Contrast Medium-induced Nephropathy Research Articles

Magnetic vagus nerve stimulation ameliorates contrast-induced acute kidney injury by circulating plasma exosomal miR-365-3p

BackgroundContrast-induced acute kidney injury (CI-AKI) is manifested by a rapid decline in renal function occurring within 48–72 h in patients exposed to iodinated contrast media (CM). Although intravenous hydration is currently the effective method confirmed to prevent CI-AKI, it has several drawbacks. Some investigations have demonstrated the nephroprotective effects of vagus nerve stimulation (VNS) against kidney ischemia-reperfusion injury, but no direct research has investigated the use of VNS for treating CI-AKI. Additionally, most current VNS treatment applies invasive electrical stimulator implantation, which is largely limited by the complications. Our recent publications introduce the magnetic vagus nerve stimulation (mVNS) system pioneered and successfully used for the treatment of myocardial infarction. However, it remains uncertain whether mVNS can mitigate CI-AKI and its specific underlying mechanisms. Therefore, we herein evaluate the potential therapeutic effects of mVNS on CM-induced nephropathy in rats and explore the underlying mechanisms.ResultsmVNS treatment was found to significantly improve the damaged renal function, including the reduction of elevated serum creatinine (Scr), blood urea nitrogen (BUN), and urinary N-acetyl-β-D-glucosaminidase (NAG) with increased urine output. Pathologically, mVNS treatment alleviated the renal tissue structure injury, and suppressed kidney injury molecule-1 (KIM-1) expression and apoptosis in renal tubular epithelial cells. Mechanistically, increased circulating plasma exosomal miR-365-3p after mVNS treatment enhanced the autophagy and reduced CM-induced apoptosis in renal tubular epithelial cells by targeting Ras homolog enriched in brain (Rheb).ConclusionsIn summary, we demonstrated that mVNS can improve CI-AKI through enhanced autophagy and apoptosis inhibition, which depended on plasma exosomal miR-365-3p. Our findings highlight the therapeutic potential of mVNS for CI-AKI in clinical practice. However, further research is needed to determine the optimal stimulation parameters to achieve the best therapeutic effects.Graphical abstract

Impact of very high doses of contrast media on acute kidney injury rates in patients admitted with ST-elevation myocardial infarctions

Abstract Introduction Previous studies have shown that in patients with ST-elevation myocardial infarctions (STEMI) maybe the main contributor of acute kidney injury (AKI) is the STEMI itself with its hemodynamic sequelae and to a lesser extent contrast media induced nephropathy (CIN). However, the possible impact of very high doses of contrast media (CM) on kidney function in this context remains unclear. Aim of the present study was therefore to investigate, how very high doses of CM influenced AKI-rates in patients admitted with STEMI. Methods Patients admitted with STEMI between 2006 and 2022 to a large German heart center entered analysis. A very high dose of contrast media was defined as >250 ml. AKI was defined by KDIGO-criteria (2012). To minimize impact of confounders patients were grouped by initial TIMI-risk-score and initial renal function (glomerular filtration rate (GFR)) in a 3x3 format. Results Of a total of 8845 patients included, 547 patients (6.2%) received a CM-dose >250 ml with an average CM-amount of 318.2±64 ml vs. 135.8±48 ml in the control group. A multivariate model revealed that patients receiving very high CM-doses were more likely to be older (OR 1.31, 95% CI 1.1-1.6, p<0.01) and to have more extensive STEMIs (CK>2000 U/ml: OR 1.33, 95% CI 1.1-1.6), while they were less likely to be female (0.77, 95% CI 0.6-0.9,p=0.01) and less likely to have undergone successful percutaneous coronary intervention (PCI): OR 0.51, 95% CI 0.4-0.6, p<0.01. Patients receiving very high doses of CM were more likely to develop AKI: 21.6% vs. 14.9,%, p<0.01. This significant impact remained after adjusting in a multivariate model (OR 1.42 95% CI 1.1-1.9, p<0.01). When stratifying patients into nine groups (3x3) both, initial TIMI-risk-score for STEMI and a lower GFR were associated with a marked increase in AKI-rates, with the lowest AKI-rate at 3.4% in patients with a low TIMI-risk and an initial GFR of 60-89 ml/min and the highest AKI rate at 37.8% in patients with a high TIMI-risk score and a GFR<60 ml/min (table (A)). However, the impact of very high CM-amounts on AKI-rates in this pre-stratified cohorts was inconsistent and only independently associated with a higher AKI-risk in 1 out of 9 groups (marked by astrisk*, table (B)). Conclusions STEMI-Patients receiving very high amounts of contrast media during emergency cardiac catheterization were on average older with larger infarctions and showed lower rates of successful percutaneous coronary interventions (PCI). For the majority of these patients even very high amounts of contrast media were not independently associated with higher rates of acute kidney injury. AKI-rates were more likely to be determined by overall risk and initial renal function.

