Contrast-induced Nephropathy Group Research Articles

Significance of combined detection of urine NGAL, KIM-1 and IL-18 in early diagnosis of contrast-induced nephropathy

Objective To investigate the significance of combined detection of urine neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and interleukin-18 (IL-18) in early diagnosis of contrast-induced nephropathy (CIN). Methods A total of 367 hospitalized patients undergone CT angiography (CTA) was enrolled into this study from May 2015 to February 2017. According to the European Society of Urology and radiology (ESUR) guidelines 2011, CIN was diagnosed in 31 patients (CIN group), and a total of 30 non CIN patients were randomly selected as non-CIN group. Another 30 patients who were hospitalized during the same period without contrast media were randomly selected as the control group. The changes of serum creatinine (Scr), urinary NGAL, KIM-1, and IL-18 were detected before and 8 h, 24 h and 72 h after CTA. The same serum and urinary samples were collected at the time of admission in the control group. The sensitivity and specificity values of combined urinary NGAL, KIM-1, and IL-18 in early diagnosis CIN were evaluated by the under area of the receiver operating characteristic curves and area under curve (AUC). Results ⑴ According to ESUR guidelines 2011, CIN was diagnosed in 31 patients (8.4%). ⑵ At 8h after CTA, the levels of urinary NGAL, KIM-1, and IL-18 were significantly increased in the CIN group, compared with non-CIN group (P<0.05). ⑶ The AUC, sensitivity and specificity for early diagnosis of CIN were 0.999, 96.8%, and 100%, when combine urinary NGAL, KIM-1, and IL-18, at 8h after CTA. AUC for 24 h, and 72 h after contrast media injection approach to 1.0, at this time sensitivity and specificity were 100%, and 100%, respectively. Conclusions ⑴ At 8 h after CTA, the urinary NGAL, KIM-1, and IL-18 levels were significantly increased in the CIN group. ⑵ The predictable time of CIN onset determined by urinary NGAL, KIM-1, and IL-18 was earlier than Scr, and the sensitivity and specificity is higher in these biomarkers than Scr in early diagnosis of CIN. Especially combination of urinary NGAL, KIM-1, and IL-18 is more valuable in predicting the sensitivity and specificity of the diagnosis, and can be used as an indicator for early diagnosis of CIN. Key words: Apolipoproteins/UR; Interleukin-18/UR; Membrane glycoproteins/UR; Nephrosis/DI

Contrast Volume to Creatinine Clearance Ratio Can be Used to Predict Contrast-Induced Nephropathy After Cardiac Catheterization

SESSION TITLE: Cardio-Pulmonary Interactions SESSION TYPE: Original Investigation Slide PRESENTED ON: Monday, October 30, 2017 at 01:30 PM - 02:30 PM PURPOSE: We sought to develop a simple risk prediction score to identify patients at risk of contrast-induced nephropathy (CIN) after cardiac catheterization. METHODS: A retrospective chart review of 513 patients who underwent cardiac catheterization from June to December 2014 was performed. Patients with end-stage renal disease (n=38) & without pre-procedural serum creatinine (n=57) were excluded. Serum creatinine before the procedure & each day for three days after the procedure was recorded. CIN was defined as an increase in serum creatinine by >25% or 0.5mg/dl from a pre-procedural value within 72 hours of contrast exposure. Pre-procedural creatinine clearance (CCr) was calculated using modification of diet in renal disease (MDRD) equation. Mehran score & Contrast Volume: Creatinine clearance ratio (CV/CCr ratio) were calculated for each patient. Receiver operating characteristic (ROC) curve was obtained & area under the curve (AUC) was calculated for both scores to see the predictive ability for CIN. RESULTS: A total of 418 patients (mean age 69.1 ± 13.8, 55% male & 45% female) were included in the study. Percutaneous coronary intervention (PCI) was performed in 29% (n=121) patients. 81% (n=98) were primary PCI. 16 patients developed CIN with a mean incidence of 3.8%. Contrast volume in CIN group was 150 ml, [95% confidence interval (CI)=36-400ml] Vs. 109.5 ml (95% CI=25ml-160 ml) in the non-CIN group, p=0.06. Mean contrast volume: creatinine clearance ratio (CV:CCr ratio) in CIN group was 3.25, (95% CI=0.70-10.60) Vs. 1.4, (95% CI 0.2-5.4), p=0.03. AUC for CV:CCr ratio was 0.735 (95% CI= 0.602- 0.867), P=0.001, optimal cut-off was 2.25, sensitivity 72.2 % & specificity 72.7%. AUC Mehran score was 0.793 (95% CI 0.646- 0.940), P=0.01, optimal cut-off was 9.5, sensitivity 85.7 % & specificity 71.0%. When compared to Mehran score, CV:Ccr ratio had similar AUC & speicificity. Mehran score had a superior sensitivity. CONCLUSIONS: Contrast volume: Creatinine Clearance ratio (CV:CCr ratio) can be used clinically to identify patients at risk of contrast-induced nephropathy (CIN) after cardiac catheterization. It requires few data, is based on a linear equation & is easy to calculate. CLINICAL IMPLICATIONS: Contrast-induced nephropathy (CIN) is independently associated with higher morbidity and mortality following cardiac catheterization. Identifying patients at risk is an important preventive step. Popular scoring systems like Mehran score uses both patients related and procedural data making it complicated to calculate and use. CV: CCr ratio can be clinically useful as it requires only two variables, easy to calculate and use. DISCLOSURE: The following authors have nothing to disclose: Yub Raj Sedhai, Reshma Golamari, Soney Basnyat, Tawseef Dar, Deepak Acharya, Jose Missri No Product/Research Disclosure Information

