Intravenous glutathione prevents renal oxidative stress after coronary angiography more effectively than oral N-acetylcysteine

Abstract

This study proposes the intravenous administration of glutathione (GSH) as a novel strategy to prevent contrast medium-induced renal oxidative stress. Renal oxidative stress is a critical cause of contrast-induced nephropathy (CIN). Recent reports have described that N-acetylcysteine (NAC) may prevent CIN by scavenging reactive oxygen species in the kidney. Twenty-one patients with reduced renal function who underwent coronary angiography (CAG) were equally assigned to the control, NAC and GSH (100mg/min for 30min before CAG) groups. CIN occurred in two patients, one in the control and the other in the NAC group. In the control group, the urinary lipid hydroperoxides (LOOHs) increased to 299.5±94.4% of the baseline at 2h after CAG (mean±SE, p<0.01). The increase in LOOHs was completely abolished in the GSH group (5.5±8.8%, p=ns), but not in the NAC group (196.8±81.3%, p<0.05). In the control group, the serum GSH level fell by 9.4±2.3% at 2h after CAG (p<0.01). The decrease was prevented in the GSH group (-1.8±8.5%, p=ns), but not in the NAC group (-10.0±3.3%, p<0.05). The renal damage by contrast medium-induced oxidative stress occurs soon after CAG, and intravenous GSH is more effective in preventing the oxidative stress than oral NAC. This advantage may make GSH a potentially more effective therapeutic strategy against CIN.