Radiocontrast-induced nephropathy(RCIN) is an acute and severe complication after coronary angiography,particularly for patients with pre-existing chronic kidney disease(CKD).It has been associated with both short-and...Radiocontrast-induced nephropathy(RCIN) is an acute and severe complication after coronary angiography,particularly for patients with pre-existing chronic kidney disease(CKD).It has been associated with both short-and long-term adverse outcomes,including the need for renal replacement therapy,increased length of hospital stay,major cardiac adverse events,and mortality.RCIN is generally defined as an increase in serum creatinine concentration of 0.5 mg/dL or 25%above baseline within 48 h after contrast administration.There is no effective therapy once injury has occurred,therefore,prevention is the cornerstone for all patients at risk for acute kidney injury(AKI).There is a small but growing body of evidence that prevention of AKI is associated with a reduction in later adverse outcomes.The optimal strategy for preventing RCIN has not yet been established.This review discusses the principal risk factors for RCIN,evaluates and summarizes the evidence for RCIN prophylaxis,and proposes recommendations for preventing RCIN in CKD patients undergoing coronary angiography.展开更多
Purpose: The purpose of this retrospective study was to assess the incidence and the risk factors of contrast-induced nephropathy (CIN) following transcatheter arterial chemoembolization (TACE) in patients with hepato...Purpose: The purpose of this retrospective study was to assess the incidence and the risk factors of contrast-induced nephropathy (CIN) following transcatheter arterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). Materials and Methods: We performed a retrospective review of 186 sessions of TACE in 122 patients with HCC. We examined the incidence and factors associated with risk of CIN, defined as an increase of at least 0.5 mg/dl (44.2 μmol/l) or 25% of the baseline serum creatinine level between 48 and 72 hours after TACE. Results: CIN developed in 14 (7.5%) of the 186 sessions after TACE. A univariate analysis showed that the Child-Pugh class B or C [10/14 (71%) vs. 70/172 (41%), P = 0.046], a low albumin level (3.0 ± 0.5 vs. 3.4 ± 0.6, P = 0.018), and a low hemoglobin level (10.6 ± 2.0 vs. 11.8 ± 2.0, P = 0.035) were significantly associated with the development of CIN. Multivariate analysis revealed that the hemoglobin value was associated with CIN [odds ratio (OR) 1.6;P = 0.038]. Conclusions: CIN after TACE is closely associated with the severity of liver cirrhosis, and with low levels of albumin and hemoglobin. Effective preventive methods remain to be considered in patients with HCC and advanced LC who are undergoing TACE.展开更多
Recent advances in medical sciences, especially in imaging, have dramatically increased the use of contrast agents. The constantly changing nature of medicine and the availability of new information, such as new pharm...Recent advances in medical sciences, especially in imaging, have dramatically increased the use of contrast agents. The constantly changing nature of medicine and the availability of new information, such as new pharmaceutical formulations, have necessitated periodic revisions and drafting of new guidelines for the safe use of intravenous contrast agents in radiology. This study examined the majority of guidelines, articles, and authoritative references available on the use of intravenous contrast agents in adults to reduce the risk of contrast-induced nephropathy. The search engines of PubMed, Web of Science, Scopus, and Google Scholar were used, and relevant English articles cited at least twice between 1979 and 2014 were studied. Review of the collected papers showed no consensus among them for guidelines on the incidence of contrast-induced nephropathy in patients at risk. Different formulas were used to calculate estimated glomerular filtration rate, which could be problematic in some cases. Further studies are needed for unification of existing guidelines.展开更多
Objective: Contrast induced nephropathy (CIN) is the third leading cause of hospital acquired renal failure. The mechanism of CIN is not fully understood. The objectives of this study were to investigate the expressio...Objective: Contrast induced nephropathy (CIN) is the third leading cause of hospital acquired renal failure. The mechanism of CIN is not fully understood. The objectives of this study were to investigate the expression changes of the four subtypes of adenosine receptors (A1AR, A2AAR, A2BAR, and A3AR) following administration of contrast media in mice. Methods: C57BL/6J mice were randomized into treatment and control groups. Iodixanol (IDX) was administered to two treatment groups through retroorbital injection at two different dosages, 0.75 gI/kg and 2.75 gI/kg. Phosphate buffered saline (PBS) was given to the control group. Mice kidneys were harvested at day 3 and day 7 after Iodixanol administration. Kidney injuries and function were evaluated according to Hematoxylin and eosin stain, Ki67 protein expression, and TUNEL assay of paraffin embedded kidney sections, and plasma creatinine assay. RNA and protein were extracted from the kidney specimens. A1AR, A2AAR, A2BAR, and A3AR RNA and protein level of the samples were assessed using qRT-PCR and Western blotting, with GAPDH as an endogenous control. Results: H&E staining showed no significant histopathology injuries after Iodixanol administration. No evidence of kidney injury and functional impairment was found. However, there was an increased number of A1AR, A2AAR, A2BAR, and A3AR RNA transcripts detected in the kidney 3 days after Iodixanol injection. The RNA levels in all the four subtypes of adenosine receptors were increased 2-3 fold in the day 3 specimens and back to normal at day 7. Western blot demonstrated that A1AR, A2AAR, and A3AR expression increased 1.5 to 2 fold at day 3 and day 7 following Iodixanol injection. A2BAR baseline expression was low in normal physiological conditions and no significant change was detected by Western blot. Conclusions: Iodixanol significantly increases adenosine receptors gene expression in mice. This suggests that adenosine receptors may play a role in the development of CIN.展开更多
