Contrast-induced Nephrotoxicity Research Articles

The effect of lycopene on contrast-induced nephrotoxicity in diabetic patients undergoing coronary angiography

Introduction: Radiocontrast nephrotoxicity refers to one of the most prevalent and key complications in diabetic patients. Objectives: This study was aimed to investigate the therapeutic and protective effect of lycopene on contrast-induced nephrotoxicity (CIN) in diabetic patients undergoing coronary angiography. Patients and Methods: In this study, 113 patients who took lycopene with prevention of contrast induced kidney injury regime (lycopene group) or prevention of kidney injury regimen alone (regimen group) were investigated through medical records. Oral lycopene was administered 24 hours before to 72 hours after the angiography. Blood urea nitrogen (BUN), creatinine (Cr), and glomerular filtration rate (GFR) were assessed and recorded in a checklist. SPSS software was conducted for data analysis. Results: At the baseline, there was no significant difference between the mean of urea, Cr, and GFR (P>0.05). However, after administration of lycopene, a significant difference between the mean BUN was observed among groups (P<0.001), with lower rate in the patients taking oral lycopene. Although the mean Cr decreased after the administration of oral lycopene, no statistically significant difference was seen (P = 0.08). The mean GFR was not significant different between the two groups of regimen and lycopene (P=0.44). Conclusion: In patients with diabetes, taking lycopene for CIN may help improve some biochemical factors; nevertheless, its positive effect on the improvement of nephrotoxicity indices cannot be certainly determined.

An in vivo and in vitro model on the protective effect of cilnidipine on contrast-induced nephropathy via regulation of apoptosis and CaMKⅡ/mPTP pathway.

Contrast-induced nephropathy (CIN) is an acute kidney injury (AKI) observed after the administration of contrast media. Calcium channel blockers (CCBs) have been reported to exert a renal protective effect. This study aims to investigate the role of cilnidipine, a novel CCBs, on CIN by regulating the calcium/calmodulin-dependent protein kinase Ⅱ(CaMKⅡ)/mitochondrial permeability transition pore(mPTP) pathway. Here, iohexol, a representative contrast media, was used to establish CIN model. KN-93 (CaMKⅡ inhibitor) and atractyloside (mPTP opener) were administered in rats, and CaMKⅡ overexpression was used in Human proximal tubular epithelial cells. Markers of renal injury (serum creatinine, blood urea nitrogen, and urinary NAGL), hematoxylin-eosin stain, oxidative stress (ROS, superoxide dismutase[SOD], and malondialdehyde [MDA] levels), cell death (MTT and terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling[TUNEL]), mitochondrial function (mPTP, mitochondrial membrane potential[MMP], and ATP) were assessed. Western blots were used to measure the expression levels of Bax/Bcl-2, caspase-3, CaMKⅡ/mPTP signaling pathways. Results showed that cilnidipine markedly improved kidney function, and alleviated tubular cell apoptosis, oxidative stress and mitochondrial damage induced by iohexol in vitro and in vivo. The underlying mechanism may be that cilnidipine relieved CaMKⅡ activation and mPTP opening induced by iohexol. All of these protective effects of cilnidipine were attenuated by CaMKⅡ overexpression and atractyloside (mPTP opener) pretreatment. Moreover, KN-93 (CaMKⅡ inhibitor) treatment showed a similar renal protective effect with cilnidipine, while the protective effect of cilnidipine on kidney in CIN rats was not further suppressed by KN-93 cotreatment. These in vitro and in vivo results point towardthe fact that cilnidipine might be a novel therapeutic drug against contrast-induced nephrotoxicity in a CaMKⅡ-dependent manner.

Optimizing low contrast volume thoracic CT angiography: From the basics to the advanced.

