Cytopathology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece
| | - Ioannis Tsiaoussis
- Laboratory of Anatomy-Histology-Embryology, University of Crete, Medical School, Heraklion, Crete, Greece
| | - Tatyana Burykina
- Department of Analytical and Forensic Medical Toxicology, Sechenov University, 2-4 Bolshaya Pirogovskaya st., 119991, Moscow, Russia
| | - George Lazopoulos
- Department of Cardiothoracic Surgery, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece
| | | | - Dimitrios Kouretas
- Department of Biochemistry and Biotechnology, University of Thessaly, 41500, Larissa, Greece
| | - Aristides Tsatsakis
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, Heraklion, 71003, Greece
- Department of Analytical and Forensic Medical Toxicology, Sechenov University, 2-4 Bolshaya Pirogovskaya st., 119991, Moscow, Russia
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Monami M, Cignarelli A, Pinto S, D'Onofrio L, Milluzzo A, Miccoli R, Penno G, Mannucci E. Alpha-tocopherol and contrast-induced nephropathy: A meta-analysis of randomized controlled trials. INT J VITAM NUTR RES 2019; 91:188-196. [PMID: 31017554 DOI: 10.1024/0300-9831/a000573] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: Contrast-induced nephropathy (CIN) is a relevant cause of acute renal dysfunction and is associated with an increased morbidity and mortality. Purpose: Verify the effect of α-tocopherol pre-treatment on CIN prevention in subjects with chronic kidney disease. Methods: A Medline/Embase and clinicaltrials.gov were searched up to May 1st, 2017. Randomized controlled trials recruiting patients undergoing diagnostic or therapeutic radiocontrast infusion comparing the effect of either oral or i.v. multiple administration of pharmacological dose of α-tocopherol in preventing CIN versus placebo were included. A random-effects model, calculating Mantel-Haenszel odds ratio with 95% confidence interval, was applied to study the effect of α-tocopherol on CIN occurrence. Funnel plot analysis was used to assess publication bias, while agreement within studies was measured by the I2 index and tested with the Q-Cochran test. Results: Out of 242 studies, 4 trials were selected. CIN incidence resulted significantly lower in α-tocopherol compared to placebo group (5.8% vs. 15.4%, MH-OR [95% C.I.] 0.34 [0.19 - 0.59]). Alpha-tocopherol treatment was associated with both a tendential higher eGFR (mean difference 2.19 [95% C.I. -0.41; 4.79] mL/min) and lower creatinine level (mean difference -0.06 [95% C.I. -0.21; 0.09] mg/dl) compared to placebo. No relevant publication bias (p = 0.48) and heterogeneity (I2 = 0%; χ2 = 1.01, df = 3 [p = 0.80], I2 = 0%) were evident. Conclusions: Alpha-tocopherol pre-treatment is associated with reduction of incidence of CIN. Its administration deserves to be further explored as a simple and inexpensive tool for CIN prevention.
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Affiliation(s)
- Matteo Monami
- Diabetology, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
| | - Angelo Cignarelli
- Department of Emergency and Organ Transplantation, Section on Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - Sara Pinto
- Postgraduate School of Endocrinology and Metabolism, University of Pavia, Italy
| | - Luca D'Onofrio
- Department of Experimental Medicine, Sapienza University, Rome
| | - Agostino Milluzzo
- Endocrinology Section, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Medical Center, Catania, Italy
| | - Roberto Miccoli
- Department of Clinical and Experimental Medicine, Section of Diabetes and Metabolic Diseases, University of Pisa - Cisanello Hospital, Pisa, Italy
| | - Giuseppe Penno
- Department of Clinical and Experimental Medicine, Section of Diabetes and Metabolic Diseases, University of Pisa - Cisanello Hospital, Pisa, Italy
| | - Edoardo Mannucci
- Diabetology, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
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29
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Jafarpour SM, Salimian M, Mohseni M, Talari HR, Aliasgharzadeh A, Farhood B, Moradi H, Safari H. Evaluation of Ameliorative Potential of Vitamins E and C on DNA Double Strand Break (DSB) in Patients Undergoing Computed Tomography (CT): A Clinical Study. INTERNATIONAL JOURNAL OF MOLECULAR AND CELLULAR MEDICINE 2019; 7:226-233. [PMID: 31516882 PMCID: PMC6709935 DOI: 10.22088/ijmcm.bums.7.4.226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 02/24/2019] [Indexed: 01/05/2023]
Abstract
Computed tomography (CT) is one of the most important diagnostic X-ray procedures which plays an important role in increasing the patient dose values. The purpose of this clinical study was to evaluate the efficacy of vitamins E and C in lowering down the level of DNA double strand break (DSB) caused by CT scan. Sixty patients for abdomen/pelvic enhanced CT scan were randomly assigned to placebo (control), vitamin C, and vitamin E groups. The patient blood samples were taken before and immediately after the CT scan. Counting the number of DSB was performed using γ-H2AX method as a sensitive biomarker. Immediately after the CT scan, the mean number of DSBs/cell increased in all three groups of control (131%, P<0.001), vitamin C (103%, P <0.001), and vitamin E (66%, P<0.001) compared to their mean before the CT scan. Furthermore, the results showed that vitamin E decreased the mean number of DSBs/cell by 22% in comparison with the control group (P =0.023), whereas vitamin C had no significant effect on reducing the DSB (<3%, P =0.741). It is concluded that the administration of vitamin E one hour before the CT scan, significantly decreases DSB levels.
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Affiliation(s)
- Seyed Masoud Jafarpour
- Department of Radiology and Medical Physics, Faculty of Paramedicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Morteza Salimian
- Department of Medical laboratory, Faculty of Paramedicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Mehran Mohseni
- Department of Radiology and Medical Physics, Faculty of Paramedicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Hamid Reza Talari
- Department of Radiology, Kashan University of Medical Sciences, Kashan, Iran
| | - Akbar Aliasgharzadeh
- Department of Radiology and Medical Physics, Faculty of Paramedicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Bagher Farhood
- Department of Radiology and Medical Physics, Faculty of Paramedicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Habiballah Moradi
- Department of Radiology and Medical Physics, Faculty of Paramedicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Hossein Safari
- Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran
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30
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Jiang W, Yu J, Xu J, Shen B, Wang Y, Luo Z, Wang C, Ding X, Teng J. Impact of cardiac catheterization timing and contrast media dose on acute kidney injury after cardiac surgery. BMC Cardiovasc Disord 2018; 18:191. [PMID: 30290766 PMCID: PMC6173877 DOI: 10.1186/s12872-018-0928-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 09/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The association between pre-operative cardiac catheterization and cardiac surgery associated acute kidney injury (CSA-AKI) has been reported inconsistently. The purpose of this study is to evaluate the effect of the catheterization timing and contrast media dose on the incidence of postoperative acute kidney injury. METHODS Patients who underwent cardiac catheterization and cardiac surgery successively from January 2015 to December 2015 were prospectively enrolled in this study. The primary outcome was CSA-AKI which was defined as the Kidney Disease: Improving Global Outcomes Definition and Staging (KDIGO) criteria. Univariate analysis and multivariate regression were performed to identify the predictors for CSA-AKI. Baseline characteristics were balanced with propensity score method for better adjustment. RESULTS A total of 1069 consecutive eligible patients were enrolled into this study. The incidence of CSA-AKI and AKI requiring renal replacement therapy (AKI-RRT) were 38.5% (412/1069) and 1.9% (20/1069) respectively. Preoperative estimated glomerular filtration rate less than 60 mL/min/1.73m2 (OR = 2.843 95% CI 1.374-5.882), the time interval between catheterization and surgery≤7 days (OR = 2.546, 95% CI 1.548-4.189) and the dose of contrast media (CM) > 240 mg/kg (OR = 2.490, 95%CI 1.392-4.457) were identified as predictors for CSA-AKI. In the patients with the dose of CM > 240 mg/kg, the incidence of CSA-AKI was higher in patients who underwent cardiac catheterization ≤7 days before cardiac surgery than in those of > 7 days before cardiac surgery (39.4% vs. 28.8%, p = 0.025). The longer interval of more than 7 days was revealed to be inversely associated with CSA-AKI through logistic regression (OR = 0.579, 95% CI 0.337-0.994). CONCLUSION Catheterization within 7 days of cardiac surgery and a dose of CM > 240 mg/kg were associated with the onset of CSA-AKI. For patients who received a dose of CM > 240 mg/kg, postponing the cardiac surgery is potentially beneficial to reduce the risk of CSA-AKI.