Background: Percutaneous coronary intervention is now the best way of management of acute coronary syndrome (ACS). Contrast induced nephropathy is a serious complication and greatly dependent on several factors. It is...Background: Percutaneous coronary intervention is now the best way of management of acute coronary syndrome (ACS). Contrast induced nephropathy is a serious complication and greatly dependent on several factors. It is still unclear whether the vascular access migrates CIN risk. Objective: To study the impact of Radial Access (RA) compared with Femoral Access (FA) on developing contrast-induced nephropathy (CIN) in patients undergoing invasive management of acute coronary syndrome (ACS). Methods: Sixty patients eligible for invasive management of ACS at cardiology department (Menoufia University hospital and National Heart Institute) were randomized into two groups. Group I: included 30 patients with femoral approach and Group II: included 30 patients with radial approach. The occurrence of CIN estimated by KDIGO definition (absolute increase in serum creatinine (SCr) by ≥0.5 mg/dl within 48 hours;or increase in SCr to ≥25% of baseline) was estimated in both groups. Results: Only 9 patients (15%) developed CIN, 5 patients (55.6%) of them underwent PCI through FA without statistically significant difference between the two approaches.Conclusion: CIN is considered a potential complication of percutaneous coronary intervention (PCI). Our study did not show the preference of using an approach over the other.展开更多
AIM To evaluate the incidence of contrast-induced acute kidney injury(CIAKI) in kidney transplant recipients. METHODS A literature search was performed using MEDLINE, EMBASE, and the Cochrane Database of Systematic Re...AIM To evaluate the incidence of contrast-induced acute kidney injury(CIAKI) in kidney transplant recipients. METHODS A literature search was performed using MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews from the inception of the databases through July 2016. Studies assessing the incidence of CIAKI in kidney transplant recipients were included. We applied a randomeffects model to estimate the incidence of CIAKI.RESULTS Six studies of 431 kidney transplant recipients were included in the analyses to assess the incidence of CIAKI in kidney transplant recipients. The estimated incidence of CIAKI and CIAKI-requiring dialysis were 9.6%(95%CI: 4.5%-16.3%) and 0.4%(95%CI: 0.0%-1.2%), respectively. A sensitivity analysis limited only to the studies that used low-osmolar or iso-osmolar contrast showed the estimated incidence of CIAKI was 8.0%(95%CI: 3.5%-14.2%). The estimated incidences of CIAKI in recipients who received contrast media with cardiac catheterization, other types of angiogram, and CT scan were 16.1%(95%CI: 6.6%-28.4%), 10.1%(95%CI: 4.2%-18.0%), and 6.1%(95%CI: 1.8%-12.4%), respectively. No graft losses were reported within 30 d post-contrast media administration. However, data on the effects of CIAKI on long-term graft function were limited.CONCLUSION The estimated incidence of CIAKI in kidney transplant recipients is 9.6%. The risk stratification should be considered based on allograft function, indication, and type of procedure.展开更多
Objective To analyze the risk factors and clinical outcome of contrast induced nephropathy （CIN） in patients with coronary artery disease （CAD） after percutaneous coronary intervention （PCI） and discuss its prev...Objective To analyze the risk factors and clinical outcome of contrast induced nephropathy （CIN） in patients with coronary artery disease （CAD） after percutaneous coronary intervention （PCI） and discuss its prevention. Methods Fifty-four patients with C1N among 729 patients who received PCI were retrospectively studied and the related risk factors, cardiovascular events and preventive strategy were analyzed. Results C1N was strongly associated with pre-procedure chronic renal failure, diabetes mellitus and large-dose contrast. The incidence of cardiac mortality and major adverse cardiac events 1 year after PCI in CIN group was higher than that in group without CIN. Conclusion Chronic renal failure, diabetes mellitus and dosage of contrast agent were three independent risk factors of CIN. CIN could affect the patients＇ prognosis. A well overall perioperative management of CAD patients following PCI, especially hydration therapy, is the most important strategy for prevention of CIN.展开更多