CHA2DS2-VASc score predicts contrast-induced nephropathy in patients with ST-segment elevation myocardial infarction, who have undergone primary percutaneous coronary intervention.

We aimed to investigate the predictive value of the CHA2DS2-VASc score in the development of contrast-induced nephropathy (CIN). A total of 2972 patients who had been diagnosed with ST elevation myocardial infarction (STEMI) and who had undergone primary coronary angioplasty were included in the study. The patients were divided into three groups according to the CHA2DS2-VASc score, i.e.: low risk (1 point), intermediate risk (2 points), and high risk (≥ 3 points). The groups were followed with regard to CIN development. The median CHA2DS2-VASc score was significantly higher in the CIN(+) group compared to the CIN(-) group (3 vs. 2, p < 0.001). The rate of CIN was 3.32-fold higher (OR 3.32, 95% CI 1.98-5.55, p < 0.001) in the high-risk group (CHA2DS2-VASc ≥ 3) compared to the low-risk group (CHA2DS2-VASc = 1). Age (OR 1.25, 95% CI 1.14-1.36, p < 0.001), female gender (OR 1.52, 95% CI 1.23-1.89, p < 0.001), hypertension (OR 1.50, 95% CI 1.265-1.78, p < 0.001), peak creatinine kinase-MB (OR 1.15, 95% CI 1.10-1.21, p < 0.001), and the Killip score > 1 (OR 4.25, 95% CI 3.10-5.82, p < 0.001) were found to be independent predictors for CIN development. The CHA2DS2-VASc score is an independent and strong predictor of CIN development in patients with acute STEMI.

140 INCIDENCE AND RISK FACTORS FOR CONTRAST INDUCED NEPHROPATHY IN PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION AT A TERTIARY CENTRE

Category: Research in AKI (Basic, translational, clinical including clinical trials) Presenter: Dr AZRINI ABDUL AZIZ Keywords: contrast induced nephropathy, percutaneous coronary intervention Contrast induced nephropathy (CIN) following percutaneous coronary intervention (PCI) is associated with adverse outcomes. Risk factors to predict CIN are chronic renal failure, diabetes, congestive cardiac failure and contrast volume. The aim is to determine the incidence of CIN after PCI in a tertiary centre and identify risk factors for patients to develop to CIN for preventive measures. All patients who underwent PCI between January - June 2016 were screened. Patients with rise in creatinine by 25% or 44mmol/L (0.5mg/dL) from baseline within 48 to 72hours after contrast administration in the absence of other explanation were selected. A total of 524 patients who underwent PCI between January to June 2016 were included in the study. 32 (6.1%) patients develop CIN with 4 patients (12.5%) requiring renal replacement therapy. 19 out of 32 patients (59.4%) were diabetic, and 17 (53.1%) had eGFR less than 60. The mean contrast volume administered was 169.63ml for the CIN group and 165.11ml for the non CIN group with p=0.851. The mean age for the CIN group was 60.91 and 55.72 for the non CIN group with p=0.037. The overall incidence of CIN post PCI is low at 6.1%, however 12.5% required renal replacement therapy. This could be attributed to lower contrast volume and preventive measures with hydration and use of N-acetylcysteine. Predisposing risk factors to develop CIN are diabetics, those with eGFR less than 60ml/min and elderly patients. Routine blood monitoring and follow up is recommended especially in high risk group.