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Affiliation(s)
- Wuhua Jiang
- Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, No 180 Fenglin Rd, Shanghai, 200032, China.,Shanghai Institute of Kidney and Dialysis, Shanghai, China.,Shanghai Medical Center of Kidney, Shanghai, China
| | - Jiawei Yu
- Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, No 180 Fenglin Rd, Shanghai, 200032, China.,Shanghai Institute of Kidney and Dialysis, Shanghai, China.,Shanghai Medical Center of Kidney, Shanghai, China
| | - Jiarui Xu
- Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, No 180 Fenglin Rd, Shanghai, 200032, China.,Shanghai Institute of Kidney and Dialysis, Shanghai, China.,Shanghai Medical Center of Kidney, Shanghai, China
| | - Bo Shen
- Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, No 180 Fenglin Rd, Shanghai, 200032, China.,Shanghai Institute of Kidney and Dialysis, Shanghai, China.,Shanghai Medical Center of Kidney, Shanghai, China
| | - Yimei Wang
- Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, No 180 Fenglin Rd, Shanghai, 200032, China.,Shanghai Institute of Kidney and Dialysis, Shanghai, China.,Shanghai Medical Center of Kidney, Shanghai, China
| | - Zhe Luo
- Department of Cardiac Surgery Intensive Care Unit, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chunsheng Wang
- Department of Cardiovascular Surgery, Zhongshan Hospital, Shanghai, China
| | - Xiaoqiang Ding
- Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, No 180 Fenglin Rd, Shanghai, 200032, China.,Shanghai Institute of Kidney and Dialysis, Shanghai, China.,Shanghai Medical Center of Kidney, Shanghai, China.,Department of Nephrology, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China
| | - Jie Teng
- Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, No 180 Fenglin Rd, Shanghai, 200032, China. .,Shanghai Institute of Kidney and Dialysis, Shanghai, China. .,Shanghai Medical Center of Kidney, Shanghai, China. .,Department of Nephrology, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China. .,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China.
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31
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Fergus KB, Baradaran N, Tresh A, Conrad MB, Breyer BN. Use of angioembolization in urology: a review. Transl Androl Urol 2018; 7:535-544. [PMID: 30211044 PMCID: PMC6127546 DOI: 10.21037/tau.2018.05.12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 05/14/2018] [Indexed: 01/10/2023] Open
Abstract
This review discusses current and developing indications for angioembolization (AE) techniques in urology cases, including trauma and non-trauma uses for kidney, prostate, and bladder conditions. AE methods, complications and technical and clinical outcomes are outlined for each indication for the purpose of aiding urologists in selecting ideal candidates for this procedure.
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Affiliation(s)
- Kirkpatrick B. Fergus
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Nima Baradaran
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Anas Tresh
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Miles B. Conrad
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA, USA
| | - Benjamin N. Breyer
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
- Department of Biostatistics and Epidemiology, University of California-San Francisco, San Francisco, CA, USA
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32
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Abstract
Acute kidney injury, which is caused by renal ischemia-reperfusion injury (IRI), occurs
in several clinical situations and causes severe renal damage. There is no effective
therapeutic agent available for renal IRI at present. In this study, we performed an
experiment based on an in vivo murine model of renal IRI to examine the
effect of carnosol. Thirty Sprague-Dawley rats were randomized into three groups (10 rats
in each group): the sham, IRI, and carnosol groups. Rats in the carnosol group were
injected intravenously with 3 mg/kg of carnosol, and those in the sham and IRI groups were
injected intravenously with 10% dimethyl sulfoxide 1 h before ischemia. Rats were
sacrificed after 24 h of reperfusion. The blood and kidneys were harvested, renal function
was assessed, and histologic evaluation was performed to analyze renal injury. A renal
myeloperoxidase activity assay, in-situ apoptosis examination,
enzyme-linked immunosorbent assay, immunohistochemical assay, and western blot were also
performed. Carnosol pretreatment significantly reduced renal dysfunction and histologic
damage induced by renal IRI. Carnosol pretreatment suppressed renal inflammatory cell
infiltration and pro-inflammatory cytokine expression. In addition, carnosol markedly
inhibited apoptotic tubular cell death, caspase-3 activation, and activation of the p38
pathway. Carnosol pretreatment protects rats against renal IRI by inhibiting inflammation
and apoptosis. Although future investigation is needed, carnosol may be a potential
therapeutic agent for preventing renal IRI.
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Affiliation(s)
- Yi Zheng
- Department of Urology, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, People's Republic of China
| | - Yong Zhang
- Department of Urology, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, People's Republic of China
| | - Yichun Zheng
- Department of Urology, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, People's Republic of China
| | - Nan Zhang
- Department of Urology, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, People's Republic of China
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33
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Mueller-Peltzer K, Negrão de Figueiredo G, Fischereder M, Habicht A, Rübenthaler J, Clevert DA. Contrast-enhanced ultrasound (CEUS) as a new technique to characterize suspected renal transplant malignancies in renal transplant patients in comparison to standard imaging modalities. Clin Hemorheol Microcirc 2018; 69:69-75. [PMID: 29630539 DOI: 10.3233/ch-189114] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Renal transplant patients have a higher risk for malignancies of the renal transplant. In most cases suspected renal malignancies will be detected during the regular ultrasound follow-up and will require cross-sectional imaging to rule out a malignant aetiology. But it is well known that contrast agents for computed tomography or magnetic resonance imaging are critical in patients with limited renal function. OBJECTIVE This study aims to compare the sensitivity and specificity of contrast-enhanced ultrasound (CEUS) and gold standard imaging modalities in characterizing suspected renal transplant malignancies in renal transplant patients. METHODS A total of 22 renal transplant patients who underwent one or more CEUS examinations and at least one standard imaging modality (CT or MRI) between 2005 and 2017 were included. Patient ages ranged from 28.2 years to 74.6 (mean age 55.7 years; SD±13.0 years). CEUS of 22 patients was correlated with a standard imaging modality, CT (15 out of 22) or MRI (7 out of 22), serving as gold standard. RESULTS CEUS showed a sensitivity of 100%, a specificity of 94.4%, a positive predictive value (PPV) of 80%, and a negative predictive value (NPV) of 100%. CONCLUSIONS CEUS is an eligible method to help characterizing suspected renal malignancies in renal transplant patients compared to the well-established imaging modalities CT and MRI. As an imaging modality with no nephrotoxic effects CEUS can be used repeatedly even in patients with limited renal function.