TRIM8 regulates contrast induced renal cell injury via the TLR4/MyD88/ NF kB pathway

Purpose: To investigate the effect of tripartite motif-containing protein 8 (TRIM8) on contrast media-induced injury on kidneys in mice and on human renal tubular epithelial cells.
 Methods: Contrast media-induced nephropathy (CIN) model was constructed by injecting meglumine diatrizoate in mice. Small interference technology was used to knock down the expression of TRIM8 in HK-2 cells, while quantitative real-time polymerase chain reaction (qRT-PCR) and enzyme-linked immunosorbent assay (ELISA) were used to determine the expression levels of the inflammatory factors: TNF-α, TGF-β1, IL-1β, and IL-4. Cell counting kit-8 (CCK-8) assay was employed to determine the cell viability of each group, and TUNEL staining applied to detect apoptosis morphology using a fluorescence microscope. Flow-type Annexin V-FITC/PI double staining and Caspase-3 activity colorimetry were used to observe the changes in apoptosis. Expression of apoptosis factors, including Bax, Caspase3, Caspase9, and anti-apoptotic factor Bcl-2, was determined by qRT-PCR, while expressions of the TLR4/MyD88/NF-kB pathway were determined using Western blot and qRT-PCR.
 Results: In CIN group, the kidney tissues significantly expressed IL-1β and Caspase3, while the contents of BUN, SCr, and UP all increased (p < 0.05). At the same time, expression of TRIM8 in the kidney tissues was up-regulated. After knocking down TRIM8, HK-2 cells inhibited the contrast agent-induced apoptosis and inflammation and as well as TLR4/MyD88/NF-kB pathway (p < 0.05).
 Conclusion: TRIM8 regulates contrast-induced renal cell damage via TLR4/MyD88/NF-KB pathway. The results of the current study may provide new insights for the development of new treatment strategies for CIN.

PD40-02 A RANDOMIZED STUDY USING COMBINATION OF STATIN AND ASCORBIC ACID FOR PREVENTION OF CONTRAST-INDUCED NEPHROPATHY (NCT03391830)