Histopathological evaluation and redox assessment in blood and kidney tissues in a rabbit contrast-induced nephrotoxicity model

Contrast-induced nephropathy (CIN) is a leading cause of hospital-acquired acute kidney injury as a result of iodinated contrast-media use for diagnostic purposes. Pathophysiology remains unclear. In the present study iopromide was administered to New Zealand white rabbits without any prior intervention. Oxidative stress was assessed in blood and tissue level at three anatomical kidney areas (medullary, cortical, juxtamedullary). Histopathological evaluation was also performed. Serum creatinine and urea increased in the CIN groups over 25% at two hours after administration and returned to baseline at 48 h. In kidney tissues, a significant reduction (40%) of catalase in renal cortexes of the CIN groups was observed. Necrosis and tubular vacuolization was also noted that correlated with urea and creatinine levels. Lipid peroxidation decreased at 10 h after administration (>45%) and remained low even at 48 h. Plasma protein carbonyls were significantly increased (67%) in 2 h and dropped later. Serum levels of creatinine and urea at 24 and 48 h significantly correlated with the Total Antioxidant Activity and lipid peroxidation, respectively. Oxidative stress is shown to be involved in CIN development in the rabbit, with more pronounced effects to be confined to the cortex and outer stripe of the outer medulla.

Drug Effects and Clinical Investigations for Contrast-Induced Nephropathy After Coronary Angiography or Percutaneous Coronary Intervention in Patients With Diabetes.

The aim of the study was to investigate the risk factors of preprocedural laboratory investigations and drug effects to the incidence of contrast-induced nephropathy (CIN) in patients with diabetes who underwent coronary angiography or percutaneous coronary intervention and to assess the short-term safety. We retrospectively studied a total of 568 patients with diabetes who underwent coronary angiography or percutaneous coronary intervention from January, 2013 to January, 2014 in our hospital and compared the baseline clinical characteristics, especially the laboratory investigations and preprocedural drugs of those 2 groups (with CIN group and without CIN group), and half year follow-up. Overall, 53 (9.33%) patients were developed into CIN according to the definition of an increase of 25% from the baseline of serum creatinine concentration, supposing that on the basis of an increase of 44.2 μmol/L, the incidence would be 0.88% (5/568). No significant differences were found between the 2 groups with respect to age, diabetes mellitus duration, operation type, contrast type and volume, left ventricular ejection fraction, and combined diseases including hypertension, myocardial infarction, Arrhythmia, etc. However, patients with CIN tended to be lighter in body weight (P = 0.027) and were more often female [odds ratio (OR) = 2.8, P < 0.01], and also had a higher prevalence with acute coronary syndrome (OR = 5.1, P < 0.01). On the contrary to most studies, the preprocedural serum creatinine in with CIN group in our study was lower than without CIN group (P < 0.001). As for the preprocedural drugs, statins seemed could decrease the incidence of CIN (OR = 0.34, P < 0.05), and the use of diuretics might increase the occurrence of CIN (OR = 2.62, P < 0.05). As regard to the follow-up results, the hospitalization days and expense of with CIN group were significantly longer and higher than the without CIN group, but no significance was found between rehospitalization rate in half year. Preprocedural preventions are essential because there is no effective treatment for CIN our findings could be considered in clinical practice. There are many risk factors for CIN; it is necessary to distinguish the high-risk patients so as to carry out corresponding protection actions.

Platelet to Lymphocyte Ratio Predicts Contrast-Induced Nephropathy in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.

We investigated the relationship between platelet to lymphocyte ratio (PLR) and contrast-induced nephropathy (CIN) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). We enrolled 5719 patients in 3 tertiary hospitals from January 2005 to December 2010. The PLR was calculated as the ratio of platelet to lymphocyte counts on admission. Serum creatinine level was measured before and within 72 hours after contrast medium administration. To evaluate the relation between PLR and CIN, the 5719 patients were divided into a CIN group and a non-CIN group. Contrast-induced nephropathy occurred in 252 (4.4%) patients. Patients in the CIN group had significantly higher PLR than those in the non-CIN group (173.8 [62.3] and 116.2 [51.7], respectively; P < .001). In logistic regression analysis, PLR was an independent predictor of CIN (odds ratio: 1.432, 95% confidence interval: 1.205-1.816, P = .031), along with age, diabetes mellitus, creatinine, estimated glomerular filtration rate, and neutrophil to lymphocyte ratio. In conclusion, a higher PLR was an independent risk factor for the development of CIN in patients with STEMI undergoing pPCI.