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Affiliation(s)
- K Mueller-Peltzer
- Department of Radiology, Ludwig-Maximilians-University Munich-Grosshadern Campus, Munich, Germany
| | - G Negrão de Figueiredo
- Department of Radiology, Ludwig-Maximilians-University Munich-Grosshadern Campus, Munich, Germany
| | - M Fischereder
- Department of Internal Medicine IV, Ludwig-Maximilians-University Munich-Grosshadern Campus, Munich, Germany
| | - A Habicht
- Department of Internal Medicine IV, Ludwig-Maximilians-University Munich-Grosshadern Campus, Munich, Germany
| | - J Rübenthaler
- Department of Radiology, Ludwig-Maximilians-University Munich-Grosshadern Campus, Munich, Germany
| | - D-A Clevert
- Department of Radiology, Ludwig-Maximilians-University Munich-Grosshadern Campus, Munich, Germany
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Li X, Chen H, Liu F, Chen Y, Zhang H, Wang Z. Accurate Monitoring of Renal Injury State through in Vivo Magnetic Resonance Imaging with Ferric Coordination Polymer Nanodots. ACS OMEGA 2018; 3:4918-4923. [PMID: 30221228 PMCID: PMC6130784 DOI: 10.1021/acsomega.8b00514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 04/25/2018] [Indexed: 06/08/2023]
Abstract
It is highly challenging to detect the pathophysiology of the diseased kidneys and achieve precise diagnosis because there are few in vivo noninvasive imaging techniques to quantitatively assess kidney dysfunction. This longstanding challenge is normally attributed to the limited molecular contrast agents which can be addressed with renal clearable nanoprobes. In this report, we demonstrate the use of magnetic resonance imaging along with renal clearable ferric coordination polymer nanodots (Fe-CPNDs) for in vivo monitoring the kidney dysfunction effects following drug (daunomycin)-induced kidney injury. After intravenous injection of Fe-CPNDs, the change of the MR signal in the kidney can be precisely correlated with local pathological lesion which is demonstrated by renal anatomic details and biochemical examinations of urine and blood. This finding opens the door to the possibility of noninvasively assessing kidney dysfunction and local injuries.
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Affiliation(s)
- Xiaodong Li
- Department
of Radiology, The First Hospital of Jilin
University, Changchun 130021, China
| | - Hongda Chen
- State
Key Laboratory of Electroanalytical Chemistry, Changchun Institute
of Applied Chemistry, Chinese Academy of
Sciences, Changchun 130022, China
- University
of Chinese Academy of Sciences, Beijing 100039, China
| | - Fuyao Liu
- State
Key Laboratory of Electroanalytical Chemistry, Changchun Institute
of Applied Chemistry, Chinese Academy of
Sciences, Changchun 130022, China
| | - Yixin Chen
- Department
of Radiology, The First Hospital of Jilin
University, Changchun 130021, China
| | - Huimao Zhang
- Department
of Radiology, The First Hospital of Jilin
University, Changchun 130021, China
| | - Zhenxin Wang
- State
Key Laboratory of Electroanalytical Chemistry, Changchun Institute
of Applied Chemistry, Chinese Academy of
Sciences, Changchun 130022, China
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35
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Mueller-Peltzer K, Rübenthaler J, Fischereder M, Habicht A, Reiser M, Clevert DA. The diagnostic value of contrast-enhanced ultrasound (CEUS) as a new technique for imaging of vascular complications in renal transplants compared to standard imaging modalities. Clin Hemorheol Microcirc 2018; 67:407-413. [PMID: 28885208 DOI: 10.3233/ch-179221] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Vascular complications in renal transplant patients are a well-known issue in post transplant patient care. If malfunctioning of the renal transplant is suspected to be caused by vascular complications an early diagnosis and therapy is required to maintain the renal transplant. Computed tomography (CT), digital substraction angiography (DSA) and radioisotope renography are the gold standard imaging modalities to diagnose vascular complications. OBJECTIVE To analyse the sensitivity and specificity of contrast-enhanced ultrasound (CEUS) in comparison to the standard imaging modalities CT, DSA and radioisotope renography in the diagnosis of vascular complications in renal transplant patients. METHODS A total of 33 renal transplant recipients with elevated kidney function parameters with initial diagnostic imaging between 2006 and 2017 were included in the study. The imaging studies and clinical data were analysed retrospectively. The diagnostic accuracy of CEUS was compared to CT, DSA and renal scintigraphy respectively which are classified as gold standard for diagnosis of vascular complications in renal transplant patients. Out of 23 patients 15 patients showed vascular complications in CT, DSA or radioisotope renography and in 15 out of 15 patients CEUS detected the vascular complication. RESULTS CEUS showed a sensitivity of 100%, a specificity of 66.7%, a positive predictive value (PPV) of 71.4%, and a negative predictive value (NPV) of 100%. CONCLUSIONS CEUS is a non-nephrotoxic and safe method for the initial imaging of vascular complications in renal transplant recipients. Compared to the gold standard imaging modalities CT, DSA and radioisotope renography CEUS shows a high sensitivity and NPV in detecting vascular complications. In cases with suspected stenosis of the transplant renal artery additional DSA might be needed.
