Application of urine al-MG and NAG and the preventive effect of hydration treatment for kidney damage caused by contrast agents

Abstract

Objectives Explore the role of hydration treatment of percutaneous coronary intervention (PCI) prevention of contrast-induced nephropathy in the treatment of patients,understanding CIN clinical incidence,explore the early kidney damage parts that CIN caused and sensitive detection indicators.Methods One hundred and twenty one hundred and twenty patients receiving PCI were randomly assigned to the control group and treatment group,60 in each.The patients of treatment group were received rehydration therapy through intravenous fluid infusion (2ml/kg · h).Control group were received a normal diet and drinking water.Urinary a1-MG,mAlb,NAG and osmotic pressure were checked for evidence of tubular or glomerular damage at start,1 day and 2 days after the administration of a radiocontrast agent.The levels of serum creatinin,BUN and cystatin C were also assessed at the same time.Results (1) In control group,comparison with the value before coronary angiography,urinary a1-MG and NAG significantly increased at day 1 after angiography (P ＜ 0.01) ; urinary osmotic pressure and GFR (MDRD) levels decreased at day 2 after angiography.In comparison to the levels at day 1 after angiography,urinary a1-MG and NAG decreased at day 2 after angiography (P ＜0.05) ;urinary osmoticpressureand GFR(MDRD) levels at day 2 after angiography had no significantly change compared with the value of day 3 (P ＞ 0.05).(2) In treatment group,comparison with the value before coronary angiography,urinary a1-MG and NAG significantly increased at day 1 after angiography (P ＜ 0.01),but urinary osmotic pressure and GFR (MDRD) levels at day 2 after angiography had no significantly change (P ＞0.05).In comparison to the levels at day 1 after angiography,urinary a1-MG and NAG decreased but had no significantly change compared to baseline (P ＞ 0.05) ; urinary osmotic pressure and GFR (MDRD) levels had no significantly change at day 2 after angiography (P ＞0.05).(3)To compare to the treatedment group,the values of urinary a1-MG and NAG increased at day 1 after angiography in control group(P ＜0.05) ; the values of urinary a1-MG and NAG still increased at day 2 (P ＜0.05) too,but those of urinary osmotic pressure and GFR(MDRD) levels had no significantly change at day 1 or 2 after angiography between the two groups (P ＞ 0.05).Conclusions ①NAG and a1-MG are both reliable indicators of early detection of CIN ;②The early CIN first caused renal tubular damage;③The obvious effect of hydration therapy on the prevention and treatment of early contrast agent kidney damage is conducive to injury in renal tubular function early recovery ; ④The basis of renal insufficiency and / or associated with type 2 diabetes,hypertension in patients will have significantly higher incidence of CIN ;⑤GFR (the MDRD formula) can reach the assessment of glomerular filtration rate,but early detection of CIN role is limited.The detection effect of cystatin C is not obvious. Key words: Kidney Disease ; Contrast Media ; Hydrotheraph