Efficacy of oral supplemental hydration for the prevention of contrast-induced nephropathy in rats.

To compare oral rehydration solution (ORS) with saline infusion for preventing contrast-induced nephropathy (CIN) in a rat model. Adult male Sprague-Dawley rats (310-360g) received intravenous indomethacin (10mg/kg), N G-nitro-L-arginine methyl ester (10mg/kg), and iohexol (10mL/kg) to induce acute contrast-induced renal injury (CIN group); control rats received saline only. For hydration, rats received either continuous infusion (20mL/kg/h) of saline or three oral doses (20mL/kg each) of ORS. Acute renal injury was evaluated by assaying urine collected for 24h beginning 2h before the contrast injection, evaluating blood taken 22h after the contrast injection, and examining the kidneys histopathologically. Hydration with saline prevented only the contrast-induced increase in plasma creatinine, whereas ORS prevented deleterious changes in plasma creatinine, blood urea nitrogen, and creatinine clearance as well as in urinary protein, albumin, and N-acetyl-D-glucosaminidase concentrations. Histopathologic changes noted in the CIN group were diminished in both saline and ORS groups. Both intravenous saline administration and oral hydration with ORS decreased the severity of CIN. Hydration with ORS was comparable to intravenous saline infusion in preventing CIN-associated abnormalities.

Trimetazidine in the prevention of contrast-induced nephropathy in chronic kidney disease.

Contrast induced nephropathy (CIN) may be defined as Acute Renal Failure (ARF) that occurs within 24-72h of exposure to intra-venous or intra-arterial iodinated contrast media that cannot be attributed to other causes. CIN occurs in up to 5% of hospitalized patients with normal renal function prior to injection of contrast media. It occurs more frequently in patients with renal impairment particularly if associated with diabetic nephropathy. Among all procedures utilizing contrast agents for either diagnostic or therapeutic purposes, coronary angiography and percutaneous coronary interventions are associated with the highest rates of CIN. Trimetazidine has been described as a cellular anti-ischemic agent. Previous studies demonstrated that Trimetazidine prevents the deleterious effects of ischemia-reperfusion at both the cellular and mitochondrial levels and exerts an anti-oxidant effect. It inhibits excess release of oxygen free radicals, limits cellular acidosis, protects Adenosine Triphosphate (ATP) stores, reduces membrane lipid peroxidation and inhibits neutrophil infiltration. To evaluate the role of Trimetazidine (TMZ) in prevention of contrast induced nephropathy (CIN) in patients with renal impairment undergoing coronary angiography. This study was conducted on one hundred patients having a basal creatinine clearance below 90ml/min and presenting for coronary angiography procedures. The patients were divided into two equal groups each including fifty patients where both groups received parenteral hydration in the form of isotonic saline at a rate of 1mg/kg body weight per hour starting 12h before angiography and up to 12h thereafter. In Group 1, patients received additional medication in the form of trimetazidine 35mg twice daily for 72h and starting 48h before the procedure which was not received in group 2 (control). There was a significant difference regarding the rate of CIN among TMZ versus control groups (10% vs. 26%). The amount of contrast was significantly higher in the CIN group (165.00±108.41 vs 89.85±38.60, P=0.000). Administration of trimetazidine in a dose of 35mg twice daily orally in conjunction with standard early saline hydration is an effective method to prevent or reduce the incidence of contrast-induced renal dysfunction following the administration of contrast media during coronary angiography procedures in patients with mild-moderate basal renal insufficiency.