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Affiliation(s)
- K Mueller-Peltzer
- Department of Radiology, Ludwig-Maximilians-University Munich - Grosshadern Campus, Munich, Germany
| | - J Rübenthaler
- Department of Radiology, Ludwig-Maximilians-University Munich - Grosshadern Campus, Munich, Germany
| | - M Fischereder
- Department of Internal Medicine IV, Ludwig-Maximilians-University Munich - Grosshadern Campus, Munich, Germany
| | - A Habicht
- Department of Internal Medicine IV, Ludwig-Maximilians-University Munich - Grosshadern Campus, Munich, Germany
| | - M Reiser
- Department of Radiology, Ludwig-Maximilians-University Munich - Grosshadern Campus, Munich, Germany
| | - D-A Clevert
- Department of Radiology, Ludwig-Maximilians-University Munich - Grosshadern Campus, Munich, Germany
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Urinary cGMP predicts major adverse renal events in patients with mild renal impairment and/or diabetes mellitus before exposure to contrast medium. PLoS One 2018; 13:e0195828. [PMID: 29649334 PMCID: PMC5896998 DOI: 10.1371/journal.pone.0195828] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 04/01/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The use of iodine-based contrast agents entails the risk of contrast induced nephropathy (CIN). Radiocontrast agents elicit the third most common cause of nephropathy among hospitalized patients, accounting for 11-12% of cases. CIN is connected with clinically significant consequences, including increased morbidity, prolonged hospitalization, increased risk of complications, potential need for dialysis, and increased mortality rate. The number of in-hospital examinations using iodine-based contrast media has been significantly increasing over the last decade. In order to protect patients from possible complications of such examinations, new biomarkers are needed that are able to predict a risk of contrast-induced nephropathy. Urinary and plasma cyclic guanosine monophosphate (cGMP) concentrations are influenced by renal function. Urinary cGMP is primarily of renal cellular origin. Therefore, we assessed if urinary cGMP concentration may predict major adverse renal events (MARE) after contrast media exposure during coronary angiography. METHODS Urine samples were prospectively collected from non-randomized consecutive patients with either diabetes or preexisting impaired kidney function receiving intra-arterial contrast medium (CM) for emergent or elective coronary angiography at the Charité Campus Mitte, University Hospital Berlin. Urinary cGMP concentration in spot urine was analyzed 24 hours after CM exposure. Patients were followed up over 90 days for occurrence of death, initiation of dialysis, doubling of plasma creatinine concentration or MARE. RESULTS In total, 289 consecutive patients were included into the study. Urine cGMP/creatinine ratio 24 hours before CM exposure expressed as mean±SD was predictive for the need of dialysis (no dialysis: 89.77±92.85 μM/mM, n = 277; need for dialysis: 140.3±82.90 μM/mM, n = 12, p = 0.008), death (no death during follow-up: 90.60±92.50 μM/mM, n = 280; death during follow-up: 169.88±81.52 μM/mM, n = 9; p = 0.002), and the composite endpoint MARE (no MARE: 86.02±93.17 μM/mM, n = 271; MARE: 146.64±74.68 μM/mM, n = 18, p<0.001) during the follow-up of 90 days after contrast media application. cGMP/creatinine ratio stayed significantly increased at values exceeding 120 μM/mM in patients who developed MARE, required dialysis or died. CONCLUSIONS Urinary cGMP/creatinine ratio ≥ 120 μM/mM before CM exposure is a promising biomarker for the need of dialysis and all-cause mortality 90 days after CM exposure in patients with preexisting renal impairment or diabetes.
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37
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Zhang Y, Jiang L, Wang B, Xi X. Epidemiological characteristics of and risk factors for patients with postoperative acute kidney injury: a multicenter prospective study in 30 Chinese intensive care units. Int Urol Nephrol 2018; 50:1319-1328. [PMID: 29480442 DOI: 10.1007/s11255-018-1828-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 02/17/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Although there were studies to investigate the risk factors for acute kidney injury (AKI) after surgery, most of them focused on one specific type of surgeries. The risk factors for postoperative AKI in patients undergoing all surgeries in intensive care units (ICU) have not been reported. METHODS Data from 1731 patients undergoing surgery in 30 ICUs of 28 tertiary hospitals in Beijing from March to August 2012 were prospectively collected. AKI was defined and staged by the KDIGO criteria. Multivariate logistic regression analysis was performed to assess independent risk factors for postoperative AKI. RESULTS Postoperative AKI occurred in 44.8% of patients (stage 1 54.8%; stage 2 21.9%, stage 3 23.3%). Cardiovascular surgery was identified as an independent factor for postoperative AKI as well as emergency surgery [odds ratio (OR) 1.403], nephrotoxic drugs (OR 1.303), APACHE II score (OR 1.055), SOFA score (OR 1.115), duration for positive fluid balance (OR 1.165), use of diuretics (OR 2.293), sepsis (OR 1.501), and CKD (OR 4.517). AKI stage 3 versus stages 1-2 was associated with higher mortality in ICU, hospital, and 28-day follow-up after cardiovascular, abdominal, limb, and chest surgeries, while this was not observed after neurosurgery or other surgeries. CONCLUSION Risk factors for AKI in ICU patients after different types of surgery were identified. This might be the first step to reduce the high incidence of AKI after surgery. The presence of AKI in ICU patients was associated with higher mortality after most types of surgery, but not after neurosurgery. TRIAL REGISTRATION ChiCTR-ONC-11001875.
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Affiliation(s)
- Yu Zhang
- Department of Critical Care Medicine, Fu Xing Hospital, Capital Medical University, Beijing, 100038, China
- Department of Intensive Care Units, Tangshan People's Hospital, Tangshan, 063000, China
| | - Li Jiang
- Department of Critical Care Medicine, Fu Xing Hospital, Capital Medical University, Beijing, 100038, China
| | - Baomin Wang
- Department of Intensive Care Units, Tangshan People's Hospital, Tangshan, 063000, China
| | - Xiuming Xi
- Department of Critical Care Medicine, Fu Xing Hospital, Capital Medical University, Beijing, 100038, China.
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38
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Bianco A, Zucco R, Lotito F, Pavia M. To what extent do hospitalised patients receive appropriate CT and MRI scans? Results of a cross-sectional study in Southern Italy. BMJ Open 2018; 8:e018125. [PMID: 29440209 PMCID: PMC5829596 DOI: 10.1136/bmjopen-2017-018125] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess the frequency of appropriateness of inpatient CT and MRI scans performed in Southern Italy. METHODS The study was carried out by retrospectively reviewing medical records of adult patients admitted between 1 January and 31 December 2012 in two hospitals. The evaluation of appropriateness was performed according to the American College of Radiology Appropriateness Criteria, which assigns a score between 1 and 9. RESULTS Eight hundred and fifty-three medical records were reviewed. Six hundred and thirty-nine patients received CT examinations and 256 received MRI examinations. Four hundred and ninety-six (77.6%) of the patient population had appropriate CT and 202 (78.9%) received appropriate MRI examinations. The appropriateness was associated with: a confirmation of the diagnostic hypothesis, only one examination performed during hospital stay, the anatomical scan region, with musculoskeletal system being the least appropriate anatomical scan region. Moreover, for CT examinations, appropriateness was also associated with no use of contrast agent. CONCLUSIONS Our findings highlight the need to reduce inappropriate use of CT and MRI. The study showed that the tool used is reliable to measure the extent of appropriateness of diagnostic imaging for inpatient examinations.
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Affiliation(s)
- Aida Bianco
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Rossella Zucco
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Francesca Lotito
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Maria Pavia
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
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Pakfetrat M, Malekmakan L, Salmanpour Z, Nikoo MH, Izadpanah P. Comparison of Normal Saline, Ringer's Lactate, and Sodium Bicarbonate for Prevention of Contrast-induced Nephropathy in Patients with Coronary Angiography: A Randomized Double-blind Clinical Trial. Indian J Nephrol 2018; 29:22-27. [PMID: 30814789 PMCID: PMC6375023 DOI: 10.4103/ijn.ijn_48_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Contrast-induced nephropathy (CIN) is one the most important renal complications following contrast injection in percutaneous coronary intervention. We compared the protective effect of normal saline (NLS), Ringer's lactate (RL), and sodium bicarbonate (Bi). In this study, patients with coronary angiography indication were divided into three groups by simple randomization method: NLS, RL, and Bi solution groups. Creatinine (Cr) alterations, glomerular filtration rate, and urine pH were evaluated prior and after the procedure. Data were analyzed with SPSS and P value less than 0.05 was taken as significant. In this study, 300 patients [150 men (50%), mean age 59.1 ± 10.6 years] were studied. The CIN incidence overall was 10% (30 patients): 8.3% (8 patients) in NLS; 16.5% (17 patients) in RL; and 5% (5 patients) in Bi group. It was significantly different among three groups (P = 0.018), and CIN incidence was significantly lower in Bi vs. RL group (P = 0.012). Baseline Cr clearance was higher in patients who developed CIN (78.4 ± 26.0 vs. 69.8 ± 21.6 mL/dL, P = 0.044). Urine pH after trial in CIN group was lower than the patients without CIN (5.5 ± 1.4 vs. 6.3 ± 1.8 mL/dL, P = 0.024). Higher urine pH and its change during study were seen in Bi group (P < 0.05). Cr at the initiation of study and the use of RL vs. Bi may be prognostic factors in CIN progression (P < 0.002). Sodium barcarbonate as fluid had more protective effect than NSL or RL on prevention of CIN in patients undergoing coronary angiography. The risk factors for CIN in our study were higher baseline serum Cr and use of RL as hydration fluid.
