Abstract
Modern achievements of interventional cardiology in treatment of coronary heart disease (CHD) have significantly increased frequency of interventions and volume of contrast media (CM). Contrast-induced acute kidney injury (CIAKI) associated with CM administration is determined by 26.5 μmol/l increase in serum creatinine (SCr) within 48 - 72 hours or > 1.5-fold SCr increase versus its known or estimated level in the previous 7 days. Without effective disease management, prevention with early CIAKI risk stratification and cessation of nephrotoxic medications taken by patients are important. Given significant complexity in existing CIAKI treatment, modern therapeutic options are limited only to adequate renal injury prevention. The problem’s significance and diagnostic limitations associated with SCr definition require search for clinically and diagnostically significant AKI biomarkers. In terms of coronarography and percutaneous coronary interventions, several studies have been conducted on clinical and diagnostic significance of some biomarkers. This article characterizes and discloses prospective practical use of neutrophil gelatinase-associated lipocalin (NGAL), liver-type fatty acid binding protein (L-FABP), kidney injury molecule-1 (KIM-1), cystatin C (CysC) and interleukins-6,8,18 (IL-6,8,18) in interventional cardiology.
Highlights
Modern achievements of interventional cardiology in treatment of coronary artery disease (CAD) have significantly increased frequency of performed interventions and, volume of administered contrast media (CM)
Contrast-induced acute kidney injury (CIAKI) associated with CM administration is determined by 26.5 μmol/l increase in serum creatinine (SCr) within 48 - 72 hours or > 1.5-fold SCr increase versus its known or estimated level in the previous 7 days
The researcher group concluded that intravenous hydration under invasive EDP control is a safe and effective CIAKI prevention in patients planned for coronary angiography (CAG) and percutaneous coronary interventions (PCI) [31]
Summary
Modern achievements of interventional cardiology in treatment of coronary artery disease (CAD) have significantly increased frequency of performed interventions and, volume of administered contrast media (CM). As a number of patients receiving endovascular care and CM consumption increase yearly, contrast-induced acute kidney injury (CIAKI) incidence increases [1] [2]. Direct AKI develops within the first 12 - 24 h after an interventional procedure and statistically increases hospitalization duration, complications incidence, mortality and associated hospital costs [2] [4]. Despite toxic CM effects on the renal tubule epithelium, no safe replacement has yet been found. Given significant complexity in existing CIAKI treatment, modern therapeutic options are limited only to adequate renal injury prevention. Oxidative stress and direct cytotoxic CM effect [5] [6] [7]. Combination of oxidative stress with inflammation leads to nephron mass damage and death, resulting in AKI (Figure 1). In most CIAKI cases, renal malfunction is transient, with full recovery within 3 - 5 days [9]
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