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Yue R, Zuo C, Zeng J, Su B, Tao Y, Huang S, Zeng R. Atorvastatin attenuates experimental contrast-induced acute kidney injury: a role for TLR4/MyD88 signaling pathway. Ren Fail 2018; 39:643-651. [PMID: 28805489 PMCID: PMC6447912 DOI: 10.1080/0886022x.2017.1361838] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objectives: To investigate the protective effect of different atorvastatin doses on contrast-induced acute kidney injury and the related mechanism. Methods: Healthy male Sprague–Dawley (SD) rats were randomly divided into the blank control group, experimental control group and different-dose atorvastatin groups. A rat model of contrast-induced acute kidney injury was established. We detected changes in serum creatinine (Scr) and blood urea nitrogen (BUN) before and after model establishment, observed and scored renal tubular injury, analyzed rat renal cell apoptosis, and measure the expression of signal pathway proteins and downstream inflammatory factors. Results: After contrast agent injection, the Scr and BUN levels of the experimental control group were significantly increased, the different doses applied in the atorvastatin group significantly reduced the Scr and BUN levels (p < .05) and ameliorated the contrast-induced acute kidney injury (p < .05) and significantly reduced Toll-like receptor 4 (TLR4), Myeloid differentiation factor 88 (Myd88), and Nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) protein expression and relative mRNA expression levels (p < .05) and significantly decreased expression levels of downstream inflammatory factors (p < .05). Conclusion: Different atorvastatin doses have protective effects on contrast-induced acute renal tubular injury in rats, possibly by targeting TLR4, suppressing TLR4 expression, regulating the TLR4/Myd88 signaling pathway, and inhibiting the expression of downstream inflammatory factors.
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Affiliation(s)
- Rongzheng Yue
- a Department of Nephrology , West China Hospital, School of Clinic Medicine, Sichuan University , Chengdu , PR China
| | - Chuan Zuo
- b Department of Rheumatology and Immunology , West China Hospital, School of Clinic Medicine, Sichuan University , Chengdu , PR China
| | - Jing Zeng
- c Department of Internal Medicine , West China Hospital, School of Clinic Medicine, Sichuan University , Chengdu , PR China
| | - Baihai Su
- a Department of Nephrology , West China Hospital, School of Clinic Medicine, Sichuan University , Chengdu , PR China
| | - Ye Tao
- a Department of Nephrology , West China Hospital, School of Clinic Medicine, Sichuan University , Chengdu , PR China
| | - Songmin Huang
- a Department of Nephrology , West China Hospital, School of Clinic Medicine, Sichuan University , Chengdu , PR China
| | - Rui Zeng
- d Department of Cardiovascular Diseases , West China Hospital, School of Clinic Medicine, Sichuan University , Chengdu , PR China
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2
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Stawicki S, Sims C, Sharma R, Weger N, Truitt M, Cipolla J, Schrag S, Lorenzo M, Chaar MEL, Torigian D, Kim P, Sarani B. Vena Cava Filters: A Synopsis of Complications and Related Topics. J Vasc Access 2018. [DOI: 10.1177/112972980800900204] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Deep venous thrombosis and pulmonary embolism constitute common preventable causes of morbidity and mortality. The incidence of venous thromboembolism (VTE) continues to increase. Standard anticoagulation therapy may reduce the risk of fatal PE by 75% and that of recurrent VTE by over 90%. For patients who are not candidates for anticoagulation, a vena cava filter (VCF) may be beneficial. Despite a good overall safety record, significant complications related to VCF are occasionally seen. This review discusses both procedural and non-procedural complications associated with VCF placement and use. We will also discuss VCF use in the settings of pregnancy, malignancy, and the clinical need for more than one filter.