Pancreatic vipoma is an extremely rare tumor accounting for less than 2% of endocrine pancreatic neoplasms with a reported incidence of 0.1-0.6 per million. While cross-sectional imaging findings are usually not speci...Pancreatic vipoma is an extremely rare tumor accounting for less than 2% of endocrine pancreatic neoplasms with a reported incidence of 0.1-0.6 per million. While cross-sectional imaging findings are usually not specific, exact localization of the tumor by means of either computed tomography(CT) or magnetic resonance(MR) is pivotal for surgical planning. However, cross-sectional imaging findings are usually not specific and further characterization of the tumor may only be achieved bysomatostatin-receptor scintigraphy(SRS). We report the case of a 70 years old female with a two years history of watery diarrhoea who was found to have a solid, inhomogeneously enhancing lesion at the level of the pancreatic tail at Gadolinium-enhanced MR(Somatom Trio 3T, Siemens, Germany). The tumor had been prospectively overlooked at a contrast-enhanced multi-detector CT(Aquilion 64, Toshiba, Japan) performed after i.v. bolus injection of only 100 cc of iodinated non ionic contrast media because of a chronic renal failure(3.4 mg/mL) but it was subsequently confirmed by SRS. The patient first underwent a successful symptomatic treatment with somatostatin analogues and was then submitted to a distal pancreasectomy with splenectomy to remove a capsulated whitish tumor which turned out to be a well-differentiated vipoma at histological and immuno-histochemical analysis.展开更多
Magnesium deficiency is common in patients with type 2 diabetes mellitus (type 2 DM). When adequate magnesium supplementation is chronically given, patients with type 2 DM appear to have improved glucose control and m...Magnesium deficiency is common in patients with type 2 diabetes mellitus (type 2 DM). When adequate magnesium supplementation is chronically given, patients with type 2 DM appear to have improved glucose control and may have delayed chronic complications. In addition, magnesium supplementation may slow the progression of chronic kidney disease (CKD) and decrease the risk of contrast-induced nephropathy in patients with type 2 DM. Keeping serum magnesium at 2.0 mEq/L or greater appears to accomplish these benefits for patients with type 2 DM. Periodically measuring serum magnesium and estimated glomerular filtration rate (eGFR) allows a physician to adjust the supplemental magnesium dose to accomplish these therapeutic goals while avoiding hypermagnesemia.展开更多
Objective To lessen the occurrence of contrast-induced nephropathy （CIN）, the preventive measures of CIN were reviewed. Data sources The data used in this review were from PubMed with relevant English articles and f...Objective To lessen the occurrence of contrast-induced nephropathy （CIN）, the preventive measures of CIN were reviewed. Data sources The data used in this review were from PubMed with relevant English articles and from Chinese Knowledge Information （CNKI） published from 1989 to 2009. The search terms were ＂contrast medium＂, ＂contrast-induced nephropathy＂ and ＂prevention＂. Articles involved in prevention of CIN were selected. Study selection CIN is the third most common cause of acute kidney injury and is associated with an unfavorable prognosis. The best treatment is prophylaxis because CIN can not be reversed or ameliorated. Results Thirty articles were included. Among various preventive measures, pericatheterization hydration is almost universally accepted as an appropriate and safe measure to prevent CIN, although there is no agreement as to composition, amount, and timing of hydration. Based on the use of concomitant nephrotoxic agents or high doses of contrast medium （CM） is one of risk factors for CIN, discontinuation of potentially nephrotoxic drugs 2-3 days before and after the procedure until renal function recover, and using the lowest possible dose of CM can decrease the risk of CIN. It is promising that removing the majority of CM from the coronary sinus, before it enters the systemic circulation, during coronary angiography can reduce the risk for CIN in animal studies and in limited clinical trials. Inconsistent data exist with respect to application of some vasodilators （endothelin antagonists and adenosine antagonists） and antioxidants （N-acetylcysteine and statins） in preventing CIN in high-risk patients, and new vasodilators and antioxidants continue to be tested. Conclusions Pericatheterization hydration, discontinuation of nephrotoxic drugs, and using the lowest possible dose of CM are effective measures to lessen the risk for CIN. Other prophylactic strategies and some drugs are promising, but further confirmation is required.展开更多
Background Anisodamine is widely used in therapy for treating acute glomerulonephritis and diabetic nephropathy because it can improve renal microcirculation. We performed a study to evaluate the preventive effects of...Background Anisodamine is widely used in therapy for treating acute glomerulonephritis and diabetic nephropathy because it can improve renal microcirculation. We performed a study to evaluate the preventive effects of anisodamine against contrast-induced nephropathy （CIN） in type 2 diabetics with renal insufficiency undergoing coronary angiography or angioplasty. Methods A total of 260 patients with type 2 diabetes and an estimated glomerular filtration rate （eGFR） of 60 ml^-1 - min^-1·1.73 m^-2 or less, who were undergoing coronary angiography or angioplasty, were randomly assigned to receive an infusion of either sodium chloride （control group, n=128） or anisodamine （treatment group, n=132）. Patients in the treatment group received an infusion of anisodamine at a rate of 0.2 μg · kg^-1 · min^-1 from 12 hours before