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Affiliation(s)
- Maryam Pakfetrat
- Department of Internal Medicine, Shiraz Nephro-Urology Research Center, Shiraz, Iran
| | - Leila Malekmakan
- Department of Internal Medicine, Shiraz Nephro-Urology Research Center, Shiraz, Iran
| | - Zahra Salmanpour
- Department of Internal Medicine, Shiraz Nephro-Urology Research Center, Shiraz, Iran
| | - Mohammad Hossein Nikoo
- Department of Cardiology, Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peyman Izadpanah
- Department of Cardiology, Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Hull TD, Agarwal A, Hoyt K. New Ultrasound Techniques Promise Further Advances in AKI and CKD. J Am Soc Nephrol 2017; 28:3452-3460. [PMID: 28923914 DOI: 10.1681/asn.2017060647] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
AKI and CKD are important clinical problems because they affect many patients and the associated diagnostic and treatment paradigms are imperfect. Ultrasound is a cost-effective, noninvasive, and simple imaging modality that offers a multitude of means to improve the diagnosis, monitoring, and treatment of both AKI and CKD, especially considering recent advances in this technique. Ultrasound alone can attenuate AKI and prevent CKD by stimulating the splenic cholinergic anti-inflammatory pathway. Additionally, microbubble contrast agents are improving the sensitivity and specificity of ultrasound for diagnosing kidney disease, especially when these agents are conjugated to ligand-specific mAbs or peptides, which make the dynamic assessment of disease progression and response to treatment possible. More recently, drug-loaded microbubbles have been developed and the load release by ultrasound exposure has been shown to be a highly specific treatment modality, making the potential applications of ultrasound even more promising. This review focuses on the multiple strategies for using ultrasound with and without microbubble technology for enhancing our understanding of the pathophysiology of AKI and CKD.
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Affiliation(s)
- Travis D Hull
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Anupam Agarwal
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.,Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
| | - Kenneth Hoyt
- Department of Bioengineering, University of Texas at Dallas, Richardson, Texas; and .,Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
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Yu T, Gao J, Liu ZM, Zhang QF, Liu Y, Jiang L, Peng Y. Contrast Dose and Radiation Dose Reduction in Abdominal Enhanced Computerized Tomography Scans with Single-phase Dual-energy Spectral Computerized Tomography Mode for Children with Solid Tumors. Chin Med J (Engl) 2017; 130:823-831. [PMID: 28345547 PMCID: PMC5381317 DOI: 10.4103/0366-6999.202731] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: Contrast dose and radiation dose reduction in computerized tomography (CT) scan for adult has been explored successfully, but there have been few studies on the application of low-concentration contrast in pediatric abdominal CT examinations. This was a feasibility study on the use of dual-energy spectral imaging and adaptive statistical iterative reconstruction (ASiR) for the reduction of radiation dose and iodine contrast dose in pediatric abdominal CT patients with solid tumors. Methods: Forty-five patients with solid tumors who had initial CT (Group B) and follow-up CT (Group A) after chemotherapy were enrolled. The initial diagnostic CT scan (Group B) was performed using the standard two-phase enhanced CT with 320 mgI/ml concentration contrast, and the follow-up scan (Group A) was performed using a single-phase enhanced CT at 45 s after the beginning of the 270 mgI/ml contrast injection using spectral mode. Forty percent ASiR was used for the images in Group B and monochromatic images with energy levels ≥60 keV in Group A. In addition, filtered back-projection (FBP) reconstruction was used for monochromatic images <60 keV in Group A. The total radiation dose, total iodine load, contrast injection speed, and maximum injection pressure were compared between the two groups. The 40 keV and 60 keV spectral CT images of Group A were compared with the images of Group B to evaluate overall image quality. Results: The total radiation dose, total iodine load, injection speed, and maximum injection pressure for Group A were decreased by 19%, 15%, 34.4%, and 18.3%, respectively. The optimal energy level in spectral CT for displaying the abdominal vessels was 40 keV. At this level, the CT values in the abdominal aorta and its three branches, the portal vein and its two branches, and the inferior vena cava were all greater than 340 hounsfield unit (HU). The abdominal organs of Groups A and B had similar degrees of absolute and relative enhancement (t = 0.36 and −1.716 for liver, −0.153 and −1.546 for pancreas, and 2.427 and 0.866 for renal cortex, all P > 0.05). Signal-to-noise ratio of the abdominal organs was significantly lower in Group A than in Group B (t = −8.11 for liver, −7.83 for pancreas, and −5.38 for renal cortex, all P < 0.05). However, the subjective scores for the 40 keV (FBP) and 60 keV (40% ASiR) spectral CT images determined by two radiologists were all >3, indicating clinically acceptable image quality. Conclusions: Single-phase, dual-energy spectral CT used for children with solid abdominal tumors can reduce contrast dose and radiation dose and can also maintain clinically acceptable image quality.
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Affiliation(s)
- Tong Yu
- Imaging Center, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Jun Gao
- Imaging Center, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Zhi-Min Liu
- Imaging Center, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Qi-Feng Zhang
- Imaging Center, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Yong Liu
- Imaging Center, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Ling Jiang
- Imaging Center, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Yun Peng
- Imaging Center, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
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Andreucci M, Faga T, Serra R, De Sarro G, Michael A. Update on the renal toxicity of iodinated contrast drugs used in clinical medicine. Drug Healthc Patient Saf 2017; 9:25-37. [PMID: 28579836 PMCID: PMC5447694 DOI: 10.2147/dhps.s122207] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
An important side effect of diagnostic contrast drugs is contrast-induced acute kidney injury (CI-AKI; a sudden decrease in renal function) occurring 48-72 hours after injection of a contrast drug that cannot be attributed to other causes. Its existence has recently been challenged, because of some retrospective studies in which the incidence of AKI was not different between subjects who received a contrast drug and those who did not, even using propensity score matching to prevent selection bias. For some authors, only patients with estimated glomerular filtration rate <30 mL/min/1.73 m2 are at significant risk of CI-AKI. Most agree that when renal function is normal, there is no CI-AKI risk. Many experimental studies, however, are in favor of the existence of CI-AKI. Contrast drugs have been shown to cause the following changes: renal vasoconstriction, resulting in a rise in intrarenal resistance (decrease in renal blood flow and glomerular filtration rate and medullary hypoxia); epithelial vacuolization and dilatation and necrosis of proximal tubules; potentiation of angiotensin II effects, reducing nitric oxide (NO) and causing direct constriction of descending vasa recta, leading to formation of reactive oxygen species in isolated descending vasa recta of rats microperfused with a solution of iodixanol; increasing active sodium reabsorption in the thick ascending limbs of Henle's loop (increasing O2 demand and consequently medullary hypoxia); direct cytotoxic effects on endothelial and tubular epithelial cells (decrease in release of NO in vasa recta); and reducing cell survival, due to decreased activation of Akt and ERK1/2, kinases involved in cell survival/proliferation. Prevention is mainly based on extracellular volume expansion, statins, and N-acetylcysteine; conflicting results have been obtained with nebivolol, furosemide, calcium-channel blockers, theophylline, and hemodialysis.
