Ethanol extract of Abelmoschus manihot suppresses endoplasmic reticulum stress in contrast-induced nephropathy

Objective:To explore the efficacy and potential mechanisms of the ethanol extract of Abelmoschus manihot(L.)Medic in contrast-induced nephropathy(CIN).Methods:CIN rat models and human renal proximal tubular cells(HK-2)with iopromide-induced injury were employed to mimic CIN conditions.The effect of Abelmoschus manihot extract on the rat models and HK-2 cells was evaluated.In rat models,kidney function,histology,oxidative stress and apoptosis were determined.In HK-2 cells,cell viability,apoptosis,mitochondrial membrane potential,and endoplasmic reticulum stress were assessed.Results:Abelmoschus manihot extract significantly improved structural and functional impairments in the kidneys of CIN rats.Additionally,the extract effectively mitigated the decline in cellular viability and reduced iopromide-induced oxidative stress and lipid peroxidation.Mechanistic investigations revealed that Abelmoschus manihot extract prominently attenuated acute endoplasmic reticulum stress-mediated apoptosis by downregulating GRP78 and CHOP protein levels.Conclusions:Abelmoschus manihot extract can be used as a promising therapeutic and preventive agent in the treatment of CIN.

Navigating nephrotoxic waters:A comprehensive overview of contrast-induced acute kidney injury prevention

Contrast-induced acute kidney injury(CI-AKI)is the third leading cause of acute kidney injury deriving from the intravascular administration of contrast media in diagnostic and therapeutic procedures and leading to longer in-hospital stay and increased short and long-term mortality.Its pathophysiology,although not well-established,revolves around medullary hypoxia paired with the direct toxicity of the substance to the kidney.Critically ill patients,as well as those with pre-existing renal disease and cardiovascular comorbidities,are more susceptible to CI-AKI.Despite the continuous research in the field of CI-AKI prevention,clinical practice is based mostly on periprocedural hydration.In this review,all the investigated methods of prevention are presented,with an emphasis on the latest evidence regarding the potential of RenalGuard and contrast removal systems for CI-AKI prevention in high-risk individuals.

Innovative approaches beyond periprocedural hydration for preventing contrast-induced acute kidney injury

Contrast-induced acute kidney injury(CI-AKI)is a major concern in clinical practice,particularly among high-risk patients with preexisting renal and cardiovascular conditions.Although periprocedural hydration has long been the primary approach for CI-AKI prevention,recent advancements have led to the development of novel approaches such as RenalGuard and contrast removal systems.This editorial explores these emerging approaches and highlights their potential for enhancing CI-AKI prevention.By incorporating the latest evidence into clinical practice,health-care professionals can more effectively maintain renal function and improve outcomes for patients undergoing contrast-enhanced procedures.

Contrast Agents and Contrast-Induced Nephropathy

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.

Predictors of contrast-induced acute kidney injury in patients with coronary artery disease receiving contrast agents twice within 30 days

Background:None of study mentioned about contrast-induced acute kidney injury(CI-AKI)in people who have received contrast agents twice within in a short period of time.This study is trying to identify the predictors.Methods:We enrolled 607 patients between Oct.2010 and Jul.2015 who received contrast agents twice within 30 days in the Department of Cardiology of the General Hospital of Shenyang Military Region.The primary outcome was CI-AKI within 72 h after contrast agent exposure.Patients were divided into groups A(n=559)and group B(n=48)according to whether CI-AKI occurred after the second agent.Results:Patients in group B(CI-AKI occurred after the second agent)had a more rapid heart rate and more usage of diuretics and digitalis.In group B,CI-AKI occurred more frequently after the first agent.Multivariate logistic regression showed that diuretic(P=0.006)and intra-aortic balloon pump(IABP)usage(P=0.012)were independent predictors of CI-AKI after the first agent.Angiotensin-converting enzyme inhibitor/AngiotensinⅡreceptor antagonist(ACEI/ARB)usage(P=0.039),IABP usage(P=0.040)and CI-AKI occurring after administration of the first agent(P=0.015)were independent predictors of CI-AKI after the second.Furthermore,dividing the patients into tertiles of the time interval between the two agents showed that CI-AKI occurred more frequently when the second agent was administered within 1–3 days after the first exposure than within 4–6 days(12.4%vs.5.0%,P=0.008)or≥7 days(12.4%vs.6.4%,P=0.039).Conclusions:Diuretic and IABP usage are independent predictors of CI-AKI following exposure to a first contrast agent.The major predictors of CI-AKI after exposure to a second agent are time since the first contrast exposure,ACEI/ARB usage,and IABP usage.More importantly,a three-day interval between the two agents is associated with a higher incidence of CI-AKI following the second administration.