to 12 hours after coronary angiography or angioplasty, while patients in the control group received an infusion of sodium chloride with the same volume as the treatment group. All patients received intravenous sodium chloride hydration. CIN was defined as a 25% increase in serum creatinine from baseline or an absolute increase of 〉0.5 mg/dl within three days after contrast exposure. The primary end point was the incidence of CIN. The secondary end point was a 25% or greater reduction in eGFR. Results There were no significant differences between the two groups with regard to age, gender, risk factors, laboratory results, medications and interventions. The incidence of CIN was 9.8% （13/132） in the treatment group and 20.3% （26/128） in the control group （P 〈0.05）. The secondary end point was 6.0% （8/132） in the treatment group and 16.4% （21/128） in the control group （P〈0.05）. Conclusion These results indicate the preventive effects of anisodamine against CIN in type 2 diabetics with renal insufficiency who are undergoing coronary angiography or angioplasty.展开更多
Background Diabetic patients undergoing percutaneous coronary intervention （PCI） have a higher incidence of contrast-induced nephropathy （CIN） than nondiabetic patients, and no pharmacological approach has been de...Background Diabetic patients undergoing percutaneous coronary intervention （PCI） have a higher incidence of contrast-induced nephropathy （CIN） than nondiabetic patients, and no pharmacological approach has been demonstrated to offer consistent protection. Therefore, identifying individuals who are at increased risk becomes essential. This study was designed to assess the predictive role of the ratio of contrast medium volume to estimated glomerular filtration rate （CMV/eGFR） in diabetic patients undergoing elective PCI who developed ClN.Methods We retrospectively investigated clinical factors associated with the development of CIN in 114 diabetic patients who had undergone elective PCI. The risk factors for CIN included age, gender, body mass index （BMI）, left ventricular ejection fraction （LVEF）, hemoglobin （Hb）, fasting plasma glucose （FPG）, hemoglobin A1c （HbA1c）, volume of contrast medium, basic levels of serum creatinine （Scr）, the number of treated vessels and the number of stents used.We conducted a stepwise regression analysis to evaluate the predictive role of these risk factors in the incidence of CIN.Results The incidence of CIN was 18.4% （21/114）. There were no significant differences in age, gender, BMI, LVEF, Hb,FPG, HbA1c, and incidence of hypertension and number of acute myocardial infarction （AMI） in patients between the CIN （n=21） and the non-CIN （n=93） groups. However, the eGFR was significantly lower （（72.0±12.5） ml·min-1·1.73 m-2 vs.（82.0±16.5）ml·min-1·1.7m-2, P=0.010）, and the basic serum creatinine level （（1.07±0.12） mg/dl vs.（0.97±0.19） mg/dlP=0.014） was significantly higher in the CIN group. In addition, the volume of contrast medium was significantly larger （（253±75）ml vs. （211±71）ml, P=0.017） and the CMV/eGFR ratio was significantly greater （3.64±1.26 vs.2.70±1.11, P=0.001） in the CIN group. Stepwise regression analysis showed that the CMV/eGFR ratio was a significant independent predictor for the development of CIN （P=0.001）. At a cut-off point of 〉3.1, the CMV/eGFR ratio exhibited 71% sensitivity and 70% specificity for detecting CIN.Conclusion The CMV/eGFR ratio could be a valuable predictor of CIN for diabetic patients after elective PCI. At a cut-off point of〉3.1, the CMV/eGFR ratio was an optimal predictor for the incidence of CIN.展开更多
Objective： TO study the prevention effect of salidroside on contrast-induced-nephropathy （CIN） and its underlying mechanism. Methods： A total of 24 Wistar rats were randomly divided into 4 groups with 6 in each gr...Objective： TO study the prevention effect of salidroside on contrast-induced-nephropathy （CIN） and its underlying mechanism. Methods： A total of 24 Wistar rats were randomly divided into 4 groups with 6 in each group. Rats were firstly administrated with normal saline （control and model groups）, N-acetylcysteine （NAC, NAC group） and salidroside （salidroside group） for 7 days before model establishment in each group, respectively. Histopathological analysis was performed by periodic acid-Schiff （PAS） staining. Oxidative stress related parameters including superoxide dismutase （SOD） and methane dicarboxylic aldehyde （MDA）, nitric oxide （NO）, angiotensin 11 （Ang II）, 8-hydroxy-2＇-deoxyguanosine （8-OHdG）, mRNA and protein levels of endothelial nitric oxide synthase （eNOS）, and nitric oxide synthase （NOS） activity were measured. Results： Compared with the control group, the levels of MDA, Ang II and 8-OHdG were all significantly increased and levels of SOD, NO, and eNOS mRNA and protein were decreased significantly in the model group （P〈0.05）. Meanwhile, the NOS activity was also significantly decreased in the model group （P〈0.05）. In addition, the levels of these parameters were all improved in the NAC （P〈0.05） and salidroside groups and no significant different was found between these two groups （P〉0.05）. Conclusion： Salidroside can be the potential substitute Of NAC to prevent CIN. The underlying mechanism may be associated with oxidative stress damage caused by contrast agents.展开更多
Contrast-induced nephropathy （CIN）, also called contrast-induced acute kidney injury （CI-AKI）, is a leading cause of hospital-acquired AKI as a possible complication of intravenous contrast media administration.