You have accessJournal of UrologyCME1 May 2022PD40-02 A RANDOMIZED STUDY USING COMBINATION OF STATIN AND ASCORBIC ACID FOR PREVENTION OF CONTRAST-INDUCED NEPHROPATHY (NCT03391830) Abdelwahab Hashem, Mahmoud Laymon, Mostafa Elgamal, Ahmed M. Lashin, Mohamed Ramez, Refaie Huda, and Yasser Osman Abdelwahab HashemAbdelwahab Hashem More articles by this author , Mahmoud LaymonMahmoud Laymon More articles by this author , Mostafa ElgamalMostafa Elgamal More articles by this author , Ahmed M. LashinAhmed M. Lashin More articles by this author , Mohamed RamezMohamed Ramez More articles by this author , Refaie HudaRefaie Huda More articles by this author , and Yasser OsmanYasser Osman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002601.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Several drugs have been considered for the prevention of contrast medium-induced nephropathy. we will try to assess the reno-protective role of combination of use of both ascorbic acid and statin for patients undergoing urologic diagnostic CT with a contrast agent. METHODS: This 4-days, single-center, randomized, double-blind trial was for patients underwent elective contrast-enhanced computed tomography (CECT). Eligible patients were statin naïve patients, or not on statin treatment for at two weeks with normal renal function, planned for CECT. Patients were divided into two groups: the first group received atorvastatin 80-mg loading dose given 24 hours once/daily before CECT with another 40-mg dose once/daily approximately 2 hours before the procedure and for another 2 days plus ascorbic acid 500mg once/daily in the same days of atorvastatin. The second group received two tablets of placebo once/daily before the procedure and for another 3 days. The study outcomes were to detect the difference in serum creatinine and creatinine clearance (eGFR) (calculated using the 4-variable equation of Modification of Diet in Renal Disease) within 72 hours after administration of contrast agent, and to assess the incidence of contrast medium-induced nephropathy in both groups, defined as a relative increase in baseline serum creatinine values by ≥25% and/or an absolute increase of ≥0.5 mg/dL (≥44.2μmol/L) within 472 hours after contrast administration. RESULTS: Both groups were comparable in baseline parameters. The baseline median (interquartile range [IQR]) of eGFR was 97.1 (80.7, 114.9) mL/min and 94.6 (78.2, 120.7) mL/min in placebo and Statin/Ascorbic acid group, respectively (p=0.66). The final median (IQR) of eGFR was 95.2 (72.8, 108.1) mL/min and 88.6 (71.9, 111.0) mL/min in placebo and Statin/Ascorbic acid group, respectively (p=0.48) (Table 2). However, the N(%) incidence of contrast medium-induced nephropathy occurred in 11 (9.8) and 3 (3) in placebo and Statin/Ascorbic acid group, respectively (p=0.04). CONCLUSIONS: Although the use of Statin/Ascorbic acid to prevent the contrast medium-induced nephropathy did not statistically improve the eGFR, it can decrease the incidence of the contrast medium-induced nephropathy, compared to the placebo. Source of Funding: No © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e683 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Abdelwahab Hashem More articles by this author Mahmoud Laymon More articles by this author Mostafa Elgamal More articles by this author Ahmed M. Lashin More articles by this author Mohamed Ramez More articles by this author Refaie Huda More articles by this author Yasser Osman More articles by this author Expand All Advertisement PDF DownloadLoading ...

The effects of boric acid and quercetin on contrast media-induced nephropathy in rats

We aimed to determine the effects of boric acid and quercetin on contrast media-induced nephropathy in rats. Thirty-two rats were divided into four equal groups with eight rats in each group: the control (C) group, contrast media (CM) group, contrast media plus boric acid (CMB) group, and contrast media plus quercetin (CMQ) group. Boric acid (H3(BO)3, 4% solution) at a dose of 200 mg/kg was administered by oral gavage to rats in the group CMB once daily for 4 consecutive days (days 1 to 4). Quercetin at a dose of 50 mg/kg was administered by oral gavage to rats in the CMQ group once daily for 4 consecutive days (days 1 to 4). A significant decrease was found in the serum urea and creatinine levels in the CMQ group compared with the CM group (P <0.01). The serum nitrite and nitrate levels were higher in the CM group than in the C group and were lower in the CMQ group than in the CM group (P <0.01). A significant decrease in the severity of tubular necrosis was found in the CMQ group compared to the CM group (P <0.05). Quercetin had protective effects against contrast nephropathy, but no beneficial effect of boric acid was found.