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Affiliation(s)
- S.P. Stawicki
- Department of Surgery, Division of Critical Care, Trauma and Burns, The Ohio State University Medical Center, Columbus, OH - USA
- OPUS 12 Foundation, Inc, King of Prussia, PA - USA
| | - C.A. Sims
- Department of Surgery, Division of Traumatology and Surgical Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA - USA
- OPUS 12 Foundation, Inc, King of Prussia, PA - USA
| | - R. Sharma
- Department of Surgery, Easton Hospital, Easton, PA - USA
- OPUS 12 Foundation, Inc, King of Prussia, PA - USA
| | - N.S. Weger
- Beth Israel Medical Center, Newark, NJ - USA
- OPUS 12 Foundation, Inc, King of Prussia, PA - USA
| | - M. Truitt
- Department of Surgery, Methodist Hospital, Dallas, TX - USA
- OPUS 12 Foundation, Inc, King of Prussia, PA - USA
| | - J. Cipolla
- St. Luke's Regional Resource Level I Trauma Center, Bethlehem, PA - USA
- OPUS 12 Foundation, Inc, King of Prussia, PA - USA
| | - S.P. Schrag
- Department of Surgery, Division of Trauma and Surgical Critical Care, Vanderbilt University School of Medicine, Nashville, TN - USA
- OPUS 12 Foundation, Inc, King of Prussia, PA - USA
| | - M. Lorenzo
- Department of Surgery, Methodist Hospital, Dallas, TX - USA
- OPUS 12 Foundation, Inc, King of Prussia, PA - USA
| | - M. EL Chaar
- Department of Surgery, Methodist Hospital, Dallas, TX - USA
- OPUS 12 Foundation, Inc, King of Prussia, PA - USA
| | - D.A. Torigian
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA - USA
| | - P.K. Kim
- Department of Surgery, Division of Traumatology and Surgical Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA - USA
- OPUS 12 Foundation, Inc, King of Prussia, PA - USA
| | - B. Sarani
- Department of Surgery, Division of Traumatology and Surgical Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA - USA
- OPUS 12 Foundation, Inc, King of Prussia, PA - USA
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Moura ELBD, Amorim FF, Huang W, Maia MDO. Contrast-induced acute kidney injury: the importance of diagnostic criteria for establishing prevalence and prognosis in the intensive care unit. Rev Bras Ter Intensiva 2017; 29:303-309. [PMID: 28876404 PMCID: PMC5632972 DOI: 10.5935/0103-507x.20170041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 04/07/2017] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To establish whether there is superiority between contrast-induced acute kidney injury and contrast-induced nephropathy criteria as predictors of unfavorable clinical outcomes. METHODS Retrospective study carried out in a tertiary hospital with 157 patients undergoing radiocontrast infusion for propaedeutic purposes. RESULTS One hundred forty patients fulfilled the inclusion criteria: patients who met the criteria for contrast-induced acute kidney injury (59) also met the criteria for contrast-induced nephropathy (76), 44.3% met the criteria for KDIGO staging, 6.4% of the patients required renal replacement therapy, and 10.7% died. CONCLUSION The diagnosis of contrast-induced nephropathy was the most sensitive criterion for renal replacement therapy and death, whereas KDIGO showed the highest specificity; there was no correlation between contrast volume and progression to contrast-induced acute kidney injury, contrast-induced nephropathy, support dialysis or death in the assessed population.
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Affiliation(s)
| | | | - William Huang
- Unidade de Terapia Intensiva, Hospital Santa Luzia - Brasília (DF), Brasil
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4
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Jujo K, Saito K, Ishida I, Furuki Y, Ouchi T, Kim A, Suzuki Y, Sekiguchi H, Yamaguchi J, Ogawa H, Hagiwara N. Efficacy of 24-Hour Blood Pressure Monitoring in Evaluating Response to Percutaneous Transluminal Renal Angioplasty. Circ J 2016; 80:1922-30. [PMID: 27439675 DOI: 10.1253/circj.cj-16-0347] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Percutaneous transluminal renal angioplasty (PTRA) improves patency in atherosclerotic renal artery stenosis (ARAS), but improvement in clinic blood pressure (BP) is seen in only 20-40% of patients who undergo PTRA. This study investigated the effects of PTRA on BP lowering, assessed on 24-h ambulatory BP monitoring (ABPM), and identified preoperative features predictive of satisfactory BP improvement after PTRA. METHODS AND RESULTS Of 1,753 consecutive patients undergoing coronary angiography, 31 patients with angiographically significant ARAS and translesional pressure gradient (TLPG) >20 mmHg underwent PTRA. ABPM was performed before, at 1 month and at 1 year after PTRA; patients with average systolic ABPM-BP decrease >10 mmHg at 1 month from baseline were categorized as responders. There was no obvious relationship between clinic BP and ABPM-BP at baseline. ABPM-BP was significantly higher in responders at baseline (SBP: 148 vs. 126 mmHg, P<0.01) and was improved 1 month after PTRA. This difference persisted until 1 year after PTRA. Night-time BP improved more than daytime BP in responders. Patients with higher baseline ABPM-BP achieved a larger decrease in ABPM-BP, but the severity of stenosis reflected by TLPG; renal duplex findings; and neurohumoral parameters other than baseline renal function, did not differ between the groups. CONCLUSIONS Clinic BP does not represent daily hemodynamic status, whereas high ABPM-BP is a potent predictor of satisfactory BP response to PTRA. (Circ J 2016; 80: 1922-1930).