The cornerstones of the clinical management are prevention and identification of patients at risk, e.g. patients with diabetes, renal failure or heart failure.Hydration therapy is the main line of prevention, and in a...The cornerstones of the clinical management are prevention and identification of patients at risk, e.g. patients with diabetes, renal failure or heart failure.Hydration therapy is the main line of prevention, and in addition several drugs have been investigated for prophylactic effects in high-risk patients： statins, ascorbic acid.展开更多
基金Supported by The Kaohsiung Veterans General Hospital,Grant No. VGHKS100-032 (in part)
文摘Radiocontrast-induced nephropathy(RCIN) is an acute and severe complication after coronary angiography,particularly for patients with pre-existing chronic kidney disease(CKD).It has been associated with both short-and long-term adverse outcomes,including the need for renal replacement therapy,increased length of hospital stay,major cardiac adverse events,and mortality.RCIN is generally defined as an increase in serum creatinine concentration of 0.5 mg/dL or 25%above baseline within 48 h after contrast administration.There is no effective therapy once injury has occurred,therefore,prevention is the cornerstone for all patients at risk for acute kidney injury(AKI).There is a small but growing body of evidence that prevention of AKI is associated with a reduction in later adverse outcomes.The optimal strategy for preventing RCIN has not yet been established.This review discusses the principal risk factors for RCIN,evaluates and summarizes the evidence for RCIN prophylaxis,and proposes recommendations for preventing RCIN in CKD patients undergoing coronary angiography.
文摘Purpose: The purpose of this retrospective study was to assess the incidence and the risk factors of contrast-induced nephropathy (CIN) following transcatheter arterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). Materials and Methods: We performed a retrospective review of 186 sessions of TACE in 122 patients with HCC. We examined the incidence and factors associated with risk of CIN, defined as an increase of at least 0.5 mg/dl (44.2 μmol/l) or 25% of the baseline serum creatinine level between 48 and 72 hours after TACE. Results: CIN developed in 14 (7.5%) of the 186 sessions after TACE. A univariate analysis showed that the Child-Pugh class B or C [10/14 (71%) vs. 70/172 (41%), P = 0.046], a low albumin level (3.0 ± 0.5 vs. 3.4 ± 0.6, P = 0.018), and a low hemoglobin level (10.6 ± 2.0 vs. 11.8 ± 2.0, P = 0.035) were significantly associated with the development of CIN. Multivariate analysis revealed that the hemoglobin value was associated with CIN [odds ratio (OR) 1.6;P = 0.038]. Conclusions: CIN after TACE is closely associated with the severity of liver cirrhosis, and with low levels of albumin and hemoglobin. Effective preventive methods remain to be considered in patients with HCC and advanced LC who are undergoing TACE.
文摘Recent advances in medical sciences, especially in imaging, have dramatically increased the use of contrast agents. The constantly changing nature of medicine and the availability of new information, such as new pharmaceutical formulations, have necessitated periodic revisions and drafting of new guidelines for the safe use of intravenous contrast agents in radiology. This study examined the majority of guidelines, articles, and authoritative references available on the use of intravenous contrast agents in adults to reduce the risk of contrast-induced nephropathy. The search engines of PubMed, Web of Science, Scopus, and Google Scholar were used, and relevant English articles cited at least twice between 1979 and 2014 were studied. Review of the collected papers showed no consensus among them for guidelines on the incidence of contrast-induced nephropathy in patients at risk. Different formulas were used to calculate estimated glomerular filtration rate, which could be problematic in some cases. Further studies are needed for unification of existing guidelines.