Role of diffusion weighted MRI in patients with hepatocellular carcinoma: prediction and assessment of response to trans-arterial chemoembolization

Aim: The study goal is to detect if apparent diffusion coefficient (ADC), a quantitative parameter of diffusion-weighted imaging (DWI), can recognize HCC post TACE residuals. Results were obtained by using MRI_DWI & ADC and were compared with those of Tri phasic-computed tomography (CT). patient and Methods MRI-DWI was performed to 20 patients with 24 HCC focal lesions before and 1month after TACE to calculate the ADC value of HCC. Patients were also evaluated with Tri phasic-CT after TACE. CT was performed within 1 month after TACE. Results: All patients under the study shows pretreatment restricted Diffusion weighted images with low ADC value. Mean ADC value before treatment was 1.14× 10¯³ ±0.29× 10¯³ and ranged from 0.819× 10¯³ to 2.48× 10¯³. 9 cases (45%) cases show post-TACE good therapeutic response with facilitated diffusion & mean ADC value 1.32×10¯³ with significant increase compared to pre-treatment values. 11 cases (55%) shows post-TACE partial or no therapeutic response with restricted diffusion & mean ADC value 1.18×10¯³. However, there was no statistical significant difference between ADC value of resolved and that of residual cases (P-value=0.067), DWI could predict the response of treatment as CT by 100%. All cases of Good therapeutic response had a facilitated diffusion, all cases of partial therapeutic response had a restricted diffusion but less than pretreatment and all cases with no therapeutic response had a restricted diffusion but more than pretreatment. Conclusion DWI could evaluate HCC necrosis of tumor after chemoembolization, and the ADC importance might be its ability to detect viable necrotic tumor tissues. Furthermore, DWI-MRI determines improved liver lesion location. So, DWI can be used as an option for HCC patients short term follow up after chemoembolization and may direct patient control for decreasing radiation CT examination exposure and the danger of contrast material-induced nephropathy.

Could Omega 3 fatty acids reduce the risk of contrast-induced nephropathy in patients undergoing coronary angiography? A randomized controlled trial.

Contrast medium-induced nephropathy (CIN) is a leading cause of acquired acute kidney injury and has been associated with prolonged hospitalization and adverse clinical outcomes. This study aimed to determine if omega 3 fatty acids reduce the risk of CIN in patients with chronic kidney disease undergoing coronary angiography. A total of 130 consecutive patients undergoing coronary angiography were randomly assigned to one of two groups as follows: 67 patients were assigned to the N-acetylcysteine (NAC; 1200 mg) and 63 patients were assigned to the omega 3 fatty acid (4 g). Both drugs were administered orally twice per day one day before and on the day of contrast administration. Of the 130 patients enrolled in this study, 10 (7.7%) experienced an increase of at least 0.5 mg/dL (44 μmol/L) in serum creatinine levels 48 h after administration of the contrast agent including 5 of the 67 patients in the NAC group (7.5%) and 5 of the 63 patients in the omega 3 fatty acids group (7.9%; P = 0.919). There were no significant differences in the need for renal replacement therapy (3.0% vs. 9.5%, P = 0.121) or in the mortality rate (3.0% vs. 6.3%, P = 0.361) between the two groups. Short-term prophylactic omega 3 fatty acid treatment with hydration does not reduce the risk of CIN in patients with chronic kidney disease undergoing coronary angiography.

Carbon Dioxide As a Standard of Care for Zero Contrast Interventions: When, Why and How?

Traditional contrast media containing iodine remain the gold standard for vessel visualization during endovascular procedures. On the other hand, their use has several side effects and implications and may cause contrast medium-induced nephropathy. Carbon dioxide (CO2) angiography is an old alternative technique used only for critical patients in order to prevent kidney damages or allergic reactions. Zero contrast procedure: The availability of automated CO2 injectors has led to an increase in the use of CO2 angiography, providing an option for zero contrast interventions, preserving patient renal function and saving costs for the hospital facility. Taking advantage of the properties of CO2 gas, it is possible to improve the performance of some complex procedures such as atherectomy and the detection of type II endoleaks after EVARs. However, a learning curve is needed to get good imaging, and learn about the qualities and limitations of the technique. The use of automatic delivery systems for CO2 angiography appears to be a good choice for the use of CO2 as the first imaging option. The standardization of injection protocols and the extensive use of this technique could lead to significant benefits both for the patient's prospects and health facilities.

