Administration Of Radiocontrast Agents Research Articles

Herbal medicine in the management of renal disease: A comprehensive review of its potential for acute kidney injury, chronic kidney disease, diabetic nephropathy, and hypertension

Each year, a considerable number of individuals are diagnosed with potentially life-threatening renal failure, encompassing acute kidney injury (AKI) and chronic kidney disease (CKD). New natural herbal compounds, whether used in isolation or combined with medical treatments and an appropriate regime, have been suggested for the management of renal failure. The etiology of AKI remains uncertain; nevertheless, several factors have been proposed as potential causative agents that can lead to renal failure, including renal ischemia-reperfusion injury (IRI), nephrotoxicity, sepsis, administration of radiocontrast agents, and exposure to heavy metal ions. Several commonly utilized herbs with anti-diabetic and antihypertensive properties, known for their antioxidant, anti-inflammatory, and vasorelaxant effects, have been recognized as efficacious therapeutic agents in the management of CKD. The management of renal failure typically involves treating the underlying diseases, such as IRI, sepsis, and diabetes. However, if addressing the root cause is not possible, the focus shifts to managing complications like hypertension and proteinuria.

Thirsty Kidneys: Case Report

Contrast induced nephropathy is a reversible form of acute kidney injury occurs following administration of radio-contrast agents. It is associated with serious adverse short and long-term outcomes. The risk is negligible in children with normal renal function but increased in children with underlying kidney disease, dehydration and on nephrotoxic drugs. Contrast induced nephropathy is defined as increase in serum creatinine by >0.5 mg/dL or 25% increase from baseline within 48 to 72 hours of contrast administration. It is one of the commonest cause of hospital acquired acute kidney injury. We present a case of 10 years old boy with normal kidney function who developed acute kidney injury following intravenous contrast administration.

Bilirubin Levels are Associated With Contrast-Induced Nephropathy in Peripheral Artery Disease.

The relationship between contrast-induced nephropathy (CIN) and oxidative mechanisms is well documented. Our aim was to demonstrate the possible relationship between CIN and serum bilirubin as an antioxidant molecule. This retrospective study included 359 patients with peripheral artery disease (PAD) who underwent peripheral diagnostic angiography; 179 developed CIN after the intervention and another 180 were the control group, matched for age, gender, and cardiovascular risk factors. Baseline, 48- to 72-hour, and 30-day laboratory values, major adverse cardiovascular events, and dialysis requirements were recorded. Patients with CIN had significantly higher levels of uric acid, red cell distribution width, and neutrophil-to-lymphocyte ratio (NLR) but lower total bilirubin compared to the control patients ( P < .05). Multivariate logistic regression analysis showed that diabetes mellitus, left ventricular ejection fraction, uric acid, NLR, and total bilirubin levels were independent predictors of CIN development ( P = .01, P = .001, P = .001, P = .01, and P = .001, respectively). This study demonstrated that decreased total bilirubin was associated with CIN development after the administration of radiocontrast agents in patients with PAD.

Comparative study of renal protective effects of allopurinol and N-acetyl-cysteine on contrast induced nephropathy in patients undergoing cardiac catheterization.

Objectives : To evaluate the difference in the renal protective effects of allopurinol and n-acetyl cysteine along with saline hydration in patients of contrast induced nephropathy (CIN) post cardiac interventions. CIN remains a common complication of cardiac procedures. Radio contrast agents can cause a reduction in renal function that may be related to oxidative stress underlining various patho- physiologies. Conflicting evidence suggests that administration of allopurinol, a xanthine oxidase inhibitor can prevent CIN. This is a study of 500 patients undergoing angiography and coronary revascularisation in patients showing significant coronary block. The angiography positive patients (275) were prospectively randomised to different treatment protocol to study for their reno-protective effect. The patients received either of the three drugs saline hydration (SH, 1ml/kg/hr), n-acetylcysteine (SH+NAC, 600 mg bd) or Allopurinol (SH+ALLP, 300 mg/day) 12 hours before and after administration of radio contrast agent. Levels of serum creatinine and blood urea of the 275 patients recorded at 24 hour interval were noted post angioplasty over a course of 5 days in patients receiving either omnipaque (125) or visipaque (150) contrast media. All the 500 patients were also assessed for development of any kind of adverse drug effects/reactions with the two contrast media. CIN occurred in 56 of 500 the patients (10.6%) who underwent angiography and 49 of 275 patients (17.8%) who underwent angioplasty. In the omnipaque group CIN occurred in 16/40, 8/40, nil/45 in patients receiving SH, NAC plus SH and SH plus ALLP respectively. In the visipaque group CIN occurred in 15/50, 10/50, nil/50 in the three treatments groups respectively. Allopurinol maintained a consistent fall in the serum creatinine & blood urea levels from the baseline values from the end of the 1(st) day (p < .01 & .001) in both the category. Visipaque proved to be better dye than omnipaque with less adverse drug effects/ reactions. Prophylactic oral administration of allopurinol (300 mg/day) along with hydration is better than n-acetylcysteine and saline hydration alone for protection against CIN in patients undergoing coronary procedures.