文摘Objective: Contrast induced nephropathy (CIN) is the third leading cause of hospital acquired renal failure. The mechanism of CIN is not fully understood. The objectives of this study were to investigate the expression changes of the four subtypes of adenosine receptors (A1AR, A2AAR, A2BAR, and A3AR) following administration of contrast media in mice. Methods: C57BL/6J mice were randomized into treatment and control groups. Iodixanol (IDX) was administered to two treatment groups through retroorbital injection at two different dosages, 0.75 gI/kg and 2.75 gI/kg. Phosphate buffered saline (PBS) was given to the control group. Mice kidneys were harvested at day 3 and day 7 after Iodixanol administration. Kidney injuries and function were evaluated according to Hematoxylin and eosin stain, Ki67 protein expression, and TUNEL assay of paraffin embedded kidney sections, and plasma creatinine assay. RNA and protein were extracted from the kidney specimens. A1AR, A2AAR, A2BAR, and A3AR RNA and protein level of the samples were assessed using qRT-PCR and Western blotting, with GAPDH as an endogenous control. Results: H&E staining showed no significant histopathology injuries after Iodixanol administration. No evidence of kidney injury and functional impairment was found. However, there was an increased number of A1AR, A2AAR, A2BAR, and A3AR RNA transcripts detected in the kidney 3 days after Iodixanol injection. The RNA levels in all the four subtypes of adenosine receptors were increased 2-3 fold in the day 3 specimens and back to normal at day 7. Western blot demonstrated that A1AR, A2AAR, and A3AR expression increased 1.5 to 2 fold at day 3 and day 7 following Iodixanol injection. A2BAR baseline expression was low in normal physiological conditions and no significant change was detected by Western blot. Conclusions: Iodixanol significantly increases adenosine receptors gene expression in mice. This suggests that adenosine receptors may play a role in the development of CIN.
文摘Background: Percutaneous coronary intervention is now the best way of management of acute coronary syndrome (ACS). Contrast induced nephropathy is a serious complication and greatly dependent on several factors. It is still unclear whether the vascular access migrates CIN risk. Objective: To study the impact of Radial Access (RA) compared with Femoral Access (FA) on developing contrast-induced nephropathy (CIN) in patients undergoing invasive management of acute coronary syndrome (ACS). Methods: Sixty patients eligible for invasive management of ACS at cardiology department (Menoufia University hospital and National Heart Institute) were randomized into two groups. Group I: included 30 patients with femoral approach and Group II: included 30 patients with radial approach. The occurrence of CIN estimated by KDIGO definition (absolute increase in serum creatinine (SCr) by ≥0.5 mg/dl within 48 hours;or increase in SCr to ≥25% of baseline) was estimated in both groups. Results: Only 9 patients (15%) developed CIN, 5 patients (55.6%) of them underwent PCI through FA without statistically significant difference between the two approaches.Conclusion: CIN is considered a potential complication of percutaneous coronary intervention (PCI). Our study did not show the preference of using an approach over the other.
文摘AIM To evaluate the incidence of contrast-induced acute kidney injury(CIAKI) in kidney transplant recipients. METHODS A literature search was performed using MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews from the inception of the databases through July 2016. Studies assessing the incidence of CIAKI in kidney transplant recipients were included. We applied a randomeffects model to estimate the incidence of CIAKI.RESULTS Six studies of 431 kidney transplant recipients were included in the analyses to assess the incidence of CIAKI in kidney transplant recipients. The estimated incidence of CIAKI and CIAKI-requiring dialysis were 9.6%(95%CI: 4.5%-16.3%) and 0.4%(95%CI: 0.0%-1.2%), respectively. A sensitivity analysis limited only to the studies that used low-osmolar or iso-osmolar contrast showed the estimated incidence of CIAKI was 8.0%(95%CI: 3.5%-14.2%). The estimated incidences of CIAKI in recipients who received contrast media with cardiac catheterization, other types of angiogram, and CT scan were 16.1%(95%CI: 6.6%-28.4%), 10.1%(95%CI: 4.2%-18.0%), and 6.1%(95%CI: 1.8%-12.4%), respectively. No graft losses were reported within 30 d post-contrast media administration. However, data on the effects of CIAKI on long-term graft function were limited.CONCLUSION The estimated incidence of CIAKI in kidney transplant recipients is 9.6%. The risk stratification should be considered based on allograft function, indication, and type of procedure.
文摘Objective To analyze the risk factors and clinical outcome of contrast induced nephropathy （CIN） in patients with coronary artery disease （CAD） after percutaneous coronary intervention （PCI） and discuss its prevention. Methods Fifty-four patients with C1N among 729 patients who received PCI were retrospectively studied and the related risk factors, cardiovascular events and preventive strategy were analyzed. Results C1N was strongly associated with pre-procedure chronic renal failure, diabetes mellitus and large-dose contrast. The incidence of cardiac mortality and major adverse cardiac events 1 year after PCI in CIN group was higher than that in group without CIN. Conclusion Chronic renal failure, diabetes mellitus and dosage of contrast agent were three independent risk factors of CIN. CIN could affect the patients＇ prognosis. A well overall perioperative management of CAD patients following PCI, especially hydration therapy, is the most important strategy for prevention of CIN.