Contrast-enhanced CT angiography (CTA) is a widely used, noninvasive imaging technique for evaluating cardiovascular structures. Contrast-induced nephrotoxicity is a concern in renal disease; however, the true nephrotoxic potential of iodinated contrast media (CM) is unknown. If a renal impaired patient requires CTA, it is important to protect the kidneys from further harm by reducing total iodinated CM volume while still obtaining diagnostic quality imaging. These same reduced volume CM techniques can also be applied to nonrenal impaired patients in times of CM shortage. This educational review discusses several modifications to CTA that can be adapted to both conventional 64-slice and the newer generation CT scanners which enable subsecond acquisition with a reduced CM volume technique. Such modifications include hardware and software adjustments and changes to both the volume and flow rate of administered CM, with the goal to reduce the dose of CM without compromising diagnostic yield.

Association between contrast-induced nephrotoxicity and contrast enhanced computed tomography followed by endoscopic retrograde cholangiopancreatography

PurposeTo determine if endoscopic retrograde cholangiopancreatography (ERCP) performed within 72 h after contrast enhanced computed tomography (CECT) increases contrast-induced nephrotoxicity (CIN) risk in patients with abdominal complaints. MethodThis single-center retrospective cohort study included consecutive adult patients with abdominal complaints who underwent CECT between October 1, 2016, and June 30, 2019 at an emergency department (ED). CIN was diagnosed based on serum creatinine (SCr) level >0.5 mg/dL within 72 h after CECT or that increased >25 % compared to pre-CECT level. Logistic regression analysis was performed to determine independent risk factors for CIN, including age, sex, body mass index, comorbidities, medication, pre-CECT SCr level >1.5 mg/dL, and ERCP performed within 72 h after CECT. For persistent CIN, SCr level was obtained after 3 months at the earliest and compared to data obtained within 72 h after ERCP and CECT. ResultsOf 1457 patients with CECT, 90 (6.2 %) underwent ERCP within 72 h after CECT and 93 (6.4 %) developed CIN. Multivariate analysis revealed that ERCP performed within 72 h after CECT (odds ratio, 3.31; 95 % confidence interval, 1.74, 6.29; p < 0.001) and pre-CECT SCr level >1.5 mg/dL (odds ratio, 9.86; 95 % confidence interval, 5.08, 19.2; p < 0.001) were independent risk factors for CIN. Of 93 patients with CIN, 10 (11 %) had persistent CIN. No specific factors were correlated with persistent CIN in the 3-month time frame. ConclusionERCP performed within 72 h after CECT and pre-CECT SCr level >1.5 mg/dL are associated with CIN development.

Correlation of Intravenous Administration of Iodinated Nonionic Contrast Agents with Contrast-Induced Nephrotoxicity in Sedated Dogs

One of most accessible physical method of investigation in veterinary medicine is represented by the radiographic study. The contrast agents are used in veterinary radiology to highlight the anatomical structures. The contrast agents can absorb X-Ray and are used in special radiological procedures such as angiography, urography, myelography, contrast Computed Tomography or evaluation of gastrointestinal tract. The aim of the this paper was to perform a retrospective study to identify the complications associated with non-ionic contrast agents administration in dogs that undergo contrast radiography or contrast CT examination. Between January 2016 and January 2018, we selected a number of 234 dogs that were evaluated using contrast agents procedures (contrast radiography, contrast CT). A number of 192 cases had blood analysis before and after contrast administration and were included in the study. Keywords: contrast-induced nephropathy, contrast-induced acute kidney injury, nephrotoxicity, contrast agents, dogs

Iodine-induced Nephropathy in Patients with Oncological Disorders Treated with Chemotherapy

Cancer represents the second most important cause of death and morbidity in Europe, with more than 3.7 million new cases and 1.9 million deaths reported each year. Computed tomography plays a fundamental role in the management of oncology patients, and the superior diagnostic value that contrast-enhanced images offer is frequently critical. It is well recognized that iodinated contrast media have a cytotoxic effect, and this is felt to be one of the mechanisms responsible for contrast-induced nephrotoxicity. The study aims to analyze the correlation between administration of iodinated contrast substance (namely, Iohexol) and serum creatinine values 48 hours afterwards in patients with oncological conditions undergoing chemotherapy, which perform CT examinations (observational study). Keywords: CT, contrast media induced nephropathy, chemotherapy

MRI for diagnosis of post-renal transplant complications: current state-of-the-art and future perspectives.