Efficacy of allopurinol pretreatment for prevention of contrast-induced nephropathy: a randomized controlled trial

BackgroundContrast-induced nephropathy (CIN) remains a common complication of radiographic procedures. Radiocontrast agents can cause a reduction in renal function that may be due to reactive oxygen species. Conflicting evidence suggests that administration of antioxidants prevents CIN. MethodsWe assessed the efficacy of allopurinol in preventing CIN. We prospectively randomized 159 patients with a serum creatinine concentration >1.1mg/dL undergoing cardiac catheterization/interventions to receive allopurinol (300mg, p.o.) 24h before administration of radiocontrast agent and hydration (1mg/kg/hN/saline for 12h pre- and post-contrast, n=79), or hydration alone (1mg/kg/hN/saline for 12h pre- and post-contrast, n=80). ResultsCIN occurred in 6 of 80 patients (7.5%) in the control group and no subjects in the allopurinol group (p=0.013). In the allopurinol group, median serum creatinine concentration decreased significantly from 1.43mg/dL [1.1–4.15mg/dL] to 1.35mg/dL [0.7–4.15mg/dl] at 48h and to 1.27mg/dL [0.66–4.37mg/dL] at 4days after radiocontrast administration (p<0.0001 and p<0.0001 compared with baseline, respectively). In the control group, median serum creatinine concentration decreased non-significantly from 1.48mg/dL [1.1–2.96mg/dL] to 1.43mg/dL [0.73–3.02mg/dL] and to 1.45mg/dL [0.86–3.71mg/dL] (p=0.045 and p=0.57, respectively) 48h and 4days after radiocontrast administration. ConclusionsProphylactic oral administration of allopurinol, along with hydration, may protect against CIN in high-risk patients undergoing coronary procedures.

Contrast-induced nephropathy risk due to emergency contrast-enhanced computed tomography

In this study, we aimed to compare serum creatinine, blood urea, and glomerular filtration rate (GFR) levels of patients at baseline and 48 h after the administration of radiocontrast agent in the emergency department. We prospectively enrolled 114 patients who underwent contrast-enhanced computed tomography scan and had a baseline creatinine level of 1.5 mg/dl or less. Serum creatinine and blood urea levels were measured at baseline and 48 h after the administration of radiocontrast agent. GFR and Mehran risk score were calculated at baseline and 48 h after the administration of radiocontrast agent. Baseline mean serum creatinine was 1.03±0.25 mg/dl. Forty-eight hours after the administration of radiocontrast agent, mean serum creatinine was 1.04±0.31 mg/dl, baseline mean blood urea was 8.14±4.04 mmol/l, mean blood urea was 8.42±4.42 mmol/l, baseline mean GFR was 76.74±27.08 ml/min, and mean GFR was 77.21±27.92 ml/min. There were no significant differences between baseline and 48 h after the administration of radiocontrast agent serum creatinine, blood urea levels, and GFR (P>0.05). There was no statistically significant difference between basal and 48 h after the administration of radiocontrast agent serum creatinine and GFR levels of patients who were enrolled in this study. Results had shown that administration of intravenous radiocontrast agent (≤100 ml) for emergency imaging in the emergency department did not produce a risk for contrast-induced nephropathy in patients with serum creatinine levels of 1.5 mg/dl or less.

Assessment of Iothalamate Plasma Clearance

Measurement of GFR is important for the management of chronic kidney disease (CKD). Although bolus administration of radiocontrast agents is commonly used to measure GFR, the optimal duration of sampling to assess their plasma clearance is unknown. The purpose of this study was to evaluate whether the duration of plasma sampling influences precision and estimation of GFR. GFR was measured by sampling plasma 12 times over 5 h in 56 patients with CKD (mean age 64 yr, 98% men, 79% Caucasian, 34% diabetics, estimated GFR 31.8 +/- 14.2 ml/min/1.73 m(2)). In a subset of 12 patients we measured GFR by sampling plasma 17 times over 10 h. Short sampling intervals considerably overestimated GFR measured using total plasma iothalamate clearance, especially in larger patients. In the higher estimated GFR group (>30 ml/min/1.73 m(2)), the 5-h GFR was 17% higher and 2-h GFR 54% higher compared with the 10-h GFR, which averaged 40.3 ml/min/1.73 m(2). In the lower estimated GFR group (<30 ml/min/1.73 m(2)), the 5-h GFR was 36% higher and 2-h GFR 126% higher compared with the 10-h GFR, which averaged 22.2 ml/min/1.73 m(2). Short sampling duration also reduced the precision of the estimated GFR from 1.67% for 10-h GFR, to 3.48% for 5-h GFR, and to 7.07% for 2-h GFR. GFR measured over a longer duration with multiple plasma samples spanning the distribution and elimination phases may improve precision and provide a better measure of renal function.