Ultrasound-assisted extraction of Achyrocline satureioides prevents contrast-induced nephropathy in mice

Achyrocline satureioides or Macela, has been largely used in traditional folk medicine in Brazil as an anti-inflammatory agent and to treat various digestive disorders. The aim of the present study was to evaluate the preventive action of the extracts of A. satureioides obtained by maceration and ultrasound-assisted extraction, quercetin and N-acetylcysteine against contrast-induced nephropathy in mice. The antioxidant activity, cytotoxicity and inhibition of nitric oxide (NO) production in macrophages were evaluated. Also, chemical analyses of phenolic compounds, total flavonoids, and quercetin by LC–MS/MS present in various extracts of A. satureioides were performed. Thirty six mice were divided into six groups: control group (C), Contrast-Induced Nephropathy group (CIN), Group N-acetylcysteine 200mg/kg (NAC); Group quercetin 10mg/kg (Q), Group Macela 10mg/kg (M10), and Group Macela 50mg/kg (M50). The serum levels of urea and creatinine, advanced oxidation protein products (AOPP) and renal ultrastructure were evaluated by electron microscopy scanning. Ultrasound-assisted extraction improved the quality of extract (with 100% ethanol), since did not show toxicity to fibroblasts, and showed potent antioxidant activity and a high content of phenolic compounds, flavonoids, and quercetin, in addition to being able to reduce the production of NO in dose-dependent effect in macrophages. Results showed that animals treated with Macela extracts maintained normal levels of urea, creatinine, and AOPP, while preserving ultrastructure of the renal cells. The obtained results were more promising than NAC and Q groups in protecting against renal failure caused by CIN, showing that the plant can be a promising drug for preventing this disease.

Contrast-Induced Nephropathy Is Less Common in Patients with Good Coronary Collateral Circulation

Background/Aims: Contrast-induced nephropathy (CIN) is a typically reversible type of acute renal failure that develops after exposure to contrast agents; underlying endothelial dysfunction is thought to be an important risk factor for CIN. Although the mechanism of coronary collateral circulation (CCC) is not fully understood, a pivotal role of the endothelium has been reported in many studies. The aim of this study was to investigate whether there is a relationship between CCC and CIN. Methods: Patients with at least one occluded major coronary artery and blood creatinine analyses performed before and on the second day after angiography were included in the study. CIN was defined as a 25% or greater elevation of creatinine on the second day after exposure to the contrast agent. Collateral grading was performed according to the Rentrop classification. Patients were grouped according to whether they developed CIN or not, i.e., CIN(-) and CIN(+) group. Results: A total of 214 patients who met the inclusion criteria were included in the study. CIN was diagnosed in 43 patients (20.1%) in the study population. Good CCC was identified in 112 patients (65.5%) in the CIN(-) group, whereas it was identified in 13 patients (30.2%) in the CIN(+) group. In the CIN(-) group, good CCC was significantly more frequent (p < 0.001). Furthermore, collateral circulation was an independent predictor of CIN. Conclusion: Good collateral circulation was associated with a lower frequency of CIN, and poor collateral circulation was an independent predictor of CIN.

Pre-Procedural Risk Score of Contrast-Induced Nephropathy in Elderly Patients Undergoing Elective Coronary Angiography.

To establish a scoring model to predict the risk of contrast-induced nephropathy (CIN) in elderly patients undergoing elective coronary angiography (CAG).A total of 1286 patients aged > 65 years who had undergone elective CAG between August 2009 and February 2013 were enrolled in this study. They were randomly (3:2) assigned to a development (n = 756) or validation dataset (n = 530). Independent predictors of CIN were identified by using logistic regression and were assigned a weighted integer, which was used to establish a score model.CIN incidence in the development set was 6.3%. The risk score model contained 3 variables (with the weighted integer): age > 75 years (1.5), creatinine clearance (CrCl) < 60 mL/minute (1), and congestive heart failure (CHF) (1.5). CIN incidence was 3.1%, 9.1%, and 29.0% in the low-risk group (≤ 1), moderate risk group (1 - 3), and high-risk group (≥ 3), respectively. The risk model demonstrated good prediction value in the development (c-statistic = 0.727) and validation (c-statistic = 0.695) datasets. Compared to the non-CIN group, the CIN group had a significantly higher rate of inhospital major adverse cardiac events (P < 0.01).The risk score model with 3 variables, namely age > 75 years, CrCl < 60 mL/minute, and CHF, is a clinical prediction tool for CIN in elderly patients before elective CAG. CIN is one of the independent risk factors of major adverse cardiac events (MACE).

Risk factors for contrast-induced nephropathy after coronary angiography.