文摘Pancreatic vipoma is an extremely rare tumor accounting for less than 2% of endocrine pancreatic neoplasms with a reported incidence of 0.1-0.6 per million. While cross-sectional imaging findings are usually not specific, exact localization of the tumor by means of either computed tomography(CT) or magnetic resonance(MR) is pivotal for surgical planning. However, cross-sectional imaging findings are usually not specific and further characterization of the tumor may only be achieved bysomatostatin-receptor scintigraphy(SRS). We report the case of a 70 years old female with a two years history of watery diarrhoea who was found to have a solid, inhomogeneously enhancing lesion at the level of the pancreatic tail at Gadolinium-enhanced MR(Somatom Trio 3T, Siemens, Germany). The tumor had been prospectively overlooked at a contrast-enhanced multi-detector CT(Aquilion 64, Toshiba, Japan) performed after i.v. bolus injection of only 100 cc of iodinated non ionic contrast media because of a chronic renal failure(3.4 mg/mL) but it was subsequently confirmed by SRS. The patient first underwent a successful symptomatic treatment with somatostatin analogues and was then submitted to a distal pancreasectomy with splenectomy to remove a capsulated whitish tumor which turned out to be a well-differentiated vipoma at histological and immuno-histochemical analysis.
文摘Magnesium deficiency is common in patients with type 2 diabetes mellitus (type 2 DM). When adequate magnesium supplementation is chronically given, patients with type 2 DM appear to have improved glucose control and may have delayed chronic complications. In addition, magnesium supplementation may slow the progression of chronic kidney disease (CKD) and decrease the risk of contrast-induced nephropathy in patients with type 2 DM. Keeping serum magnesium at 2.0 mEq/L or greater appears to accomplish these benefits for patients with type 2 DM. Periodically measuring serum magnesium and estimated glomerular filtration rate (eGFR) allows a physician to adjust the supplemental magnesium dose to accomplish these therapeutic goals while avoiding hypermagnesemia.
文摘Objective To lessen the occurrence of contrast-induced nephropathy （CIN）, the preventive measures of CIN were reviewed. Data sources The data used in this review were from PubMed with relevant English articles and from Chinese Knowledge Information （CNKI） published from 1989 to 2009. The search terms were ＂contrast medium＂, ＂contrast-induced nephropathy＂ and ＂prevention＂. Articles involved in prevention of CIN were selected. Study selection CIN is the third most common cause of acute kidney injury and is associated with an unfavorable prognosis. The best treatment is prophylaxis because CIN can not be reversed or ameliorated. Results Thirty articles were included. Among various preventive measures, pericatheterization hydration is almost universally accepted as an appropriate and safe measure to prevent CIN, although there is no agreement as to composition, amount, and timing of hydration. Based on the use of concomitant nephrotoxic agents or high doses of contrast medium （CM） is one of risk factors for CIN, discontinuation of potentially nephrotoxic drugs 2-3 days before and after the procedure until renal function recover, and using the lowest possible dose of CM can decrease the risk of CIN. It is promising that removing the majority of CM from the coronary sinus, before it enters the systemic circulation, during coronary angiography can reduce the risk for CIN in animal studies and in limited clinical trials. Inconsistent data exist with respect to application of some vasodilators （endothelin antagonists and adenosine antagonists） and antioxidants （N-acetylcysteine and statins） in preventing CIN in high-risk patients, and new vasodilators and antioxidants continue to be tested. Conclusions Pericatheterization hydration, discontinuation of nephrotoxic drugs, and using the lowest possible dose of CM are effective measures to lessen the risk for CIN. Other prophylactic strategies and some drugs are promising, but further confirmation is required.
文摘Background Anisodamine is widely used in therapy for treating acute glomerulonephritis and diabetic nephropathy because it can improve renal microcirculation. We performed a study to evaluate the preventive effects of anisodamine against contrast-induced nephropathy （CIN） in type 2 diabetics with renal insufficiency undergoing coronary angiography or angioplasty. Methods A total of 260 patients with type 2 diabetes and an estimated glomerular filtration rate （eGFR） of 60 ml^-1 - min^-1·1.73 m^-2 or less, who were undergoing coronary angiography or angioplasty, were randomly assigned to receive an infusion of either sodium chloride （control group, n=128） or anisodamine （treatment group, n=132）. Patients in the treatment group received an infusion of anisodamine at a rate of 0.2 μg · kg^-1 · min^-1 from 12 hours before to 12 hours after coronary angiography or angioplasty, while patients in the control group received an infusion of sodium chloride with the same volume as the treatment group. All patients received intravenous sodium chloride hydration. CIN was defined as a 25% increase in serum creatinine from baseline or an absolute increase of 〉0.5 mg/dl within three days after contrast exposure. The primary end point was the incidence of CIN. The secondary end point was a 25% or greater reduction in eGFR. Results There were no significant differences between the two groups with regard to age, gender, risk factors, laboratory results, medications and interventions. The incidence of CIN was 9.8% （13/132） in the treatment group and 20.3% （26/128） in the control group （P 〈0.05）. The secondary end point was 6.0% （8/132） in the treatment group and 16.4% （21/128） in the control group （P〈0.05）. Conclusion These results indicate the preventive effects of anisodamine against CIN in type 2 diabetics with renal insufficiency who are undergoing coronary angiography or angioplasty.
