Early Diagnosis Of Contrast-induced Nephropathy Research Articles

Values of serum neutrophil gelatinase-associated lipocalin and cystatin C after percutaneous coronary intervention for early diagnosis of contrast-induced nephropathy.

Serum creatinine (SCr) is not a sensitive and reliable index for the early diagnosis of acute kidney injury caused by contrast-induced nephropathy (CIN). The aim of this study was to explore the values of serum neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C (Cys-C) after percutaneous coronary intervention (PCI) for the early diagnosis of CIN. Three hundred patients receiving PCI from January 2018 to December 2020 were assigned to a CIN group (n=25) and a non-CIN group (n=275), respectively. SCr, Cys-C and NGAL levels were measured, and their sensitivities for early CIN diagnosis were evaluated by the area under the receiver operating characteristic curve (AUC) values. The NGAL and Cys-C levels of the CIN group began to rise 6 and 12 h after operation, respectively (P<0.05). The CIN group had higher NGAL and Cys-C levels than those of the non-CIN group 12, 24 and 48 h after operation (P<0.05). The AUC values of NGAL, Cys-C and SCr 24 h after operation were 0.885, 0.874 and 0.856, respectively. The serum NGAL and Cys-C levels of patients after PCI reflect the early changes of renal function, which are valuable for early CIN diagnosis.

PRECISE-DAPT score as a predictor for contrast-induced acute kidney injury in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention

Abstract:Background: Patients who undergo primary percutaneous coronary intervention (PCI), are at great risk of contrast-induced nephropathy (CIN). The PRECISE-DAPT score had been implemented nowadays to determine the best period of dual anti-platelet therapy after PCI. Aim of work: To determine the predictive value of the admission PRECISE-DAPT score in the early diagnosis of CIN. Subjects and methods: A prospective cohort study carried out in the cardiology department at Zagazig university hospital and national heart institute, Cairo, during the period from January 2020 to August 2020. The study included 200 patients admitted with first acute ST segment elevation myocardial infarction (STEMI) and underwent primary percutaneous coronary intervention. All patients were subjected to complete history taking. General examination for all body systems and local cardiological examination were done. We also did full lab investigations as CBC, CK-MB, Troponin, creatinine (at admission and within 72h post PCI) and GFR. Patient's resting ECG and transthoracic echocardiography (TTE) were done. PRECISE-DAPT score was calculated for all cases. Coronary angiography and PCI were performed. Results: We detected a high statistically significant increase in precise DAPT score (23.6 ± 10.4) p

Significance of Cystatin C for Early Diagnosis of Contrast-Induced Nephropathy in Iraqi Patients Undergoing Coronary Angiography

Background: Contrast-induced nephropathy (CIN) has been traditionally defined as an increase in serum creatinine (sCr) after contrast media (CM) exposure. It is generally a transient and reversible form of acute renal failure. Objectives: The objective was to compare changes in serum creatinine and serum cystatin C (sCys C) in patients undergoing CM administration during coronary angiography (CAG) and/or intervention, and whether these changes are a reliable index for early identification of CIN. Materials and Methods: In this prospective study, 50 patients were included, 9 of them were omitted, and remaining 41 patients undergoing CAG and/or intervention. sCr, serum urea, sCys C, and estimated glomerular filtration rate (eGFR) were evaluated at baseline as well as 24 h after exposure to CM. Results: Forty one patients, six of them develop CIN (CIN group) and the remainder 35 not develop CIN (non-CIN group). Clinical parameters showed no significant association between CIN group and non-CIN group except in diabetes mellitus. As comparing patients before and after catheterization, the CIN group showed increase in sCr and serum urea, while remain nearly the same for sCys C, and obvious decrease for eGFR1 and eGFR2, in addition there is significant association for sCr, eGFR1, and eGFR2. In the non-CIN group, only the serum urea showed significant difference. Conclusion: The concentration change of sCr is significantly superior to cystatin C as an early biomarker in the CIN detection. An absolute increase of the concentration of sCr is highly sensitive and specific for the CIN in comparing to cystatin C.