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Affiliation(s)
| | | | - Raffaele Serra
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, Department of Medical and Surgical Sciences
| | - Giovambattista De Sarro
- Pharmacology Unit, Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
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Demel SL, Grossman AW, Khoury JC, Moomaw CJ, Alwell K, Kissela BM, Woo D, Flaherty ML, Ferioli S, Mackey J, De Los Rios la Rosa F, Martini S, Adeoye O, Kleindorfer DO. Association Between Acute Kidney Disease and Intravenous Dye Administration in Patients With Acute Stroke: A Population-Based Study. Stroke 2017; 48:835-839. [PMID: 28258258 DOI: 10.1161/strokeaha.116.014603] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 12/22/2016] [Accepted: 01/03/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND PURPOSE Computed tomographic angiography and conventional angiography provide timely vascular anatomic information in patients with stroke. However, iodinated contrast dye may cause acute kidney injury (AKI). Within a large, biracial population, we examined in-hospital incidence of new or worsening kidney disease in patients with stroke and its association with administration of intravenous dye. METHODS All adult residents of the Greater Cincinnati/Northern Kentucky region with acute ischemic stroke or intracerebral hemorrhage who presented to an emergency department in 2010 were included. Prevalence of unsuspected kidney disease at the time of emergency department presentation and the incidence of AKI after admission in 2 groups of patients-those who did and those who did not receive intravenous dye-were determined. RESULTS In 2010, 2299 patients met inclusion criteria (89% ischemic stroke and 11% intracerebral hemorrhage); mean age 69 years (SD 15), 22% black, and 54% women. Among these patients, 37% had kidney disease at baseline, including 22% (516/2299) in whom this was unsuspected. Two percent (2%; 15/853) of patients with baseline kidney disease developed AKI during the hospital stay. Of those with no baseline kidney disease, 1% (14/14 467) developed AKI. There was no association between dye administration and new or worsening kidney disease. CONCLUSIONS Although 22% of patients in the Greater Cincinnati/Northern Kentucky stroke population had unsuspected kidney disease, the incidence of new or worsening kidney disease was low, and AKI was not associated with dye administration. These findings confirm single-center reports that the risk of severe renal complications after contrast dye is small.
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Affiliation(s)
- Stacie L Demel
- From the Neuroscience Institute (S.L.D., A.W.G., J.C.K., C.J.M., K.A., B.M.K., D.W., M.L.F., S.F., F.D.L.R.l.R., O.A., D.O.K.) and Department of Emergency Medicine (O.A.), University of Cincinnati College of Medicine, OH; Department of Neurology and Rehabilitation, University of Cincinnati Medical Center, OH (S.L.D., A.W.G., B.M.K., D.W., M.L.F., S.F., D.O.K.); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (J.C.K.); Department of Neurology, University of Indiana School of Medicine, Indianapolis (J.M.); Sanna Healthcare Network, Lima, Peru (F.D.L.R.l.R.); and Department of Neurology, Baylor College of Medicine, Houston, TX (S.M.).
| | - Aaron W Grossman
- From the Neuroscience Institute (S.L.D., A.W.G., J.C.K., C.J.M., K.A., B.M.K., D.W., M.L.F., S.F., F.D.L.R.l.R., O.A., D.O.K.) and Department of Emergency Medicine (O.A.), University of Cincinnati College of Medicine, OH; Department of Neurology and Rehabilitation, University of Cincinnati Medical Center, OH (S.L.D., A.W.G., B.M.K., D.W., M.L.F., S.F., D.O.K.); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (J.C.K.); Department of Neurology, University of Indiana School of Medicine, Indianapolis (J.M.); Sanna Healthcare Network, Lima, Peru (F.D.L.R.l.R.); and Department of Neurology, Baylor College of Medicine, Houston, TX (S.M.)
| | - Jane C Khoury
- From the Neuroscience Institute (S.L.D., A.W.G., J.C.K., C.J.M., K.A., B.M.K., D.W., M.L.F., S.F., F.D.L.R.l.R., O.A., D.O.K.) and Department of Emergency Medicine (O.A.), University of Cincinnati College of Medicine, OH; Department of Neurology and Rehabilitation, University of Cincinnati Medical Center, OH (S.L.D., A.W.G., B.M.K., D.W., M.L.F., S.F., D.O.K.); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (J.C.K.); Department of Neurology, University of Indiana School of Medicine, Indianapolis (J.M.); Sanna Healthcare Network, Lima, Peru (F.D.L.R.l.R.); and Department of Neurology, Baylor College of Medicine, Houston, TX (S.M.)
| | - Charles J Moomaw
- From the Neuroscience Institute (S.L.D., A.W.G., J.C.K., C.J.M., K.A., B.M.K., D.W., M.L.F., S.F., F.D.L.R.l.R., O.A., D.O.K.) and Department of Emergency Medicine (O.A.), University of Cincinnati College of Medicine, OH; Department of Neurology and Rehabilitation, University of Cincinnati Medical Center, OH (S.L.D., A.W.G., B.M.K., D.W., M.L.F., S.F., D.O.K.); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (J.C.K.); Department of Neurology, University of Indiana School of Medicine, Indianapolis (J.M.); Sanna Healthcare Network, Lima, Peru (F.D.L.R.l.R.); and Department of Neurology, Baylor College of Medicine, Houston, TX (S.M.)
| | - Kathleen Alwell
- From the Neuroscience Institute (S.L.D., A.W.G., J.C.K., C.J.M., K.A., B.M.K., D.W., M.L.F., S.F., F.D.L.R.l.R., O.A., D.O.K.) and Department of Emergency Medicine (O.A.), University of Cincinnati College of Medicine, OH; Department of Neurology and Rehabilitation, University of Cincinnati Medical Center, OH (S.L.D., A.W.G., B.M.K., D.W., M.L.F., S.F., D.O.K.); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (J.C.K.); Department of Neurology, University of Indiana School of Medicine, Indianapolis (J.M.); Sanna Healthcare Network, Lima, Peru (F.D.L.R.l.R.); and Department of Neurology, Baylor College of Medicine, Houston, TX (S.M.)
| | - Brett M Kissela
- From the Neuroscience Institute (S.L.D., A.W.G., J.C.K., C.J.M., K.A., B.M.K., D.W., M.L.F., S.F., F.D.L.R.l.R., O.A., D.O.K.) and Department of Emergency Medicine (O.A.), University of Cincinnati College of Medicine, OH; Department of Neurology and Rehabilitation, University of Cincinnati Medical Center, OH (S.L.D., A.W.G., B.M.K., D.W., M.L.F., S.F., D.O.K.); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (J.C.K.); Department of Neurology, University of Indiana School of Medicine, Indianapolis (J.M.); Sanna Healthcare Network, Lima, Peru (F.D.L.R.l.R.); and Department of Neurology, Baylor College of Medicine, Houston, TX (S.M.)