COMPARISON OF DIFFERENT AGENTS ON RADIOGRAPHIC CONTRAST AGENT INDUCED NEPHROPATHY

Aim: Nephropathy induced by contrast media (CM) still a problem in clinical practice and a variety of therapeutic interventions have been used in an attempt to prevent radiocontrast-induced nephropathy. However most of the published reports are placebo controlled studies and especially in patients with pre-existing renal insufficiency. Therefore, in this study we wanted to investigate and to compare the efficacy of not only one agent, but also N-acetylcysteine, theophylline, nifedipine and misoprostol in the prevention of RCIN in subjects without renal insufficiency. Methods: We studied 97 non-diabetic patients without pre-existing renal insufficiency who received 100 ml low osmolar CM, Iomeprol or Iopamidol. Patients were randomized to five groups; Group S; only saline hydration (SH) used control group, group N; SH plus N-acetylcysteine, group M; SH plus misoprostol, Group N; SH plus nifedipine and Group T; SH plus theophylline. Patients were treated for three days and received 2000 ml saline i.v. each day. Serum creatinine and creatinine clearance were measured before and three days after CM application. Results: We were able to observe RCIN in four patients in group T and one patient in group NAC. Serum creatinine level increased after administration of radiocontrast agent in group M and T. Conclusion: We did not only observe any no additional advantage in administration of N-acetylcysteine (NAC), theophylline, nifedipine and misoprostol to SH alone in the prevention of RCIN but also an adverse effect of theophylline. Therefore, further studies with much more patients were included are necessary.

Reducing radiocontrast use in the cardiac catheterization laboratory--a behavioral modification approach.

This study assessed the impact of behavioral modification techniques on reducing the volume of contrast dye used during cardiac catheterization and percutaneous coronary intervention (PCI). Excessive administration of radiocontrast agents in the catheterization laboratory is associated with numerous adverse effects including radiocontrast nephropathy. This may be precipitated by using large volumes of contrast dye, particularly in diabetic patients and those with pre-existing renal dysfunction. Data were prospectively collected on 20,322 consecutive patients undergoing cardiac catheterization and PCI between January 1997 and December 2001. A focused behavioral modification program was initiated in late 1998. The physician was informed verbally during the course of the procedure and by letter after the procedure regarding the volume of contrast dye used for cases in which the radiocontrast volume exceeded 300 mL. Data were analyzed using the Fischer's exact test. In the prefeedback years (1997 and 1998), high contrast use occurred in 7.7% (n = 602) of the total cases (n = 7799). In the postfeedback years (1999, 2000, and 2001), this declined to 3.6% (n = 445) of the total cases (n = 12,523), representing a 53% reduction (P < .001). The effect was most pronounced in PCI, with the percentage of high contrast cases decreasing from 24% (n = 563) of the total PCI cases (n = 2348) to 10.6% (n = 359) of the total PCI cases (n = 3386), representing a 56% reduction (P < .001). Our study demonstrates the effectiveness of behavioral modification and the contribution it can make in reducing the volume of contrast dye used in the cardiac catheterization laboratory, particularly in PCI. Adoption of such strategies may enhance patient safety and reduce contribution it can make in reducing the volume of contrast dye used in the cardiac catheterization laboratory, particularly in PCI. Adoption of such strategies may enhance patient safety and reduce costs.

Cortical Blindness and Neurologic Injury Complicating Cervical Transforaminal Injection for Cervical Radiculopathy

Cortical Blindness and Neurologic Injury Complicating Cervical Transforaminal Injection for Cervical Radiculopathy

Drugs for the prevention and treatment of acute renal failure.

Certain preventive measures might decrease the incidence or severity of acute renal failure, including vigorous hydration before the administration of radiocontrast agents, and use of mannitol, loop diuretics, dopamine, and calcium antagonists. However, the pharmacologic agents should be used judiciously, and clinicians should not accept blindly that they are indicated in all clinical situations involving acute renal failure until further studies are available.

Variation of urinary enzymes N-acetyl-beta-glucosaminidase, alanine-aminopeptidase, and lysozyme in patients receiving radio-contrast agents

A urinary enzyme pattern consisting of two lysosomal enzymes, N-acetyl-beta-glucosaminidase and lysozyme, and one enzyme originating from kidney tubular brush border membrane, alanine-aminopeptidase, were studied in 30 patients undergoing intravenous urography and arteriography. N-acetyl-beta-glucosaminidase and lysozyme showed the greatest diagnostic sensitivity and were still abnormal on the fifth day after the administration of radio contrast agent. The results, which are statistically significant (Student's t test), suggest that radio-contrast agents are potentially nephotoxic.

Effects of intravenous infusion of urographic contrast agents on glomerular filtration rate, serum concentration and urinary excretion of uric acid in subjects with normal renal function.

The utilization of modern triiodinated radiocontrast agents for intravenous urography (IVU) is widely considered as a very safe procedure in patients free of currently well defined risk factors, amongst which the prominent ones are preexisting renal disease and diabetes mellitus complicated by deteriorated renal function (1,2,3). Whereas the incidence of nephrotoxicity accidents is extremely low in patients with no preexisting renal insufficiency, the risk of an acute, and sometimes definitive, deterioration of renal function following administration of radiocontrast agents has been evaluated as high as 90 % in insulin dependent diabetic patients with severe preexisting renal impairment (1).