Kidney transplantation has developed into a widespread procedure to treat end stage renal failure, with transplantation results improving over the years. Postoperative complications have decreased over the past decades, but are still an important cause of morbidity and mortality. Early accurate diagnosis and treatment is the key to prevent renal allograft impairment or even graft loss. Ideally, a diagnostic tool should be able to detect post-transplant renal dysfunction, differentiate between the different causes and monitor renal function during and after therapeutic interventions. Non-invasive imaging modalities for diagnostic purposes show promising results. Magnetic resonance imaging (MRI) techniques have a number of advantages, such as the lack of ionizing radiation and the possibility to obtain relevant tissue information without contrast, reducing the risk of contrast-induced nephrotoxicity. However, most techniques still lack the specificity to distinguish different types of parenchymal diseases. Despite some promising outcomes, MRI is still barely used in the post-transplantation diagnostic process. The aim of this review is to survey the current literature on the relevance and clinical applicability of diagnostic MRI modalities for the detection of various types of complications after kidney transplantation.

Utilization of Carbon Dioxide Angiography and Percutaneous Balloon Angioplasty for Treatment of Transplant Renal Artery Stenosis

Transplant renal artery stenosis (TRAS) may lead to graft dysfunction and failure. Progressive deterioration of renal allograft function may be exacerbated by contrast-induced nephrotoxicity during iodine contrast administration for renovascular imaging of allografts. We present our institutional experience of endovascular management for TRAS using CO2 digital subtraction angiography (CO2-DSA) and balloon angioplasty to manage failing renal transplants. Four patients with renal allografts from March 2017-May 2018 were referred for graft dysfunction and pending renal transplant failure. Indications for referral included refractory hypertension, decreasing renal functioning, and elevated renovascular systolic velocities. Median age of the four patients was 41.5 years (22-60 years). There were two male and female patients. Chronic hypertension and type 2 diabetes mellitus were the most common comorbidities. An average total of 75mL of CO2 was used, supplemented with 17.4mL of iodinated contrast. All patients had improvements in renal function following intervention with a mean decrease in systolic and diastolic blood pressure of 25.8% and 21.4%, respectively. We also observed a mean decrease of BUN by 13.6% and creatinine by 37.4%. Additionally, eGFR increased by 37.7%. All allografts survived after surgery, and only one patient required repeat angioplasty for recurrence. CO2-DSA with balloon angioplasty can be successfully utilized to salvage deteriorating kidney allograft function in patients with TRAS.

Influence of Clinical Factors on Risk of Contrast-Induced Nephrotoxicity From IV Iodinated Low-Osmolality Contrast Material in Patients With a Low Estimated Glomerular Filtration Rate.

OBJECTIVE. The objective of our study was to explore whether clinical factors historically associated with contrast material-causative kidney injury (contrast-induced nephrotoxicity [CIN]) increase risk after use of IV iodinated low-osmolality contrast material (LOCM) in patients with stage IIIb-V chronic kidney disease. MATERIALS AND METHODS. In this retrospective hypothesis-generating study, 1:1 propensity score matching was used to assess post-CT acute kidney injury (AKI) after unenhanced or contrast-enhanced CT in patients with stable estimated glomerular filtration rate (eGFR; 1112 patients with an eGFR = 30-44 mL/min/1.73 m2 and 86 patients with an eGFR < 30 mL/min/1.73 m2 and no dialysis). Historical risk factors including diabetes mellitus, age more than 60 years, hypertension, loop diuretic use, hydrochlorothiazide use, and cardiovascular disease were evaluated for modulation of CIN risk. Stepwise multivariable logistic regression was performed. RESULTS. Overall IV LOCM was an independent risk factor for post-CT AKI in patients with an eGFR of less than 30 mL/min/1.73 m2 (odds ratio, 3.96 [95% CI, 1.29-12.21]; p = 0.016) but not in those with an eGFR of 30-44 mL/min/1.73 m2 (p = 0.24). In patients with an eGFR of less than 30 mL/min/1.73 m2, the tested covariates did not significantly modify the risk of CIN (p = 0.096-0.832). In patients with an eGFR of 30-44 mL/min/1.73 m2, risk of CIN emerged in those with cardiovascular disease (p = 0.015; number needed to harm from LOCM = 11 patients); the other tested cofactors had no significant effect (p = 0.108-0.822). CONCLUSION. CIN was observed when eGFR was less than 30 mL/min/1.73 m2. In those with an eGFR of 30-44 mL/min/1.73 m2, CIN was not observed with LOCM alone but was observed in the presence of cardiovascular disease. Other cofactors historically thought to increase CIN risk (e.g., diabetes mellitus) did not increase risk of CIN. Further study is needed to determine whether these exploratory results are true associations.