Contrast Media-Induced Nephropathy in Patients with Unruptured Cerebral Aneurysm After Coiling Endovascular Treatment

The endovascular coiling procedure to treat cerebral aneurysms using contrast media has become more popular. However, studies of the incidence of, and risk factors for, contrast media-induced nephropathy (CIN) after coiling procedures have been limited. Thus, we evaluated the incidence and risk factors for CIN in patients who had undergone cerebral aneurysmal coiling procedures. We retrospectively reviewed the electric medical records of 380 patients who had undergone cerebral aneurysmal coiling treatment under general anesthesia. CIN was defined as an absolute increase in serum creatinine (≥0.5 mg/dL) or a relative increase (≥25%) in the baseline serum creatinine value at 48-72 hours after exposure to a contrast agent. Elective cerebral aneurysmal coiling procedures were performed in 230 patients. Of the 230 patients, CIN developed in 13 (5.6%). The presence of diabetes mellitus (30.8% vs. 9.7%; P= 0.040) and patient age >75 years (30.8% vs. 6.5%; P= 0.012) were risk factors for CIN. Our study has demonstrated that the incidence of CIN in patients undergoing elective cerebral aneurysmal coiling procedures is ∼6.0%. We also identified underlying diabetes mellitus and advanced age (≥75 years) as potential risk factors.

Contrast media in urogenital radiology

BACKGROUND. Contrast media are widely used in urogenital radiology. The ideal contrast agent should be totally inert, causing no interactions with organism, and with a rapid and complete excretion. Adverse reactions could occur after using any type of contrast media. Contrast enhanced procedures are performed with increasing frequency and the patients population is progressively older and with multiple co-morbid conditions, thus contrast media toxicity is becoming a serious problem. Contrast media-induced nephropathy (CIN) is considered an important cause of hospital-acquired renal failure. The administration of gadolinium-based contrast agents has been recently associated with the development of a serious adverse reaction, potentially lethal in patients with renal insufficiency, named nephrogenic systemic fibrosis (NSF). METHODS. Literature review on contrast media in urogenital radiology, CIN, NSF. CONCLUSIONS. Since 1996, the Contrast Media Safety Committee of the European Society of Urogenital Radiology (ESUR) has released its guidelines regarding safety about the use of contrast media. CIN, and the emerging NSF, are topics of increasing interest for urologists, radiologists, nephrologists, dermatologists and all the clinicians. Contrast media have progressively become safer in the last years. Even if rare, some adverse reactions still occurr up to now. CIN and its prevention remain an issue under debate. In the past, whenever a patient required a contrast-enhanced imaging study, the trend was to select magnetic resonance imaging with gadolinium-based contrast agents in order to avoid the well-known CIN of iodinated-based contrast agents. The awareness of NFS is changing the contrast-enhanced imaging in patients with renal failure. At present we have to investigate NSF etiopathogenesis, in order to prevent and eventually to cure it. The understanding of the risk factors for both CIN and NSF is an emerging need, the adoption of all preventive measures to reduce the risks remain a mandatory issue.

The ratio of contrast medium volume to estimated glomerular filtration rate as a predictor of contrast-induced nephropathy after endovascular aortic repair.

This study aimed to determine the perioperative predictors of contrast medium-induced nephropathy (CIN) after endovascular aortic repair (EVAR). The data of 203 consecutive patients who underwent elective EVAR for thoracic and abdominal aortic aneurysm between January 2014 and September 2014 were retrospectively analyzed. CIN was defined according to the diagnostic criteria of the European Society of Urogenital Radiology. Fourteen patients (6.9%) developed CIN after EVAR. Contrast medium volume (CV), preoperative serum creatinine, estimated glomerular filtration rate (eGFR), and the CV/eGFR ratio were significantly related with CIN development after EVAR. The CV/eGFR ratio was significantly higher in patients with CIN than those without CIN. Receiver operator characteristic curve analysis showed that the area under the curve of the CV/eGFR ratio was 0.782, indicating that it was the most important predictor. The appropriate CV/eGFR ratio cutoff was 1.62. Sensitivity and specificity were 85.7% and 65.6%, respectively. The CV/eGFR ratio was a useful predictor of contrast medium-induced nephropathy after EVAR. It is possible that the score can be used in patients when managing the EVAR techniques and contrast medium volume. J. Med. Invest. 65:116-121, February, 2018.