文摘Background Diabetic patients undergoing percutaneous coronary intervention （PCI） have a higher incidence of contrast-induced nephropathy （CIN） than nondiabetic patients, and no pharmacological approach has been demonstrated to offer consistent protection. Therefore, identifying individuals who are at increased risk becomes essential. This study was designed to assess the predictive role of the ratio of contrast medium volume to estimated glomerular filtration rate （CMV/eGFR） in diabetic patients undergoing elective PCI who developed ClN.Methods We retrospectively investigated clinical factors associated with the development of CIN in 114 diabetic patients who had undergone elective PCI. The risk factors for CIN included age, gender, body mass index （BMI）, left ventricular ejection fraction （LVEF）, hemoglobin （Hb）, fasting plasma glucose （FPG）, hemoglobin A1c （HbA1c）, volume of contrast medium, basic levels of serum creatinine （Scr）, the number of treated vessels and the number of stents used.We conducted a stepwise regression analysis to evaluate the predictive role of these risk factors in the incidence of CIN.Results The incidence of CIN was 18.4% （21/114）. There were no significant differences in age, gender, BMI, LVEF, Hb,FPG, HbA1c, and incidence of hypertension and number of acute myocardial infarction （AMI） in patients between the CIN （n=21） and the non-CIN （n=93） groups. However, the eGFR was significantly lower （（72.0±12.5） ml·min-1·1.73 m-2 vs.（82.0±16.5）ml·min-1·1.7m-2, P=0.010）, and the basic serum creatinine level （（1.07±0.12） mg/dl vs.（0.97±0.19） mg/dlP=0.014） was significantly higher in the CIN group. In addition, the volume of contrast medium was significantly larger （（253±75）ml vs. （211±71）ml, P=0.017） and the CMV/eGFR ratio was significantly greater （3.64±1.26 vs.2.70±1.11, P=0.001） in the CIN group. Stepwise regression analysis showed that the CMV/eGFR ratio was a significant independent predictor for the development of CIN （P=0.001）. At a cut-off point of 〉3.1, the CMV/eGFR ratio exhibited 71% sensitivity and 70% specificity for detecting CIN.Conclusion The CMV/eGFR ratio could be a valuable predictor of CIN for diabetic patients after elective PCI. At a cut-off point of〉3.1, the CMV/eGFR ratio was an optimal predictor for the incidence of CIN.
基金Supported by the National Nature Science Foundation of China(No.81273968 and No.81471027)Ministerial Project of the National Working Commission on Aging(No.QLB2014W002)
文摘Objective： TO study the prevention effect of salidroside on contrast-induced-nephropathy （CIN） and its underlying mechanism. Methods： A total of 24 Wistar rats were randomly divided into 4 groups with 6 in each group. Rats were firstly administrated with normal saline （control and model groups）, N-acetylcysteine （NAC, NAC group） and salidroside （salidroside group） for 7 days before model establishment in each group, respectively. Histopathological analysis was performed by periodic acid-Schiff （PAS） staining. Oxidative stress related parameters including superoxide dismutase （SOD） and methane dicarboxylic aldehyde （MDA）, nitric oxide （NO）, angiotensin 11 （Ang II）, 8-hydroxy-2＇-deoxyguanosine （8-OHdG）, mRNA and protein levels of endothelial nitric oxide synthase （eNOS）, and nitric oxide synthase （NOS） activity were measured. Results： Compared with the control group, the levels of MDA, Ang II and 8-OHdG were all significantly increased and levels of SOD, NO, and eNOS mRNA and protein were decreased significantly in the model group （P〈0.05）. Meanwhile, the NOS activity was also significantly decreased in the model group （P〈0.05）. In addition, the levels of these parameters were all improved in the NAC （P〈0.05） and salidroside groups and no significant different was found between these two groups （P〉0.05）. Conclusion： Salidroside can be the potential substitute Of NAC to prevent CIN. The underlying mechanism may be associated with oxidative stress damage caused by contrast agents.
基金Supported by the National Natural Science Foundation of China(No.81573936 and 81373614)Shanghai Municipal Hospital Xinxing Qianyan Project(No.SHDC12015126)Shanghai Pujiang Program(No.15PJD036)
文摘Contrast-induced nephropathy （CIN）, also called contrast-induced acute kidney injury （CI-AKI）, is a leading cause of hospital-acquired AKI as a possible complication of intravenous contrast media administration.
文摘The cornerstones of the clinical management are prevention and identification of patients at risk, e.g. patients with diabetes, renal failure or heart failure.Hydration therapy is the main line of prevention, and in addition several drugs have been investigated for prophylactic effects in high-risk patients： statins, ascorbic acid.