Protective Effect of Ginger Extract against Contrast media-Induced Nephrotoxicity in Rats.

Background: Nephrotoxicity was reported in the initial clinical trials of contrast media. Aim of study: Our study was designed to evaluate the protective effect of ginger extract against nephrotoxicity induced by contrast agent. Material & Methods: Animals were divided into 5 groups as follow: Group1 (Control): They were not received any treatment during experiment period. Group2 (Ginger): Animals were deprived from water for 72 hours , then orally administrated with 400 mg/Kg/day of ginger extract for 72 hours. Group3 (protective): Animals were pre administrated orally with ginger extract with 400 mg/Kg for one week, then rats were deprived of water for 72 hours, then urografin was induced by a single (I.V.) at dose of 10mL per kg after that animals were orally administrated with 400 mg/Kg/day of ginger extract for 3 consecutive days. Group 4 (positive)(contrast media): Animals were induced by a single intravenous (I.V.) of urografin at dose of 10mL per kg after deprivation of water for 72 hours. Group 5(therapeutic): Animals rats were deprived of water for 72 hours, then Contrast-induced nephrotoxicity was induced (as group 4) , after that animals were post administrated with ginger extract 400 mg/Kg (for 3 days). Results: Administration contrast media caused significant elevation in serum urea, creatinine concentration, kidney tissue levels of MDA and NO. Also it caused significant increase in Cystain C , NGAL and TNFα levels. Also it significantly decreased SOD activity and GSH level. Treatment with Ginger extract restored the elevation of concentration of urea and creatinine, also oxidative stress markers in groups 3 and 5 and decreased Cystain C , NGAL and TNFα levels. Histopathological analysis confirmed that. Conclusion: ginger extract have a protective role in contrast media induced nephrotoxicity.

Protective Effect of Artemisia argyi and Its Flavonoid Constituents against Contrast-Induced Cytotoxicity by Iodixanol in LLC-PK1 Cells.

Preventive effects and corresponding molecular mechanisms of mugwort (Artemisia argyi) extract and its flavonoid constituents on contrast-induced nephrotoxicity were explored in the present study. We treated cultured LLC-PK1 cells with iodixanol to induce contrast-induced nephrotoxicity, and found that A. argyi extracts ameliorated the reduction in cellular viability following iodixanol treatment. The anti-apoptotic effect of A. argyi extracts on contrast-induced nephrotoxicity was mediated by the inhibition of mitogen-activated protein kinase (MAPK) phosphorylation and the activation of caspases. The flavonoid compounds isolated from A. argyi improved the viability of iodixanol-treated cells against contrast-induced nephrotoxicity. Seven compounds (1, 2, 3, 15, 16, 18, and 19) from 19 flavonoids exerted a significant protective effect. Based on the in silico oral-bioavailability and drug-likeness assessment, which evaluate the drug potential of these compounds, compound 2 (artemetin) showed the highest oral bioavailability (49.55%) and drug-likeness (0.48) values. We further investigated the compound–target–disease network of compound 2, and proliferator-activated receptor gamma (PPAR-γ) emerged as a predicted key marker for the treatment of contrast-induced nephrotoxicity. Consequently, compound 2 was the preferred candidate, and its protective effect was mediated by inhibiting the contrast-induced inflammatory response through activation of PPAR-γ and inhibition of MAPK phosphorylation and activation of caspases.