Contrast-induced nephropathy (CIN) is of concern after the use of radiocontrast media for coronary angiography (CAG) and percutaneous coronary intervention (PCI). We studied the incidence of CIN and its risk factors in patients undergoing CAG. In this prospective study, we included all patients with normal renal parameters undergoing CAG with nonionic radiocontrast media. We excluded patients with known chronic kidney disease, baseline creatinine more than 1.5 mg/dL, significant hypotension, anemia, and patients with acute myocardial infarction undergoing emergency PCI. Serum creatinine was done at baseline and serially for seven days after the procedure. Appropriate statistical tests were used to analyze the results and P <0.05 was considered statistically significant. The study population (n = 500, 348 males and 152 females) had a mean age of 56.6 ± 12.5 years. Twelve patients (2.4%) developed CIN and were equally distributed irrespective of the age, diabetes, or PCI procedure. CIN was observed to be more common in patients with hypertension than in those without hypertension (P = 0.0158). The total volume of contrast administered to CIN group (175 ± 59.3) was not significant as compared to that of non-CIN (159.1 ± 56) group (P = 0.334). None of the patients in our study required renal replacement therapy, and there was no mortality. CIN is observed in 2.4% of patients undergoing CAG and had a self-limiting course. Hypertension is the only observed risk factor, and further large-scale studies are necessary to delineate the novel risk factors for CIN in the general population with normal kidney function.

The value of urinary neutrophil gelatinase-associated lipocalin for early diagnosis of contrast-induced nephropathy

Objective: To explore the value of urinary neutrophil gelatinase-associated lipocalin (NGAL) for early diagnosis of contrast-induced nephropathy (CIN) in patients who underwent percutaneous coronary angiography (CAG) or percutaneous coronary intervention (PCI). Methods: From May 2015 to January 2016, 506 consecutive patients who underwent CAG or PCI in our hospital were enrolled in this prospective study. Patients were divided into CIN group (n=47) and non-CIN group (n=459). Clinical and interventional data were compared between the two groups. Spearman ranking correlation coefficient was used to define the relation between NGAL and CIN, and multivariable logistic regression analysis was performed to identif independent predictors of CIN. Receiver-operator characteristic (ROC) curve was generated, and area under the curve (AUC) was calculated and sensitivity and specificity for CIN diagnosis were analyzed. Results: (1) Basic clinical and interventional data including age, incidence of diabetes, hypertension and chronic heart failure, level of systolic blood pressure, serum creatine before procedure, use of isotonic contrast agent, contrast volume, Mehran score, operation time, treatment number of coronary artery, hydration and medication were all similar between two groups (all P>0.05). (2) Urinary NAGL level at 24 and 48 h after procedure, serum creatinine (Scr) level at 48 h after procedure, and ΔNGAL24-0 h were significantly higher in CIN group than in non-CIN group (all P<0.01), but the differences of urinary NGAL level before procedure, Scr level 24 h after procedure, and ΔNGAL48-24 h were similar between two groups (all P>0.05). (3)The positive correlation was found by Spearman ranking correlation between ΔNGAL24-0 h and CIN (r=0.478, P<0.001). (4) Multivariable logistic regression analysis showed that estimated glomerular filtration rate(OR=1.020, 95%CI 1.005-1.035, P=0.007) and ΔNGAL24-0 h (OR=1.020, 95%CI 1.014-1.027, P<0.001) were the independent predictors of CIN.(5) ROC curve showed that the AUC of NGAL with the cutoff value 4.65 was 0.899(0.854, 0.944)for diagnosis of CIN (sensitivity 93.6%, and specificity 0.944). Conclusion: The rise of urinary NGAL level at 24 and 48 hours after CAG or PCI is suggestive of CIN and could be used as a reliable parameter for the early diagnose of CIN.

Expression of neutrophil gelatinase-associated lipocalin in low osmolar contrast-induced nephropathy in rats and the effect of N-acetylcysteine.

Serum creatinine (Scr), which is a conventional indicator of contrast-induced nephropathy (CIN), is unable to reflect the damage of kidney promptly. The present study aimed to investigate the value of neutrophil gelatinase-associated lipocalin (NGAL) in kidney and serum of CIN rats to observe whether NGAL can be used as a superior indicator of CIN. Furthermore, N-acetylcysteine (NAC) was used to assess its effect on CIN. A total of 120 adult male Sprague Dawley rats were randomly divided into four groups (n=30/group): CIN rats (CIN), normal rats treated with NAC (NAC), CIN rats treated with NAC (NAC+CIN) and the control group (CON). Serum Scr and NGAL values were measured at 2, 12, 24, 48 and 72 h following the procedure. Immunohistochemistry and western blot analysis were used to detect NGAL within the kidney tissue. Hematoxylin and eosin staining were used to access the renal injury score. Oxidative stress within the kidney was analyzed via malondialdehyde (MDA) and superoxide dismutase (SOD). The level of NGAL in the serum and tissue of the CIN group increased significantly 2 h after the procedure (P<0.05). However, the Scr value did not exhibit a significantly change until 48 h later. Based on the renal injury scores, NAC reduced the kidney damage caused by the contrast. NAC treatment was associated with a decrease in SOD levels and an increase in MDA. These findings suggested that NGAL was a superior indicator of CIN than Scr, as NGAL was able to detect kidney damage much earlier. Furthermore, NAC treatment inhibited oxidative stress, thus protecting against CIN.