Contrast media-induced nephropathy: how has Italy contributed in the past 30 years? A systematic review.

Background and objectiveThe use of contrast media in Italy has exponentially increased in the past 3 decades. However, it is unknown whether there has been an increase in clinical research evaluating the risks associated with contrast media usage, especially regarding contrast-induced nephropathy. To fill this gap in knowledge, we performed a systematic review.Study eligibility criteriaMeta-analyses, observational studies, and clinical trials assessing contrast media-induced nephropathy as the safety outcome, in which at least one author was affiliated with an Italian university/health care structure, were eligble.Data sourcesOvid MEDLINE, Ovid Embase, Cochrane Methodology Register, and Web of Science were screened.ParticipantsMen and women exposed to contrast media.ResultsIn total, 60 original articles were retrieved with an incremental trend between 1990 and 2017. Cohort studies were the most common study design represented. In total, 45 of 60 (75.0%) studies were monocenter studies and 41 of 60 (68.3%) received no funding. In all, 91.7% of studies disclosed no conflicts of interest and 81.7% had no external collaboration. Most of the studies provided a level of evidence of III-2 (32/60; 53.3%) and II (23/60; 38.3%). In total, 50 of 60 studies (83.3%) were published in a scientific journal ranked in the first quartile of their subject area.ConclusionThere was an increased number of studies evaluating contrast-induced nephropathy in Italy during the last three decades. These studies covered procedures to prevent contrast-induced nephropathy or aimed to identify risk factors, biomarkers, and scores, and their related prognosis.

Current Evidence of Contrast Medium-Induced Nephropathy (CIN) After Administration of Low-Osmolarity Iodine-Based Contrast Agents

Purpose of review Contrast medium-induced nephropathy (CIN) may occur after intravascular administration of low-osmolarity iodine-based contrast media. The goal of this review is to provide an updated overview of the current knowledge of CIN. Questions to be investigated are as follows: What are risk factors of CIN? How should the risk factors be assessed? Have any preventive measures proven effective?

Atorvastatin alleviates iodinated contrast media-induced cytotoxicity in human proximal renal tubular epithelial cells.

Contrast media (CM)-induced nephropathy (CIN) is a serious complication of intravascularly applied radiocontrast media. At present, no drugs have been approved for the prevention of CIN. The present study aimed to explore the effects and potential mechanisms of atorvastatin on iodinated CM-induced cytotoxicity in the human proximal renal tubular epithelial cells. The cytotoxic effect of iohexol (50, 100 and 200 mg I/ml) and the protective effect of atorvastatin pretreatment (1, 20 and 40 µM) were assessed. The cytotoxicity of iohexol was evaluated via the MTT cell viability and lactate dehydrogenase assays. The amount of apoptotic cells was determined by flow cytometry. Morphological changes in HK-2 cells were observed via transmission electron microscopy. The mRNA expression of NOX4 and p22phox was measured through reverse transcription-quantitative polymerase chain reaction analysis. The cytotoxicity was induced by iohexol in HK-2 cells. Atorvastatin was identified to significantly alleviate the suppression of cell viability induced by iohexol. Notably, 40 µM atorvastatin also significantly reduced the mRNA expression of intracellular NOX4 and p22phox, and the percentage of apoptotic cells. Furthermore, morphological changes characteristic of injured cells were alleviated by atorvastatin pretreatment. These results suggest that atorvastatin exhibits a protective effect on HK-2 cells against iohexol-induced cytotoxicity through the downregulation of NOX4 and p22phox. Thus, atorvastatin is a potential therapeutic agent for the prevention of CIN and required further study.