Ginger extract protect Iodinated Contrast Media Nephrotoxicity in rats through modulation of Oxidative Stress, Cystain C, NGAL and TNF α

Background: Nephrotoxicity was reported in the initial clinical trials of contrast media. Aim of study: Our study was designed to evaluate the protective effect of ginger extract against nephrotoxicity induced by contrast agent. Material and Methods: Animals were divided into 5 groups as follow: Group1 (Control): They were not received any treatment during experiment period. Group2 (Ginger): Animals were deprived from water for 72 hours , then orally administrated with 400 mg/Kg/day of ginger extract for 72 hours. Group3 (protective): Animals were pre administrated orally with ginger extract with 400 mg/Kg for one week, then rats were deprived of water for 72 hours, then urografin was induced by a single (I.V.) at dose of 10mL per kg after that animals were orally administrated with 400 mg/Kg/day of ginger extract for 3 consecutive days. Group 4 (positive)(contrast media): Animals were induced by a single intravenous (I.V.) of urografin at dose of 10mL per kg after deprivation of water for 72 hours. Group 5(therapeutic): Animals rats were deprived of water for 72 hours, then Contrast-induced nephrotoxicity was induced (as group 4) , after that animals were post administrated with ginger extract 400 mg/Kg (for 3 days). Results: Administration contrast media caused significant elevation in serum urea, creatinine concentration, kidney tissue levels of MDA and NO. Also it caused significant increase in Cystain C , NGAL and TNFa levels. Also it significantly decreased SOD activity and GSH level. Treatment with Ginger extract restored the elevation of concentration of urea and creatinine, also oxidative stress markers in groups 3 and 5 and decreased Cystain C, NGAL and TNFa levels. Histopathological analysis confirmed that. Conclusion: ginger extract have a protective role in contrast media induced nephrotoxicity.

Micronuclei frequency and blood cell number in rabbit contrast-induced nephrotoxicity model with antioxidants as a preventive strategy

Micronuclei frequency and blood cell number in rabbit contrast-induced nephrotoxicity model with antioxidants as a preventive strategy

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.

Three-Dimensional Computed Tomography Reconstruction in Transplant Renal Artery Stenosis.

Transplant renal artery stenosis is a frequently recognized complication of kidney transplant procedures. A single-center retrospective study was conducted to examine the use of 3-dimensional computed tomography reconstruction in diagnosing transplant artery stenosis. During 2013 at our center, 86 patients underwent kidney transplant. All patients underwent ultrasonographic analyses. Patients with clinically suspected transplant renal artery stenosis were examined by 3-dimensional computed tomography reconstruction and were treated with endovascular approaches or medically managed. Ten patients were diagnosed with transplant renal artery stenosis by 3-dimensional computed tomography reconstruction. No evidence of contrast-induced nephrotoxicity was observed. Nine of the 10 patients underwent percutaneous transluminal angio-plasty, whereas the remaining patient was treated conservatively. Procedural success rate was 100%. Patients were followed for a mean period of 20 ± 3 months. Blood pressure improved from a mean of 163/90 to 132/73 mm Hg at the end of the follow-up period. In the 9 patients who underwent angioplasty, serum creatinine improved from 198 ± 24 to 134 ± 16 μmol/L at the end of the follow-up period. The cystatin C level in some patients declined after interventional therapy. Three-dimensional computed tomography reconstruction is a safe choice for patients who present with increased serum creatinine levels and refractory hypertension. Percutaneous transluminal angioplasty is the preferred therapeutic technique for transplant renal artery stenosis.

A new update for radiocontrast-induced nephropathy aggravated with glycerol in rats: the protective potential of epigallocatechin-3-gallate