A retrospective evaluation of contrast-induced kidney injury in dogs (2006-2012).

To evaluate a population of dogs for evidence of contrast-induced nephropathy (CIN). A retrospective case review between 2006 and 2012. A university teaching hospital. A total of 1,217 client-owned dogs that were administered intravenous iodinated contrast agents were reviewed for evidence of CIN. Inclusion required a measured serum creatinine within 1 week prior as well as within 1 week following administration of contrast. Eighty-six dogs with 92 contrast administrations qualified for inclusion. None. CIN was defined as an increase in >44.2 μmol/L (0.5 mg/dL) from baseline creatinine concentration within 1 week following administration of an intravenous iodinated contrast agent. A total of 7.6% of contrast administrations (7/92) fulfilled the definition of CIN. The creatinine postcontrast administration as well as the change in creatinine concentration was significantly higher in the CIN group than in the non-CIN group (median postcreatinine 150 μmol/L [1.7 mg/dL] versus 70.7 μmol/L [0.8 mg/dL], median change in creatinine 53 μmol/L [0.6 mg/dL] versus 0 μmol/L). Patient signalment, initial creatinine, number of total contrast administrations, dose of contrast received, duration of anesthesia, IV fluid administration, administration of nephrotoxic agents, and use or vasopressor therapy were not significantly different between groups. The temporal association between contrast administration and renal injury in these cases highlights the potential for CIN in dogs. Due to the retrospective nature of this study, a causal association between contrast administration and renal injury cannot be determined. A prospective study is needed to further evaluate CIN in dogs.

Association of contrast-induced nephropathy with bare metal stent restenosis in STEMI patients treated with primary PCI

Background: Contrast induced nephropathy (CIN) has been proven as a clinical condition related to adverse cardiovascular outcomes. However, relationship between CIN and stent restenosis (SR) remains unclear. In this study, we aimed to investigate the association of CIN with SR rates after primary percutaneous coronary intervention (PCI) and bare metal stent (BMS) implantation.Methods: A total number of 3225 patients who had undergone primary PCI for STEMI were retrospectively recruited. The medical reports of subjects were searched to find whether the patients had a control coronary angiogram (CAG) and 587 patients with control CAG were included in the study. The laboratory parameters of 587 patients were recorded and patients who developed CIN after primary PCI were defined. Contrast induced nephropathy was defined as either a 25% increase in serum creatinine from baseline or 0.5 mg/dL increase in absolute value, within 72 h of intravenous contrast administration.Results: The duration between primary PCI and control CAG was median 12 months [8–24 months]. The rate of SR was significantly higher in CIN (+) group compared to CIN (−) group (64% vs. 46%, p < 0.01). In multivariate Cox regression analysis, male gender, stent length, admission WBC levels and presence of CIN (HR 1.39, 95% CI 1.06–1.82, p < 0.01) remained as the independent predictors of SR in the study population.Conclusion: Gender, stent length, higher serum WBC levels and presence of CIN are independently correlated with SR in STEMI patients treated with BMS implantation.

Sildenafil prevents renal dysfunction in contrast media-induced nephropathy in Wistar rats.