Contrast-induced acute kidney injury:A review of practical points

Contrast-induced acute kidney injury(CI-AKI) is oneof the most common causes of AKI in clinical practice.CI-AKI has been found to be strongly associated with morbidity and mortality of the patients.Furthermore,CI-AKI may not be always reversible and it may be associated with the development of chronic kidney disease.Pathophysiology of CI-AKI is not exactly understood and there is no consensus on the preventive strategies.CI-AKI is an active research area thus clinicians should be updated periodically about this topic.In this review,we aimed to discuss the indications of contrastenhanced imaging,types of contrast media and their impact on nephrotoxicity,major pathophysiological mechanisms,risk factors and preventive strategies of CI-AKI and alternative non-contrast-enhanced imaging methods.

Contrast-induced acute kidney injury in kidney transplant recipients: A systematic review and meta-analysis

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.

Contrast-induced Encephalopathy after Endovascular Embolization of an Anterior Communicating Artery Aneurysm:Case Report and Literature Review

We report a case of contrast-induced encephalopathy after endovascular embolization of an anterior communicating artery aneurysm.A 59-year-old woman was admitted to Tongliao Hospital for neurointerventional treatment due to a left anterior communicating artery aneurysm.She had a history of hypertension,which was controlled by regular medication.The contraindications were eliminated following a preoperative examination,and head computed tomography(CT)showed no abnormalities.After evaluation,interventional embolization was performed.Three hours postoperatively,the patient complained of a headache on the right side,which was accompanied by frequent nausea.Emergency head CT showed no intracranial hemorrhage,obvious brain tissue edema in the right cerebral hemisphere,blurred sulcus/gyrus,or metal artifacts(spring coils)in the left frontal lobe.The patient was diagnosed with contrast-induced encephalopathy(CIE).This patient achieved good prognosis through timely and reasonable treatment.CIE is very rare clinically,improper treatment may lead to irreversible clinical outcomes;it should cause alarm to doctors.

Precision nosology of contrast-induced acute kidney injury may have higher accuracy in predicting adverse outcomes: inspiration from the modified classification of AKI

The definition of contrast-induced acute kidney injury(CI-AKI)in most articles is a fixed(rise by 0.5 mg/dL,CIAKI-absolute)or proportionate(rise by 25%,CIAKI-relative)increase in serum creatinine concentration(SCr)above baseline(measured at hospital admission)within 48-72 hours of contrast exposure[1,2].Hence,an absolute increase in SCr≥0.5 mg/dl is equivalent to a relative increase in SCr≥25%in their protocols.However,we believe a precision nosology of CI-AKI may have higher accuracy in predicting adverse outcomes.We recommend further study conduct a sub-group analysis based on our modified classification of CI-AKI.

Acupuncture and moxibustion for the prevention of contrast induced nephropathy in diabetic rats by inhibiting Notch signaling pathway

Objective Apoptosis is recognized as an important mechanism in contrast-induced nephropathy(CIN).Acupuncture and moxibustion,the auxiliary treatment in China,are effective interventions for cell apoptosis in many ischemic diseases.In our previous study,we found acupuncture and moxibustion could prevent CIN.The objective of this research is to study the mechanism of acupuncture and moxibustion on tubular epithelial cell apoptosis in diabetic CIN rats.

Prevention of iodinated contrast-induced nephropathy

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.

Preventive effects of anisodamine against contrast-induced nephropathy in type 2 diabetics with renal insufficiency undergoing coronary angiography or angioplasty

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.