Contrast media (CM) is known to have nephrotoxic adverse effects. Epigallocatechin-3-gallate (EGCG) is the most abundant and active catechin in green tea, and has strong antioxidant and anti-inflammatory properties. This study investigated whether EGCG can reduce contrast-induced nephrotoxicity (CIN), alone or with glycerol (GLY)-induced renal damage, and to understand its mechanisms of protection against toxicity, using models of GLY and CIN in rats. The rats were separated into eight groups (n = 6 in each), as follows: Healthy, GLY, CM, GLY + CM, CM + EGCG 50 mg/kg (po), GLY + CM + EGCG 50 mg/kg (po), CM + EGCG 100 mg/kg (po), and GLY + CM + EGCG 100 mg/kg (po). Both doses of EGCG protected against CM-induced renal dysfunction, as measured by serum creatinine and blood urea nitrogen (BUN). In addition, EGCG treatment markedly improved CIN-induced oxidative stress, and resulted in a significant down-regulatory effect on tumor necrosis factor (TNF)-α and nuclear factor (NF)-κB mRNA expression. Moreover, histopathological analysis showed that EGCG also attenuated CM-induced kidney damage. Considering the potential clinical use of CM and the numerous health benefits of EGCG, this study showed the protective role of multi-dose EGCG treatment on CIN and GLY-aggravated CIN through different mechanisms.

A new update for radiocontrast induced nephropathy aggravated with glycerol in rats: The protective potential of epigallocatechin-3-gallate

AbstractContrast media (CM) is known to have nephrotoxic adverse effects. Epigallocatechin-3-gallate (EGCG) is the most abundant and active catechin in green tea, and has strong antioxidant and anti-inflammatory properties. This study investigated whether EGCG can reduce contrast-induced nephrotoxicity (CIN), alone or with glycerol (GLY)-induced renal damage, and to understand its mechanisms of protection against toxicity, using models of GLY and CIN in rats. The rats were separated into eight groups (n = 6 in each), as follows: Healthy, GLY, CM, GLY + CM, CM + EGCG 50 mg/kg (po), GLY + CM + EGCG 50 mg/kg (po), CM + EGCG 100 mg/kg (po), and GLY + CM + EGCG 100 mg/kg (po). Both doses of EGCG protected against CM-induced renal dysfunction, as measured by serum creatinine and blood urea nitrogen (BUN). In addition, EGCG treatment markedly improved CIN-induced oxidative stress, and resulted in a significant down-regulatory effect on tumor necrosis factor (TNF)-α and nuclear factor (NF)-κB mRNA expression. Mor...

A novel approach to contrast-induced nephrotoxicity: the melatonergic agent agomelatine.

To study the potential nephroprotective role of agomelatine in rat renal tissue in cases of contrast-induced nephrotoxicity (CIN). The drug's action on the antioxidant system and proinflammatory cytokines, superoxide dismutase (SOD) activity, levels of glutathione (GSH) and malondialdehyde (MDA) and the gene expression of interleukin-6 (IL-6), tumour necrosis factor (TNF)-α and nuclear factor kappa B (NF-κB) was measured. Tubular necrosis and hyaline and haemorrhagic casts were also histopathologically evaluated. The institutional ethics and local animal care committees approved the study. Eight groups of six rats were put on the following drug regimens: Group 1: healthy controls, Group 2: GLY (glycerol), Group 3: CM (contrast media--iohexol 10 ml kg(-1)), Group 4: GLY+CM, Group 5: CM+AGO20 (agomelatine 20 mg kg(-1)), Group 6: GLY+CM+AGO20, Group 7: CM+AGO40 (agomelatine 40 mg kg(-1)) and Group 8: GLY+CM+AGO40. The groups were evaluated by one-way analysis of variance and Duncan's multiple comparison test. Agomelatine administration significantly improved the serum levels of blood urea nitrogen (BUN) and creatinine, SOD activity, GSH and MDA. The use of agomelatine had substantial downregulatory consequences on TNF-α, NF-κB and IL-6 messenger RNA levels. Mild-to-severe hyaline and haemorrhagic casts and tubular necrosis were observed in all groups, except in the healthy group. The histopathological scores were better in the agomelatine treatment groups. Agomelatine has nephroprotective effects against CIN in rats. This effect can be attributed to its properties of reducing oxidative stress and inhibiting the secretion of proinflammatory cytokines (NF-κB, TNF-α and IL-6). CIN is one of the most important adverse effects of radiological procedures. Renal failure, diabetes, malignancy, old age and non-steroidal anti-inflammatory drug use pose the risk of CIN in patients. Several clinical studies have investigated ways to avoid CIN. Theophylline/aminophylline, statins, ascorbic acid and iloprost have been suggested for this purpose. Agomelatine is one of the melatonin ligands and is used for affective disorders and has antioxidant features. In this study, we hypothesized that agomelatine could have nephroprotective, antioxidant and anti-inflammatory effects against CIN in rats.