Efficacy of Atorvastatin in Prevention of Contrast-induced Nephropathy in High-risk Patients Undergoing Angiography: A Double-blind Randomized Controlled Trial

Objective:To evaluate the efficacy and safety of atorvastatin (ATN) 80 mg in the prevention of contrast medium- induced nephropathy (CIN) in high risk patients undergoing angiograph.Materials and Methods:This was a prospective, double-blind, two-arm, parallel group RCT. A total of 216 patients undergoing coronary angiography were screened, and 188 eligible patients were randomized to two treatment arms. Patients in Group A received tablet N-acetylcysteine (NAC) 1200 mg once daily, and patients in Group B received tablet atorvastatin 80 mg + NAC 1200 mg once daily, for 3 days before, and 2 days after angiography.Results:A total of 160 patients completed the trial. Postprocedure, nine and two CIN cases were found in Group A and B, respectively. The mean change in serum creatinine was 0.086 ± 0.168 in Group A and 0.021 ± 0.083 in Group B, which was statistically significant (P = 0.0289). Postprocedure, the estimated glomerular filteration rate was reduced by 19.52 in Group A and 13.55 in Group B (P = 0.003).Conclusion:This trial indicates the positive role of statins in preventive strategy against CIN along with NAC.

Abstract TP319: Duplex Assisted Carotid Artery Stenting Without Administration of Contrast Media

Background: Conventional carotid artery stenting (CAS) with administration of contrast media carries a risk of adverse reactions such as contrast media-induced nephropathy or an allergic reaction. Objective We aimed to present a novel technique, that is, duplex-assisted CAS without administration of contrast media and validate its safety and feasibility. Methods: Fifteen patients with severe carotid stenosis (≥70 %) associated with chronic kidney disease (CKD) (stage ≥3) or allergy to contrast media underwent duplex-assisted CAS without administration of contrast media. The embolic protection device (EPD) placed in the common carotid artery (CCA) was clearly visible on the longitudinal section (Fig. A) and was then advanced into the internal carotid artery (ICA) by duplex-guidance (Fig. B). When starting the delivery of the stent, the position of the distal stent end is confirmed by duplex monitoring (Fig. C). Postdilatation was performed after the stent (Fig. D arrowheads) deployment if enough expansion of the carotid artery was not achieved. Adequate stent position (Fig. E arrowheads) and technical success was confirmed by duplex images and intravascular ultrasound (Fig. F). Conventional CAS was also performed in 165 patients and used as the control group. Results: The technical success rate was 100 % in duplex-assisted CAS group. Combined stroke or death rates during the post-procedural period did not differ significantly between the duplex assisted CAS group (0/15, 0 %) and conventional CAS group (4/165, 2.4 %). None of the 14 patients with CKD in the duplex-assisted CAS group experienced further deterioration of renal function. Conclusion: This method seemed to be a safe and effective treatment for patients with CKD or an allergy to contrast media. The most important factor for the indication of duplex-assisted CAS was to obtain the clear visualization of the luminal narrowing with minimal calcification on the longitudinal section of the duplex ultrasonography.

Xuezhikang ameliorates contrast media-induced nephropathy in rats via suppression of oxidative stress, inflammatory responses and apoptosis

Background: The aim of this study was to assess the preventive effect of xuezhikang (XZK) to replace atorvastatin on the contrast media-induced acute kidney injury (CI-AKI).Methods: The male Sprague–Dawley rats were divided into five groups: group 1 (sham), injected with normal saline; group 2 (XZK), treated with XZK; group 3 contrast media (CM), injected with CM; group 4 (CM + ATO), injected with CM + pretreatment with atorvastatin; group 5 (CM + XZK), injected with CM + pretreatment with XZK. Twenty-four hours after injection with normal saline or CM, the blood sample and the kidneys were collected for the measurement of biochemical parameters, oxidative stress markers, nitric oxide production, inflammatory parameters, as well as renal histopathology and apoptosis detection.Results: Our results indicated that XZK restored the renal function by reducing serum blood urea nitrogen (BUN) and serum creatinine (Scr), depressing renal malondialdehyde (MDA), increasing renal NO production, decreasing TNF-ɑ and IL-6 expression, attenuating renal pathological changes and inhibiting the apoptosis of renal tubular cells.Conclusion: XZK’s therapeutic effect is similar, or even better than atorvastatin at the same effectual dose in some parts.