Role of serum cystatin C in the prediction of contrast-induced nephropathy after intra-arterial interventions

Background:The diagnosis of contrast-induced nephropathy(CIN)is usually based on changes in serum creatinine(sCr).However,sCr has poor sensitivity as a biomarker of kidney injury.The aim of this study was to investigate the usefulness of serum cystatin C(sCysC)to predict CIN after intra-arterial interventions.Methods:A total of 360 consecutive patients underwent intra-arterial procedures using digital subtraction angiography.SCr,sCysC,and estimated glomerular filtration rate were measured at 1 to 2 days before and at 48,72 h,and 7 days after the procedure.Results:Thirty-one patients(8.61%)developed CIN.Receiver operating characteristic(ROC)curve analysis showed that preoperative sCysC levels had good discriminatory power(area under the curve[AUC]=0.634;95%confidence interval[CI]=0.526-0.743)for evaluating the risk of CIN after an endovascular procedure,with a sensitivity of 53.33%and specificity of 73.70%.ROC analysis showed that sCysC at 48 h after contrast medium administration was predictive of CIN after an endovascular procedure(AUC=0.735;95%CI=0.647-0.822)with satisfactory sensitivity of 74.20%and specificity of 63.90%.Diabetes mellitus was an independent risk factor for CIN(odds ratio=2.778;95%CI=1.045-7.382;P=0.040).Conclusions:SCysC is an appropriate biomarker to predict the occurrence of CIN.Baseline sCysC before an intervention is useful to obtain a preliminary estimate of the risk of CIN.A 48-h cut-off value of sCysC of 0.99 mg/L after an endovascular procedure may help to rule out patients at lower risk of CIN.

Role of Dongchongxiacao (Cordyceps) in prevention of contrast-induced nephropathy in patients with stable angina pectoris

OBJECTIVE： To study the preventative effects of Dongchongxiacao （Cordyceps） on contrast-induced nephropathy （CIN） in patients with stable angina pectoris （SAP）. METHODS： One-hundred and three SAP inpatients were divided randomly into two groups： basic treat- ment （n=51） and Dongchongxiacao （Cordyceps） treatment （n=52）; corbrin capsules （3 g; t.d.s.） were used 3 days before angioplasty and 3 days after an- gioplasty）. Serum creatinine （Scr） was assessed at the time of hospital admission and 1, 2, and 3 days after angioplasty. Values of kidney injury mole- cule-1 （KIM-1）, neutrophil gelatinase-associated li- pocalin （NGAL） and interleukin （IL） 18 in the kidney were detected before angioplasty and 1 day after angioplasty in the patients of both groups. The prevalence of CIN between the two groups was then compared. RESULTS： CIN occurred in 9 of 103 patients （8.74%）. The prevalence of CIN in the Dongchongxiacao （Cordyceps） treatment group was lower than that of the basic treatment group （5.77% vs 11.76%） but the difference was not significant （P〉0.05）. The post-procedure mean peak of Scr, post-procedure increase in Scr levels from baseline, and urine levelsof KIM-1, NGAL and IL18 after the procedure in the Dongchongxiacao （Corclyceps） treatment group were significantly lower than those in the basic treatment group （P〈0.05）. CONCLUSION： Prophylactic treatment with Dongchongxiacao （Cordyceps） in SAP patients who undergo coronary angiography or coronary inter- vention could prevent contrast-induced renal im- pairment.

Prediction of contrast-induced nephropathy in diabetics undergoing elective percutaneous coronary intervention： role of the ratio of contrast medium volume to estimated glomerular filtration rate

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.

Effect of Dongchongxiacao(Cordyceps) therapy on contrast-induced nephropathy in patients with type 2 diabetes and renal insufficiency undergoing coronary angiography