Contrast-induced nephropathy (CIN) is an iatrogenic medical event in stable cardiology patients that may lead to acute renal failure. There is no current successful therapy to manage CIN. Increasing evidence in experimental models and humans has suggested that this disease is associated with renal tubular and vascular injury triggered by oxidative stress. Considering the importance of reactive oxygen species (ROS) generation in the pathogenesis of CIN, the goal of the present study was to evaluate the effects of sildenafil on CIN development. Male Wistar rats were divided into control, CIN, and CIN pretreated with sildenafil (50 mg/kg/day). CIN was induced by water deprivation, NG-nitro-L-arginine methyl ester + indomethacin injections (10 mg/kg, intraperitoneally) and intravenous iohexol administration (3 g/kg). Renal function was evaluated through glomerular filtration rate (GFR), renal blood flow (RBF), plasma creatinine, uremia, and proteinuria. Oxidative stress was assessed by flow cytometry for intracellular ROS. Treatment with sildenafil attenuated the marked reduction of GFR and RBF in the CIN group. Moreover, sildenafil treatment in CIN rats reduced plasma creatinine, uremia, and proteinuria. Flow cytometry demonstrated that sildenafil attenuated the ROS production in the CIN group. These data suggest that sildenafil may be a new therapeutic agent to prevent CIN through its ability to preserve renal function and attenuate oxidative stress.

Association of monocyte to HDL cholesterol level with contrast induced nephropathy in STEMI patients treated with primary PCI.

Contrast induced nephropathy (CIN) has been proven to be a clinical condition related to adverse cardiovascular outcomes. In recent studies, the monocyte to high density lipoprotein ratio (MHR) has been postulated as a novel parameter associated with adverse renal and cardiovascular outcomes. In this study we investigated the association of MHR with CIN in ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PCI). Consecutive STEMI patients treated with primary PCI were prospectively recruited. Subjects were categorized into two groups; as patients who developed CIN (CIN+) and patients who did not develop CIN (CIN-) during hospitalization. CIN was defined as either a 25% increase in serum creatinine from baseline or 44.20 µmol/L increase in absolute value, within 72 h of intravenous contrast administration. A total number of 209 patients were included in the study. Thirty-two patients developed CIN (15.3%). In the CIN (+) patients, monocytes were higher [1.02 (0.83-1.39) vs. 0.69 (0.53-0.90) 109/L, p<0.01] and HDL cholesterol levels were lower [0.88 (0.78-1.01) vs. 0.98 (0.88-1.14) mmol/L, p<0.01]. In addition, MHR was significantly higher in the CIN (+) group [1.16 (0.89-2.16) vs. 0.72 (0.53-0.95) 109/mmol, p<0.01]. In multivariate logistic regression analysis, MHR, Mehran score, AGEF score and CV/eGFR were independently correlated with CIN. Higher MHR levels may predict CIN development after primary PCI in STEMI patients.

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Despite ranking third as a cause of hospital-acquired acute kidney injury (AKI), iatrogenic contrast-induced nephropathy(CIN) impacts significantly on morbidity and mortality and is associated with high hospital costs. In sub-Saharan Africa, the rates and riskfactors for CIN and patient outcomes remain unexplored. We conducted a prospective observational study at the Charlotte Maxeke Johannesburg Academic Hospital, South Africa, from1 July 2014 to 30 July 2015. Hospitalised patients undergoing computed tomography scan contrast media administration and angiography wereconsecutively recruited to the study and followed up for development of AKI. CIN was defined as an increase in serum creatinine&gt;25% or an absolute increase of &gt;44 μmol/L from baseline at 48 - 72 hours post exposure to contrast media. Outcome variables were theoccurrence of CIN, length of hospitalisation and in-hospital mortality. We recruited 371 hospitalised patients with a mean (standard deviation) age of 49.3 (15.9). The rates of CIN, assessed using an absolute orrelative increase in serum creatinine from baseline, were 4.6% and 16.4%, respectively. Anaemia was an independent predictor for the developmentof CIN (risk ratio (RR) 1.71, 95% confidence interval (CI) 1.01 - 2.87; p=0.04). The median serum albumin was 34 g/L (interquartile range (IQR)29 - 39.5) and 38 g/L (IQR 31 - 42) in the CIN and control groups, respectively (p=0.01), and showed a significant trend for CIN development(RR 1.68, 95% CI 0.96 - 2.92; p=0.06). Mortality was significantly increased in the CIN group (22.4% v. 6.8%; p&lt;0.001), and CIN together withanaemia increased mortality twofold (RR 2.39, 95% CI 1.20 - 4.75; p=0.01) and threefold (RR 3.32, 95% CI 1.48 - 7.43; p=0.003), respectively. CIN has a relatively high incidence in sub-Saharan Africa and predicts poorer clinical outcomes. The presence of CIN and anaemiapositively predicted mortality. Caution should be exercised in patients with hypoalbuminaemia and anaemia undergoing contrast media administration.