The Role of MicroRNA in Contrast-Induced Nephropathy: A Scoping Review and Meta-Analysis.

Objective Early diagnosis of contrast-induced nephropathy (CIN) remains crucial for successful treatment; unfortunately, the widely used serum creatinine is elevated only in the late stage of CIN. The circulating microRNAs (miRNAs) are stable biomarker that might be useful. The aim of this scoping review and meta-analysis is to assess the role of miRNAs in CIN. Methods We performed a systematic literature search on topics that assess the role of miRNAs in CIN from several electronic databases. Results There were 6 preclinical studies and 2 of them validated their findings in human. Only miR-30a, miR-30c, miR-30e, and miR-188 have been validated in human models. Meta-analysis showed that increase in miR-30a expression was associated with higher incidence of CIN (OR 4.48 [1.52, 13.26], p = 0.007; I2: 94%, p < 0.001). An increase in miR-30e expression was associated with higher incidence of CIN (OR 2.34 [1.70, 3.20], p < 0.001; I2: 0%, p = 0.76). There is an indication that miR-188 is associated with contrast-induced apoptosis and might potentially be a drug target in the future. Conclusion This study highlighted the importance of certain miRNAs in CIN pathophysiology. Future researches should explore on the prognostic and therapeutic implication of miRNA in CIN.

Biomarkers for Diagnosis and Prediction of Outcomes in Contrast-Induced Nephropathy.

Background Serum creatinine is suboptimal as a biomarker in the early diagnosis of contrast-induced nephropathy (CIN). In this study, we investigated a panel of novel biomarkers in the early diagnosis of CIN and in assessing patient outcomes. Methods This single-centre, nested, prospective case-controlled study included 30 patients with CIN and 60 matched controls. Serum and urine samples were collected before contrast administration and at 24 hours, 48 hours, and ≥5 days after contrast administration. Concentrations of NGAL, cystatin C, β2M, IL18, IL10, KIM1, and TNFα were determined using Luminex and ELISA assays. Outcomes were biomarker diagnostic discrimination performance for CIN and mortality after generation of area under receiver operating characteristic curves (AUROCs). Results Median serum levels for 24 h cystatin C (p < 0.01) and 48 h β2M levels (p < 0.001) and baseline urine NGAL (p=0.02) were higher in CIN patients compared to controls with AUROCs of 0.75, 0.78, and 0.74, respectively, for the early diagnosis of CIN. Serum β2M levels were higher in CIN patients at all time points. Elevated baseline serum concentrations of IL18 (p < 0.001), β2M (p=0.04), TNFα (p < 0.001), and baseline urine KIM (p=0.01) and 24 h urine NGAL (p=0.02) were significantly associated with mortality. Baseline serum concentrations of IL18, β2M, and TNFα showed the best discrimination performance for mortality with AUROCs, all >0.80. Baseline NGAL was superior for excluding patients at risk for CIN, with positive and negative predictive ranges of 0.50–0.55 and 0.81–0.88, respectively. Cystatin C (p=0.003) and β2M (p=0.03) at 24 h independently predicted CIN risk. β2M predicted increased mortality of 40% at baseline and 50% at 24 hours. Conclusion Serum cystatin C at 24 h was the best biomarker for CIN diagnosis, while baseline levels of serum IL18, β2M, and TNFα were best for predicting prognosis.