Predicting Risk of Contrast-Induced Nephrotoxicity in Hospitalized Patients Undergoing Computed Tomography Using the Mehran Stratification Score

We read with interest the comprehensive review article on contrast-induced nephrotoxicity (CIN) by Nicola et al in Current Problems in Diagnostic radiology, including the most recent controversies about CIN. When discussing the role of risk factors for CIN, the authors state that “owing to the cumulative effects of multiple risk factors, an assessment tool is needed to estimate the possible level of damage,” and introduce the risk stratification score developed by Mehran et al from a large cohort of patient who underwent coronary angiography, which may predict the risk of CIN and of dialysis. Published in 2004, the Mehran risk stratification system (MRSS) involves a CIN score sheet based upon the presence of multiple risk factors including hypotension, intra-aortic balloon pump, congestive heart failure, chronic kidney disease (CKD), advanced age, anemia, diabetes, and contrast medium volume. At most general hospitals, some of these conditions are very common in hospitalized patients who undergo contrast-enhanced computed tomography (CT) for investigation of several different disorders. Therefore, at our department we tried to prospectively assess the usefulness of the MRSS in inpatients who received contrastenhanced body CT and had sufficient clinical and laboratory follow-up during hospitalization. Whereas the MRSS is validated in patients receiving intra-arterial contrast medium during coronary catheterization, to the best of our knowledge its use in CT has not been previously reported in literature. The study lasted 2 months and included 92 patients with estimated glomerular filtration rate (eGFR) below 60 mL/min and 71 matched controls with normal baseline renal function and similar age, sex distribution, and prevalence of comorbidities. The CKD group underwent CIN prophylaxis according to the European Society of Urogenital Radiology guidelines, including isotonic saline or sodium bicarbonate hydration, administration of N-acetylcysteine, and discontinuation of nephrotoxic medications. Standard weight-adjusted doses of low-osmolar contrast agents (either iopromide 370 mg I/mL or iomeprol 350 mg I/mL) were administered.

0302: Rate and predictors of contrast-induced nephrotoxicity after coronary intervention depend on renal function at baseline

Contrast induced nephrotoxicity (CIN) after coronary angiography or angioplasty (CA) has been shown to be related to mortality. The rate and predictors of CIN when preventive measures are applied are poorly documented. All consecutive patients submitted to non-urgent CA in 2014 with low-osmolar contrast medium were stratified for CIN risk: patients with renal dysfunction (defined as eGFR<60mL/min) had interruption of diuretics and received a 250-500mL intravenous saline infusion before and after CA. Serum Creatinine (SCr) levels were measured before CA and daily thereafter up to 5 days after CA. CIN was defined as an absolute increase of 44 µmol/L SCr or of 25% over baseline SCr level. Predictors of CIN and of recovery were determined by logistic regression. CIN patients had clinical follow-up for death or end-stage renal dysfunction. SCr results were available in 958 patients, 72% male, 25% diabetics, median eGFR was 71mL/min before CA (interquartiles (IQ) =54; 89). Median amount of contrast was 129mL (IQ=90; 186). At 2-4 days, CIN was observed in 188(20%), driven by a 25% increase in SCr (n=185, 19%) whereas 81 (8.5%) had an increase of >44mmol/L in SCr. CIN rate was related to quartiles of eGFR before CA: 20% when eGFR<53, 14% for eGFR between 53 and 88 and 30% for eGFR>87ml/min. The amount of contrast medium was not a predictor of CIN. In patients without renal dysfunction, a lower SCr was a predictor of CIN. Conversely, in patients with renal dysfunction, older age and diabetes were associated with CIN (figure). In contemporary routine practice, CIN occurs in 20%, driven by a relative 25% increase in SCr, and irrespective of the amount of contrast medium. In patients with renal dysfunction, older age and diabetes were associated with CIN.