Quercetin, a Promising Clinical Candidate for The Prevention of Contrast-Induced Nephropathy.

Laura Vicente-Vicente,Francisco Martín-Herrero,Alfredo Ginés Casanova,Javier Martín-Moreiras,Ana Isabel Morales,Pedro Luis Sánchez,Ignacio Cruz-González,Francisco J López-Hernández,David González-Calle,Juan Carlos Rama-Merchán,María Teresa Hernández-Sánchez,Marta Prieto

doi:10.3390/ijms20194961

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.

Highlights

Contrast-induced nephropathy (CIN) is the major complication related to cardiac diagnostic or interventional procedures that require the use of contrast media (CM)
It is remarkable that a high percentage of patients in the CM+Q group (17.0%) consumed non-steroidal anti-inflammatory drugs (NSAIDs), whereas in the CM group only 7.3% consumed them (Table 2)
This fact, along with the elevated prevalence of CIN risk factors, represents an immediate urgency in the search for strategies that can prevent the development of kidney damage following CM administration

Summary

Introduction

Contrast-induced nephropathy (CIN) is the major complication related to cardiac diagnostic or interventional procedures that require the use of contrast media (CM). CIN is the third most common cause of acute renal failure acquired in the hospital [2] and it is associated with significant morbidity and mortality in the short and long term [3,4] This condition has been linked to longer in-hospital stay and higher incidence of chronic renal failure [5]. A prolonged vasoconstriction occurs, leading to a sustained decrease in the GFR over time, whereby a renal ischemia occurs. This state of hypoxia results in the formation of reactive oxygen species that can produce tubular damage and further intensify the reduction of the GFR. In preclinical studies, massive intratubular necrosis and tubular obstruction have been observed [6]

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