Возможности ранней диагностики контрастиндуцированной нефропатии

Возможности ранней диагностики контрастиндуцированной нефропатии

Contrast-induced nephropathy: the possibility of early diagnosis in patients with type 2 diabetes mellitus after primary percutaneous coronary interventions

Aim. To study the possibilities of early diagnosis of contrast-induced nephropathy (CIN) after primary percutaneous coronary interventions (PCI) in patients with type 2 diabetes mellitus (DM) using biostarers: cystatin C, nephrine and lipocalin-2.&#x0D; Materials and methods. he study included 84 patients who received PCI for the first time. Before the PCI, the risk of CIN on the R. Mehran scale was assessed, and also modern biomarkers of renal damage were determined before and after the procedure for 3 days. All patients were divided into two groups: 1). patients with type 2 DM (n = 44 people); 2) patients without DM (n = 40 people). By sex, age, the duration of the disease group were comparable.&#x0D; Results. The parameters of the functional state of the kidney before and after PCI in patients with type 2 DM, taking into account the criteria of KDIGO (2012) and elevated levels of modern biomarkers, indicated the development of CIN. In the control group, this was observed in 35 of 40 (87.5%) patients. In both groups, there was an increase in serum creatinine levels of blood, urea, new biomarkers, and a decrease in GFR after administration of contrast agents. Normalization of only urea and blood creatinine against the background of adequate hydration was detected on day 2-3 after contrasting procedures. The GFR remained still reduced despite ongoing therapy.&#x0D; Conclusions. Cystatin C, nephrin, lipocalin 2 have high sensitivity and specificity. The determination within 3 days of these biomarkers allows us to objectively judge the dynamics of contrast-induced nephropathy in individuals with type 2 diabetes mellitus in surgical interventions on the coronary arteries with the introduction of contrast and the effectiveness of protective measures.

Serum NGAL and FGF23 may have certain value in early diagnosis of CIN

Aims: This study aimed to assess whether neutrophil gelatinase-associated lipocalin (NGAL) and fibroblast growth factor 23 (FGF23) could be reliable biomarkers for early diagnosis of contrast-induced nephropathy (CIN). Methods: 202 patients who underwent percutaneous coronary intervention (PCI) were included in the research. All subjects were divided into CIN group and non-CIN group. Serum NGAL and FGF23 were evaluated before and 0, 1, and 2 days after PCI. Serum levels of these two markers were compared intra-group and among groups. Receiver-operating characteristic (ROC) analysis and logistic regression models were conducted to assess the diagnostic performance of NGAL and FGF23 in detecting CIN. Results: When compared with baseline values, serum levels of both NGAL and FGF23 in all subjects increased after PCI, and the values peaked 1 day after PCI, but the changing was greater in CIN group. There were obvious differences between two groups in serum NGAL after 1, 2 days, and similar differences present in serum FGF23 after 1 day. ROC analysis showed that the area under the curve (AUC) of relative values (percent change from the baseline) in NGAL after 1 day was 0.899 (95% CI: 0.834–0.964, p = .000), the optimum cutoff was 49% (sensitivity = 80%, specificity = 92.4%). And the AUC in FGF23 was 0.814 (95% CI: 0.733–0.894, p = .000), the optimum cutoff was 20% (sensitivity = 73.3%, specificity = 87.6%). Both serum NGAL and serum FGF23 could improve the clinical models in identifying CIN. Conclusions: NGAL and FGF23 may have certain value in early diagnosis of CIN.

Relationship between Preoperative Urinary Microalbumin to Creatinine Ratio Level and Contrast-induced Nephropathy after Elective Coronary Angiography/Percutaneous Coronary Intervention

Objective: To investigate the predictive value of preoperative urinary microalbumin to creatinine ratio (UACR) level for early diagnosis of contrast-induced nephropathy (CIN). Methods: A total of 180 patients scheduled to undergo elective coronary angiography (CAG)/percutaneous coronary intervention (PCI) in our department from November 2016 to September 2017 were selected into this prospective study. Patients were allocated to high UACR group (UACR ≥ 30, n=35) and control group (UACR<30, n=145) according to the UACR level. The patients were also divided into CIN group (n=32) and no CIN group (n=148). Multivariable logistic regression model was used to investigate the risk factors of CIN. This trial was registered on the Chinese Clinical Trial Registry on 23 May 2017 (Registration No. ChiCTR-OOC-17011467). Results: 32 patients developed CIN (17.78%). The incidence of CIN was significantly higher in high UACR group than in the control group (P0.001). The ratio of high UACR in CIN group was significantly higher than no CIN group (P0.001). Multivariable logistic regression analysis indicated that preoperative UACR level (P0.001, 95%CI: 3.81929.223, OR: 10.564) was an independent risk factor of CIN. Conclusion: Preoperative UACR level appears to be an independent predictive factor for early diagnosis of CIN.