| | - Daniel Woo
- From the Neuroscience Institute (S.L.D., A.W.G., J.C.K., C.J.M., K.A., B.M.K., D.W., M.L.F., S.F., F.D.L.R.l.R., O.A., D.O.K.) and Department of Emergency Medicine (O.A.), University of Cincinnati College of Medicine, OH; Department of Neurology and Rehabilitation, University of Cincinnati Medical Center, OH (S.L.D., A.W.G., B.M.K., D.W., M.L.F., S.F., D.O.K.); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (J.C.K.); Department of Neurology, University of Indiana School of Medicine, Indianapolis (J.M.); Sanna Healthcare Network, Lima, Peru (F.D.L.R.l.R.); and Department of Neurology, Baylor College of Medicine, Houston, TX (S.M.)
| | - Matthew L Flaherty
- From the Neuroscience Institute (S.L.D., A.W.G., J.C.K., C.J.M., K.A., B.M.K., D.W., M.L.F., S.F., F.D.L.R.l.R., O.A., D.O.K.) and Department of Emergency Medicine (O.A.), University of Cincinnati College of Medicine, OH; Department of Neurology and Rehabilitation, University of Cincinnati Medical Center, OH (S.L.D., A.W.G., B.M.K., D.W., M.L.F., S.F., D.O.K.); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (J.C.K.); Department of Neurology, University of Indiana School of Medicine, Indianapolis (J.M.); Sanna Healthcare Network, Lima, Peru (F.D.L.R.l.R.); and Department of Neurology, Baylor College of Medicine, Houston, TX (S.M.)
| | - Simona Ferioli
- From the Neuroscience Institute (S.L.D., A.W.G., J.C.K., C.J.M., K.A., B.M.K., D.W., M.L.F., S.F., F.D.L.R.l.R., O.A., D.O.K.) and Department of Emergency Medicine (O.A.), University of Cincinnati College of Medicine, OH; Department of Neurology and Rehabilitation, University of Cincinnati Medical Center, OH (S.L.D., A.W.G., B.M.K., D.W., M.L.F., S.F., D.O.K.); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (J.C.K.); Department of Neurology, University of Indiana School of Medicine, Indianapolis (J.M.); Sanna Healthcare Network, Lima, Peru (F.D.L.R.l.R.); and Department of Neurology, Baylor College of Medicine, Houston, TX (S.M.)
| | - Jason Mackey
- From the Neuroscience Institute (S.L.D., A.W.G., J.C.K., C.J.M., K.A., B.M.K., D.W., M.L.F., S.F., F.D.L.R.l.R., O.A., D.O.K.) and Department of Emergency Medicine (O.A.), University of Cincinnati College of Medicine, OH; Department of Neurology and Rehabilitation, University of Cincinnati Medical Center, OH (S.L.D., A.W.G., B.M.K., D.W., M.L.F., S.F., D.O.K.); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (J.C.K.); Department of Neurology, University of Indiana School of Medicine, Indianapolis (J.M.); Sanna Healthcare Network, Lima, Peru (F.D.L.R.l.R.); and Department of Neurology, Baylor College of Medicine, Houston, TX (S.M.)
| | - Felipe De Los Rios la Rosa
- From the Neuroscience Institute (S.L.D., A.W.G., J.C.K., C.J.M., K.A., B.M.K., D.W., M.L.F., S.F., F.D.L.R.l.R., O.A., D.O.K.) and Department of Emergency Medicine (O.A.), University of Cincinnati College of Medicine, OH; Department of Neurology and Rehabilitation, University of Cincinnati Medical Center, OH (S.L.D., A.W.G., B.M.K., D.W., M.L.F., S.F., D.O.K.); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (J.C.K.); Department of Neurology, University of Indiana School of Medicine, Indianapolis (J.M.); Sanna Healthcare Network, Lima, Peru (F.D.L.R.l.R.); and Department of Neurology, Baylor College of Medicine, Houston, TX (S.M.)
| | - Sharyl Martini
- From the Neuroscience Institute (S.L.D., A.W.G., J.C.K., C.J.M., K.A., B.M.K., D.W., M.L.F., S.F., F.D.L.R.l.R., O.A., D.O.K.) and Department of Emergency Medicine (O.A.), University of Cincinnati College of Medicine, OH; Department of Neurology and Rehabilitation, University of Cincinnati Medical Center, OH (S.L.D., A.W.G., B.M.K., D.W., M.L.F., S.F., D.O.K.); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (J.C.K.); Department of Neurology, University of Indiana School of Medicine, Indianapolis (J.M.); Sanna Healthcare Network, Lima, Peru (F.D.L.R.l.R.); and Department of Neurology, Baylor College of Medicine, Houston, TX (S.M.)
| | - Opeolu Adeoye
- From the Neuroscience Institute (S.L.D., A.W.G., J.C.K., C.J.M., K.A., B.M.K., D.W., M.L.F., S.F., F.D.L.R.l.R., O.A., D.O.K.) and Department of Emergency Medicine (O.A.), University of Cincinnati College of Medicine, OH; Department of Neurology and Rehabilitation, University of Cincinnati Medical Center, OH (S.L.D., A.W.G., B.M.K., D.W., M.L.F., S.F., D.O.K.); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (J.C.K.); Department of Neurology, University of Indiana School of Medicine, Indianapolis (J.M.); Sanna Healthcare Network, Lima, Peru (F.D.L.R.l.R.); and Department of Neurology, Baylor College of Medicine, Houston, TX (S.M.)
| | - Dawn O Kleindorfer
- From the Neuroscience Institute (S.L.D., A.W.G., J.C.K., C.J.M., K.A., B.M.K., D.W., M.L.F., S.F., F.D.L.R.l.R., O.A., D.O.K.) and Department of Emergency Medicine (O.A.), University of Cincinnati College of Medicine, OH; Department of Neurology and Rehabilitation, University of Cincinnati Medical Center, OH (S.L.D., A.W.G., B.M.K., D.W., M.L.F., S.F., D.O.K.); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (J.C.K.); Department of Neurology, University of Indiana School of Medicine, Indianapolis (J.M.); Sanna Healthcare Network, Lima, Peru (F.D.L.R.l.R.); and Department of Neurology, Baylor College of Medicine, Houston, TX (S.M.)
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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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Molecular Ultrasound Imaging of Tissue Inflammation Using an Animal Model of Acute Kidney Injury. Mol Imaging Biol 2016; 17:786-92. [PMID: 25905474 DOI: 10.1007/s11307-015-0860-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The objective of this study was to evaluate the use of molecular ultrasound (US) imaging for monitoring the early inflammatory effects following acute kidney injury. PROCEDURES A population of rats underwent 30 min of renal ischemia (acute kidney injury, N = 6) or sham injury (N = 4) using established surgical methods. Animals were divided and molecular US imaging was performed during the bolus injection of a targeted microbubble (MB) contrast agent to either P-selectin or vascular cell adhesion molecule 1 (VCAM-1). Imaging was performed before surgery and 4 and 24 h thereafter. After manual segmentation of renal tissue space, the molecular US signal was calculated as the difference between time-intensity curve data before MB injection and after reaching steady-state US image enhancement. All animals were terminated after the 24 h imaging time point and kidneys excised for immunohistochemical (IHC) analysis. RESULTS Renal inflammation was analyzed using molecular US imaging. While results using the P-selectin and VCAM-1 targeted MBs were comparable, it appears that the former was more sensitive to biomarker expression. All molecular US imaging measures had a positive correlation with IHC findings. CONCLUSIONS Acute kidney injury is a serious disease in need of improved noninvasive methods to help diagnose the extent of injury and monitor the tissue throughout disease progression. Molecular US imaging appears well suited to address this challenge and more research is warranted.