OBJECTIVE: To study the protective effects of Dongchongxiacao(Cordyceps)(DCXC) on contrast-induced nephropathy(CIN) in patients with type 2 diabetes and renal insufficiency undergoing coronary angiography.METHODS: A total of 120 patients with type 2 diabetes whose estimated glomerular filtration rate(e GFR) was ≤ 60 m L/minee grou·1.73 m2,were divided randomly into thrps,basic treatment group(n = 41),standard DCXC therapy group(n = 39,2-g corbrin capsules,3 times/d,3 days before and after angiography),and intensive DCXC therapy group(n = 40,3-g corbrin capsules,3 times/d,3 days before and after angiography). Serum creatinine(Scr)and e GFR were assessed at the time of admission to hospital,and on days 1,2 and 3 after angiography. Urine neutrophil-gelatinase-associated-lipocalin(NGAL),kidney injury molecule-1(KIM-1) and interleukin-18(IL-18) were measured before angiography and at day 1 after angiography for all patients. The primary end point was the prevalence of CIN. The secondary end point was a 25% or greater reduction in e GFR.RESULTS: CIN occurred in 11 of 120 patients(9.17 %). The prevalence of CIN was lower in the DCXC treatment groups than in the basic treatment group(P < 0.05),with a more significant decrease in the prevalence of CIN in the intensive DCXC therapy group(P < 0.01). Compared with the basic treatment group,a lower proportion of patients in the DCXC treatment groups had an e GFR decrease of 25% or greater(P < 0.05); patients with an e GFR decrease of 25% or greater accounted for an even lower proportion in the intensive DCXC therapy group(P < 0.01). Within 1 day of the procedure,urine levels of KIM-1,NGAL and IL-18 in patients in the intensive DCXC therapy group were lower than those in the basic treatment group and standard therapy group(P < 0.05).CONCLUSION: DCXC treatment may protect against CIN in patients with type 2 diabetes and renal insufficiency undergoing coronary angiography,with intensive DCXC therapy being more effective.

Recent Advances in Chinese Medicine for Contrast-Induced Nephropathy

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.

Contrast-Induced Nephropathy--Time for Western Medicine and Chinese Medicine to Team Up

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.

Relationship between different definitions of contrast-induced nephropathy and adverse outcomes in ST-elevation myocardial infarction

Background Contrast-induced nephropathy(CIN)is a frequent and serious complication in ST-elevation myocardial infarction(STEMI)patients undergoing percutaneous coronary intervention(PCI). However,there is no consensus on the best definition of CIN in order to identify patients at risk. Methods In this retrospective,observational study,all patients with STEMI referred for PCI were included. The relationship between different CIN definitions and adverse events were analyzed. Results Totally 492 patients were enrolled. The incidence rate of CIN varied according to different definitions:10.4% when defined as an absolute increase in SCr≥0.5 mg/d L while 24.2% as elevation of SCr by 25%. In-hospital MACEs rate was significantly higher in SCr≥0.5 mg/d L(54.9% vs. 31.3%,P=0.003). Multivariate analysis showed that CIN defined as an absolute increase of SCr≥0.5 mg/d L(OR=5.03,P<0.001)or elevations of SCr by 25%(OR=2.71,P=0.003)was a strong significant predictor of in-hospital MACEs. Kaplan-Meier analysis showed that cumulative long-term survival rate was significantly lower in patients with an absolute increase in SCr≥0.5 mg/d L(Log-rank=60.84,P<0.001)or elevation of SCr by 25%(Log-rank=15.66,P<0.001). Conclusion CIN is a frequent and serious complication of STEMI treated by PCI. The definition by absolute increase of SCr≥0.5 mg/d L is better in identifying patients with CIN at high risk of poor outcomes.[S Chin J Cardiol 2019;20(3):163-167]

Early diagnostic value for contrast-induced nephropathy in patients undergoing coronary angiography:Serum cystatin C might not be superior to serum creatinine

Background Contrast induced nephropathy（CIN） is associated with increased mortality. serum creatinine（sCr） and serum cystatin C（sCys C） have diagnostic value for CIN in patients taking coronary angiography（CAG）. However, whether sCys C is superior to sCr is still controversial. Methods All 280 patients undergoing PCI from July 2015 to July 2017 in Shunde Hospital, Southern Medical University were enrolled in this prospective study. The plasma levels of sCr and sCys C were measured in fasting blood samples in the morning before angiography and at 48 hours and 72 hours after the procedure. Receiver operating characteristic curve（ROC）analysis was performed for sCr and sCys C 48 hours after procedure. Results According to sCys C criteria, CIN occurred in 85 patients（30.4%） after contrast exposure, while, CIN occurred in 22 patients（7.9%）. ROC curve analysis found that AUC for sCr and sCys C was 0.741（P〈0.05, 95% CI = 0.613-0.869） and 0.720（P〈0.05, 95%CI = 0.590-0.851）, respectively without significantly different（P=0.412）. Conclusion The sCys C is not superior to s Cr for predicting CIN in angiography patients.