Algorithm for Early Diagnosis of Contrast-Induced Nephropathy Using Biomarkers of Renal Damage

Algorithm for Early Diagnosis of Contrast-Induced Nephropathy Using Biomarkers of Renal Damage

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

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.

Serum cystatin c is not superior to serum creatinine for early diagnosis of contrast-induced nephropathy in patients who underwent angiography.

Iodiated contrast-induced nephropathy (CIN) is a serious complication of contrast-enhanced imaging. The aim of this study was to evaluate the diagnostic sensitivities and specificities of serum cystatin C (sCys C) and serum creatinine (sCr) for CIN and to further investigate difference of the incidence, risk factors, and in-hospital and 3-month prognosis of CIN according to sCys C criteria and sCr criteria. We prospectively evaluated 213 patients who underwent angiography. The sCr and sCys C concentrations were detected before and at 48hours, 72hours after the procedure. The incidence, risk factors, and in-hospital and 3-month prognosis of CIN were analyzed. Receiver operating characteristic curve (ROC) analysis was performed for sCr and sCys C 48hours after procedure. The incidence of CIN was 24.4% (sCys C criteria) and 8% (sCr criteria). Diabetes mellitus, dehydration, and hypoalbuminemia were independent risk factors for CIN. Area under the ROC of sCys C 48hours after procedure was not superior to sCr (0.715 vs 0.790, P=.178). The mortality of patients with CIN in sCr criteria increased significantly (P<.05). In this study, the incidence and risk factors of CIN were related to diagnostic criteria. The sCys C was not superior to sCr for predicting CIN in the patients who underwent angiography.

Significance of Cystatin C for Early Diagnosis of Contrast-Induced Nephropathy in Patients Undergoing Coronary Angiography.

BackgroundContrast-induced nephropathy is acute kidney injury caused by contrast medium exposure. Serum creatinine is the clinical diagnostic standard, but it does not yield quick results. The serum level of cystatin C is stable and it can reflect renal function sensitively. The study aimed to assess the usefulness of cystatin C for early diagnosis of contrast-induced nephropathy in patients undergoing coronary angiography.Material/MethodsWe included 300 patients who underwent CAG. According to the sCr at 48 h, patients were divided into 2 groups: CIN group and non-CIN group. Their demographics and basal renal function were recorded. Changes in sCr, Cys C, and e GFR were compared at the same time. ROC analysis was used to assess the sensitivity and specificity of Cys C in the early diagnosis of CIN.ResultsComparison of basal renal function and serum level of Cys C showed no significant differences between the 2 groups. Serum level of Cys C increased significantly at 24 h (p<0.001), and sCr increased significantly at 48 h. ROC analysis showed that the AUC of the change in Cys C between baseline and 24 h was 0.936 (95% CI: 0.879–0.992, p=0.000) and the optimum cut-off level was 0.26 mg/L (sensitivity=89.7% and specificity=95.6%).ConclusionsThe concentration change of Cys C is better than sCr as a biomarker in the early detection of CIN.