Is there any role of epithelial to mesenchymal transition in the pathogenesis of contrast nephropathy?

Aim: Contrast medium-induced nephropathy is one of the major complications of intravenous contrast medium use. But its pathogenesis is unclear. Epithelial mesenchymal transition (EMT) is defined as the transformation of the primer epithelial cells to mesenchymal cells. EMT in tubular cells might cause tubulointerstitial damage. In this study, we investigated whether or not EMT has a role in radiocontrast-induced nephropathy. Radiocontrast medium might be triggering reversible EMT via serum and glucocorticoid-regulated kinase 1 (SGK 1). We investigated the effect of different concentrations of the contrast agent iopromide on human proximal tubule cell (HK-2) culture by measuring the level of SGK1, snail family zinc finger 1 (SNAIL1), connective tissue growth factor (CTGF), and collagen type I alpha 1 (COL1A1).Methods: We conducted a scratch assay and qPCR. HK-2 cells were cultured in the petri dishes/flasks and starved with serum-free medium. The 40, 20, and 10 mg/mL doses of iopromide were administrated to cells. The scratches were photographed immediately and again at the 20th hour. The levels of gene expression of SGK1, SNAIL1, CTGF, and COL1A1 were measured using the real-time qPCR system at the end of the 24th hour.Results: Iopromide caused the breaking of intercellular connections, the disappearance of the cobblestone appearance of cells, and the migration of cells at the 20th hour in the scratch assay. It also increased the expression of SGK1, SNAIL1, CTGF, and COL1A1 genes.Conclusion: Our study concluded that certain important markers of EMT increase in different concentrations of the contrast agent. High osmolality might trigger EMT. The relationship between contrast agent and EMT has not been defined before. Further in vivo and in vitro studies are required.

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.

Evaluation of different sodium bicarbonate regimens for the prevention of contrast medium-induced nephropathy.

IntroductionThe rapid decline in renal function caused by radiographic contrast agents usually is transient, but it can result in chronic kidney disease. The pathophysiology of contrast-induced nephropathy (CIN) is poorly understood, but it may include acute hypoxia-induced oxidative stress and free radicals generated within the acid environment of the renal medulla. Thus, the alkalization of urine by sodium bicarbonate has been regarded as resulting in the reduction of CIN. The aim of this study was to determine whether a long-duration sodium bicarbonate regimen is more effective than a short-duration regimen in reducing CIN.MethodsOne hundred patients were assigned randomly to treatment with sodium bicarbonate solution using either the short regimen (intravenous bolus 3 mL/kg/h of 166 mEq/L sodium bicarbonate for 1 hour immediately before radiocontrast) or the long regimen (initial intravenous bolus of 3 mL/kg/h of 166 mEq/L sodium bicarbonate for 6 hr). Patients with renal dysfunction (estimated glomerular filtration rate [eGFR], 60 mL/min/1.73 m2 or less) who underwent elective or emergent coronary angiography (CAG) with/without percutaneous coronary intervention (PCI) at Nephrology Department (Theodor Bilharz Research Institute) were enrolled in the study. Data were analyzed by SPSS version 12, using Kruskal Wallis, ANOVA, Chi square test and Spearman rank correlation coefficient.ResultsThere was a significant increase in serum creatinine and a decrease in eGFR 48 hr post-intervention in group 1 (short regimen) with no statically difference regarding those parameters group 2 (long regimen). Serum potassium clearly was decreased significantly post procedure in both groups.ConclusionsThe results of our study indicated that the long regimen of bicarbonate supplementation was a more effective strategy to prevent CIN than the short regimen.