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Harris MA, Snaith B, Clarke R. Strategies for assessing renal function prior to outpatient contrast-enhanced CT: a UK survey. Br J Radiol 2016; 89:20160077. [PMID: 27557630 DOI: 10.1259/bjr.20160077] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To identify current UK screening practices prior to contrast-enhanced CT. To determine the patient management strategies to minimize the risk of contrast-induced acute kidney injury (CI-AKI) risk in outpatients. METHODS An invitation to complete an electronic survey was distributed to the CT managers of 174 UK adult National Health Service hospital trusts. The survey included questions related to local protocols and national guidance on which these are based. Details of the assessment of renal function prior to imaging and thresholds for contrast contraindication and patient management were also sought. RESULTS A response rate of 47.1% was received. Almost all sites had a policy in place for contrast administration (n = 80/82; 97.6%). The majority of sites require a blood test on outpatients undergoing a contrast-enhanced CT scan (n = 75/82; 91.5%); however, some (15/75; 20.0%) sites only check the result in patients at high risk and a small number (7/82; 8.5%) of sites indicated that it was a referrer responsibility. The estimated glomerular filtration rate (eGFR) or serum creatinine (SCr) result threshold at which i.v. contrast was contraindicated varied and 19 different threshold levels of eGFR or SCr were identified, each leading to different prophylactic strategies. Inconsistency was noted in the provision of follow-up blood tests after contrast administration. CONCLUSION The wide variation in practice reflects inconsistencies in published guidance. Evidence-based consensuses of which patients to test and subsequent risk thresholds will aid clinicians identify those patients in which the risk of CI-AKI is clinically significant but manageable. There is also a need to determine the value of the various prophylactic strategies, follow-up regimen and efficient service delivery pathways. Advances in knowledge: This survey has identified that further work is required to define which patients are high risk, confirm those which require renal function testing prior to contrast administration and how best to manage patients at risk of CI-AKI. The role of new technologies within this service delivery pathway requires further investigation.
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Affiliation(s)
| | - Beverly Snaith
- 1 Radiology, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Ruth Clarke
- 1 Radiology, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
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Andreucci M, Faga T, Riccio E, Sabbatini M, Pisani A, Michael A. The potential use of biomarkers in predicting contrast-induced acute kidney injury. Int J Nephrol Renovasc Dis 2016; 9:205-21. [PMID: 27672338 PMCID: PMC5024777 DOI: 10.2147/ijnrd.s105124] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Contrast-induced acute kidney injury (CI-AKI) is a problem associated with the use of iodinated contrast media, causing kidney dysfunction in patients with preexisting renal failure. It accounts for 12% of all hospital-acquired kidney failure and increases the length of hospitalization, a situation that is worsening with increasing numbers of patients with comorbidities, including those requiring cardiovascular interventional procedures. So far, its diagnosis has relied upon the rise in creatinine levels, which is a late marker of kidney damage and is believed to be inadequate. Therefore, there is an urgent need for biomarkers that can detect CI-AKI sooner and more reliably. In recent years, many new biomarkers have been characterized for AKI, and these are discussed particularly with their use in known CI-AKI models and studies and include neutrophil gelatinase-associated lipocalin, cystatin C (Cys-C), kidney injury molecule-1, interleukin-18, N-acetyl-β-d-glucosaminidase, and L-type fatty acid-binding protein (L-FABP). The potential of miRNA and metabolomic technology is also mentioned. Early detection of CI-AKI may lead to early intervention and therefore improve patient outcome, and in future any one or a combination of several of these markers together with development in technology for their analysis may prove effective in this respect.
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Affiliation(s)
- Michele Andreucci
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro
| | - Teresa Faga
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro
| | - Eleonora Riccio
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Massimo Sabbatini
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Antonio Pisani
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Ashour Michael
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro
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Association between Serum Ferritin and Contrast-Induced Nephropathy in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention. BIOMED RESEARCH INTERNATIONAL 2016; 2016:5420345. [PMID: 27547760 PMCID: PMC4980495 DOI: 10.1155/2016/5420345] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 07/11/2016] [Indexed: 01/07/2023]
Abstract
Background and Aims. CIN is a major and serious complication following PCI in patients with ACS. It is unclear whether a higher serum ferritin level is associated with an increased risk of CIN in high-risk patients. Thus, we conducted this study to assess the predictive value of SF for the risk of CIN after PCI. Methods. We prospectively examined SF levels in 548 patients with ACS before undergoing PCI. Multivariate logistic regression analysis was used to analyze the independent risk factors for CIN. The ROC analysis was performed to evaluate the predictive value of SF for CIN. Results. CIN occurred in 96 patients. Baseline SF was higher in patients who developed CIN compared to those who did not (257.05 ± 93.98 versus 211.67 ± 106.65; P < 0.001). Multivariate logistic regression analysis showed that SF was an independent predictor of CIN (OR, 1.008; 95% CI, 1.003–1.013; P = 0.002). The area under ROC curve for SF was 0.629, and SF > 180.9 μg/L predicted CIN with sensitivity of 80.2% and specificity of 41.4%. Conclusion. Our data show that a higher SF level was significantly associated with an increased risk of CIN after PCI.
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Sulforaphane Attenuates Contrast-Induced Nephropathy in Rats via Nrf2/HO-1 Pathway. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2016; 2016:9825623. [PMID: 27006750 PMCID: PMC4783566 DOI: 10.1155/2016/9825623] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 01/12/2016] [Accepted: 01/27/2016] [Indexed: 12/25/2022]
Abstract
Background. Oxidative stress plays an important role in the pathogenesis of contrast-induced nephropathy (CIN). The aim of this study was to investigate the antioxidant effects of sulforaphane (SFN) in a rat model of CIN and a cell model of oxidative stress in HK2 cells. Methods. Rats were randomized into four groups (n = 6 per group): control group, Ioversol group (Ioversol-induced CIN), Ioversol + SFN group (CIN rats pretreated with SFN), and SFN group (rats treated with SFN). Renal function tests, malondialdehyde (MDA), and reactive oxygen species (ROS) were measured. Western blot, real-time polymerase chain reaction analysis, and immunohistochemical analysis were performed for nuclear factor erythroid-derived 2-like 2 (Nrf2) and heme oxygenase-1 (HO-1) detection. Results. Serum blood urea nitrogen (BUN), creatinine, and renal tissue MDA were increased after contrast exposure. Serum BUN, creatinine, and renal tissue MDA were decreased in the Ioversol + SFN group as compared with those in the Ioversol group. SFN increased the expression of Nrf2 and HO-1 in CIN rats and in Ioversol-induced injury HK2 cells. SFN increased cell viability and attenuated ROS level in vitro. Conclusions. SFN attenuates experimental CIN in vitro and in vivo. This effect is suggested to activate the Nrf2 antioxidant defenses pathway.
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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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