English

English

Serum NGAL, cystatin C and urinary NAG measurements for early diagnosis of contrast-induced nephropathy in children

Aim: The study investigated a number of biomarkers for the early diagnosis of contrast-induced nephropathy (CIN), which is an important cause of acute kidney injury (AKI). Material and methods: The study included 91 children scheduled for elective cardiac angiography and 50 healthy controls. Biomarkers including serum (s) and urinary (u) sodium, serum and u-creatinine, s-cystatin-C, serum neutrophil gelatinase-associated lipocalin (NGAL) and urinary N-acetyl beta glucosaminidase (u-NAG)/creatinine ratio were measured 4 times sequentially in the patients and once in the controls. Results: The patient group comprised 40 males (44%) and 51 females (56%) while the control group comprised 16 males (32%) and 34 females (68%). Age, gender, s-creatinine, estimated-glomerular filtration rate (eGFR), s-cystatin-C and fractional-excretion of sodium did not differ significantly between the groups. Serum sodium and s-NGAL were found to be lower in the patients than those of in the controls, while their u-NAG/creatinine ratio was found to be higher. Sequential data analysis revealed that s-NGAL and u-NAG/creatinine ratio increased in the first 6 h after radiocontrast media (RCM) administration and decreased at 12 and 24 h. Serum BUN and s-cystatin-C levels also showed a significant difference during the 24-h follow-up. eGFR, s-sodium and s-creatinine levels did not change in the following period. Serum cystatin-C levels revealed a significant negative correlation with eGFR. Administered RCM doses showed a positive correlation only with u-NAG/creatinine ratios. Conclusion: In the first 24 h, s-cystatin-C, s-NGAL and especially u-NAG/creatinine ratio showed promise as biomarkers, but eGFR is not adequate for early diagnosis of CIN. Sequential measurement of biomarkers may contribute to more accurate diagnosis of AKI.

Neutrophil Gelatinase-associated Lipocalin in the Prediction of Contrast-induced Nephropathy

The aim of this study was to investigate the predictive value of neutrophil gelatinase-associated lipocalin (NGAL) in the early diagnosis of contrast-induced nephropathy (CIN). We searched MEDLINE and Embase until December 2014 for articles evaluating the diagnostic accuracy of plasma/serum and urinary NGAL levels to predict CIN. The primary analysis was based on a hierarchical, bivariate, generalized, linear, mixed model. Diagnostic odds ratio (DOR) and sample size-weighted area under the curve for the receiver operating characteristic (AUROC) were calculated. Ten studies involving 1310 patients were analyzed. Overall, the DOR/AUROC for NGAL level to predict CIN was 20.56 [95% confidence interval (CI), 9.67-43.74]/0.87 (95% CI, 0.84-0.90), with sensitivity and specificity of 0.80 (95% CI, 0.74-0.85) and 0.83 (95% CI, 0.73-0.90), respectively. Subgroup analysis showed that the diagnostic performance of the DOR/AUROC of urinary NGAL [29.48 (95% CI, 12.19-71.27)/0.87 (95% CI, 0.84-0.90)] was better than that of plasma/serum NGAL [14.63 (95% CI, 4.51-47.38)/0.85 (95% CI, 0.82-0.88)] (DOR, P = 0.005, and AUROC, P = 0.04, respectively). Plasma/serum and urinary NGAL levels seem to be useful biomarkers in the early prediction of CIN. Moreover, urinary NGAL levels perform better than plasma/serum NGAL.

Dysregulated microRNAs involved in contrast-induced acute kidney injury in rat and human

Background: Contrast-induced nephropathy (CIN) is a complex syndrome of acute nephropathy that occurs following infusion of intravascular contrast agents, and is associated with an increased risk for adverse cardiovascular events. While there is no ideal biomarker for making an early diagnosis of CIN, we hypothesized that levels of specific circulating microRNA (miRNA) species might serve such a role. Methods: miRNA microarray assays were used to detect miRNAs in the kidney tissue of rats studied as an animal model of CIN. Real-time PCR was performed to validate results of the microarray assays. Kidney-enriched miRNAs detected in rat plasma were used as biomarkers to screen for CIN. Results obtained from the rat model of CIN were further validated in human patients with CIN. Results: Fifty-one miRNAs were aberrantly expressed in the kidney tissues between CIN and control rats; and among these, 17 miRNAs showed a >2-fold change of expression in the kidney tissues of CIN rats when compared with their expressions in non-CIN control rats. Among the 17 miRNAs aberrantly-expressed miRNAs screened from kidney tissue, only six also showed significantly different expression in the plasma of CIN rats. When compared with their levels in non-CIN control rats, the levels of three miR-30 family members (miR-30a, miR-30c, and miR-30e), as well as miR-320, were significantly increased in the plasma of CIN rats, while the plasma levels of miRNAs let-7a and miR-200a were significantly decreased. In a validation study of these results conducted with human plasma samples, only miR-30a, miR-30c, and miR-30e showed > 2-fold increases in CIN patients when compared with non-CIN patients. Receiver operating curves constructed to examine the abilities of miR-30a, miR-30c, and miR-30e to discriminate CIN patients from non-CIN patients showed AUCs of 0.954, 0.888, and 0.835, respectively. Conclusions: Our study provides the first evidence that plasma miRNAs, and especially three miR-30 family members (miR-30a, miR-30c, and miR-30e), might serve as early biomarkers and (or) target candidates for CIN.

The role of neutrophil-gelatinase-associated lipocalin in early diagnosis of contrast nephropathy.

Neutrophil-gelatinase-associated lipocalin (NGAL) is a biomarker of acute kidney injury. The aim of this study was to define a cut-off for NGAL in the early diagnosis of contrast-induced nephropathy (CIN) in patients with normal kidney function. We enrolled 121 patients with normal serum creatinine who underwent coronary angiography. NGAL was measured in urine before the procedure and 12 and 24 h afterward. CIN was defined as a 0.3 mg/dl increase in serum creatinine within 48 h after the procedure. Seven of 121 patients had CIN (5.8%). The NGAL levels in the 12- and 24-h urine samples of these patients were 30 (5–45) and 20 (15–40) ng/ml, respectively, whereas those in patients without CIN were 15 (5–45) and 15 (10–51) ng/ml, respectively (P = 0.8). In patients with CIN, the sensitivity and specificity of NGAL with a cut-off of 22.5 ng/ml were 71.4% and 57.9% in 12-h urine samples, with the negative predictive values (NPV) and positive predictive values (PPV) of 97.1% and 9.4%, respectively. In conclusion, we suggest that urine NGAL with cut-off point of 22.5 ng/ml has acceptable sensitivity and specificity for early diagnosis of CIN in patients with normal serum creatinine, but regarding NPV and PPV the best performance of this value is to rule out the CIN in patients at risk who received contrast media.

Is Cystatin-C superior to creatinine in the early diagnosis of contrast-induced nephropathy?

The aim of this study was to assess whether changes in Cystatin C (CyC) after 48 h post contrast media exposure was a reliable indicator of acute kidney injury and the validity of a risk scoring tool for contrast-induced acute kidney injury (CI-AKI). We enrolled 121 patients for whom diagnostic coronary angiography were planned. The risk score for CI-AKI was calculated and serum creatinine (sCr) and CyC were measured before and 48 h post coronary angiography. CyC and sCr based AKI was calculated as a 25% increase from baseline within 48 h from contrast media exposure. Mean serum CyC and creatinine concentrations were 0.88 ± 0.27 mg/dL and 0.79 ± 0.22 mg/dL, respectively before the procedure and 1.07 ± 0.47 mg/dL and 0.89 ± 0.36 mg/dL, respectively 48 h after contrast media exposure (P < 0.001). CyC based AKI occurred in 45 patients (37.19 %) and sCr based AKI occurred in 20 patients (16.52%) after the procedure. Mean risk score was found to be 4.00 ± 3.478 and 3.60 ± 4.122 for CyC based AKI and sCr based AKI, respectively and was significantly increased in CyC based AKI group (P < 0.001). CyC measured 48 h after contrast media exposure may be a more sensitive indicator of CI-AKI relative to creatinine and Mehran risk scoring is in good correlation with CyC increase.