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Affiliation(s)
- Kentaro Jujo
- Department of Cardiology, Tokyo Women's Medical University
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5
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Wang JH, Ren K, Sun WG, Zhao L, Zhong HS, Xu K. Effects of iodinated contrast agents on renal oxygenation level determined by blood oxygenation level dependent magnetic resonance imaging in rabbit models of type 1 and type 2 diabetic nephropathy. BMC Nephrol 2014; 15:140. [PMID: 25182068 PMCID: PMC4236662 DOI: 10.1186/1471-2369-15-140] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 08/29/2014] [Indexed: 11/30/2022] Open
Abstract
Background To evaluate the effects of contrast agents containing increasing concentrations of iodine on the renal oxygenation level determined by blood oxygenation level dependent (BOLD) magnetic resonance imaging (MRI) in a rabbit model of diabetic nephropathy. Methods BOLD-MRI was performed using saline or iodinated (I) contrast agents (200, 240, 300, 350 and 400 mg I/mL) at 1, 24, 48, and 72 h after experimentally inducing type 2 diabetic nephropathy in rabbits. Differences in renal oxygenation levels between type 1 and type 2 diabetic nephropathy were also assessed by BOLD-MRI after injecting 400 mg I/mL of contrast agent. Results Contrast agents increased the R2* values of the renal cortex, outer medulla, and inner medulla to the maximum levels at 24 h. The R2* values then decreased to their lowest levels at 72 h. The R2* was highest following injection of 400 mg I/mL, especially in the outer medulla. The R2* values were not significantly different between types 1 and 2 diabetic nephropathy. Conclusions Iodinated contrast agents had the greatest influence on renal outer medulla oxygenation level at 24 h in type 2 diabetic nephropathy, with the greatest effects observed at the 400 mg I/mL dose level. There were no differences in BOLD-MRI values between type 1 and type 2 diabetic nephropathy after administering the contrast agent at 400 mg I/mL.
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Affiliation(s)
| | - Ke Ren
- Department of Radiology, The First Hospital of China Medical University, Shenyang, Liaoning 110001, People's Republic of China.
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6
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Martínez Lomakin F, Tobar C. Accuracy of point-of-care serum creatinine devices for detecting patients at risk of contrast-induced nephropathy: a critical overview. Crit Rev Clin Lab Sci 2014; 51:332-43. [PMID: 25033794 DOI: 10.3109/10408363.2014.937794] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Contrast-induced nephropathy (CIN) is a common event in hospitals, with reported incidences ranging from 1 to 30%. Patients with underlying kidney disease have an increased risk of developing CIN. Point-of-care (POC) creatinine devices are handheld devices capable of providing quantitative data on a patient's kidney function that could be useful in stratifying preventive measures. This overview aims to synthesize the current evidence on diagnostic accuracy and clinical utility of POC creatinine devices in detecting patients at risk of CIN. Five databases were searched for diagnostic accuracy studies or clinical trials that evaluated the usefulness of POC devices in detecting patients at risk of CIN. Selected articles were critically appraised to assess their individual risk of bias by the use of standard criteria; 13 studies were found that addressed the diagnostic accuracy or clinical utility of POC creatinine devices. Most studies incurred a moderate to high risk of bias. Overall concordance between POC devices and reference standards (clinical laboratory procedures) was found to be moderate, with 95% limits of agreement often lying between -35.4 and +35.4 µmol/L (-0.4 and +0.4 mg/dL). Concordance was shown to decrease with worsening kidney function. Data on the clinical utility of these devices were limited, but a significant reduction in time to diagnosis was reported in two studies. Overall, POC creatinine devices showed a moderate concordance with standard clinical laboratory creatinine measurements. Several biases could have induced optimism in these estimations. Results obtained from these devices may be unreliable in cases of severe kidney failure. Randomized trials are needed to address the clinical utility of these devices.
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Affiliation(s)
- Felipe Martínez Lomakin
- Centro de Investigaciones Biomédicas, Escuela de Medicina, Universidad de Valparaíso , Valparaíso , Chile
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7
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Mehta N, Chokshi NP, Kirkpatrick JN. Cardiac imaging in the geriatric population: what do we think we know, and what do we need to learn? Prog Cardiovasc Dis 2014; 57:204-14. [PMID: 25216620 DOI: 10.1016/j.pcad.2014.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Cardiac imaging plays an important role in coronary artery disease (CAD), congestive heart failure (HF) and valvular heart disease (VHD) in the elderly. Imaging defines the structure and function of the cardiac system, refining the understanding of patients' anatomy and physiology and informing a host of clinical care decisions, including prognosis. Yet there is a paucity of evidence to guide the rational use of many imaging modalities in patients of advanced age, a population with considerable clinical heterogeneity, high prevalence and burden of cardiovascular disease (CVD) and atypical presentations of CVD. This paper discusses important considerations for cardiac imaging for older adults, particularly in regard to CAD, VHD and HF, and then presents domains for future research to produce data that would inform clinical care guidelines, appropriate use criteria and imaging lab protocols to address the unique needs of the fast-growing elderly population.
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Affiliation(s)
- Nidhi Mehta
- Echocardiography Laboratory, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Neel P Chokshi
- Echocardiography Laboratory, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - James N Kirkpatrick
- Echocardiography Laboratory, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
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8
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Celik O, Ozturk D, Akin F, Ayca B, Yalcın AA, Erturk M, Bıyık I, Ayaz A, Akturk IF, Enhos A, Aslan S. Association Between Contrast Media Volume-Glomerular Filtration Rate Ratio and Contrast-Induced Acute Kidney Injury After Primary Percutaneous Coronary Intervention. Angiology 2014; 66:519-24. [PMID: 25005762 DOI: 10.1177/0003319714542277] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We hypothesized that contrast media volume-estimated glomerular filtration rate (CV-e-GFR) ratio may be a predictor of contrast media-induced acute kidney injury (CI-AKI). We investigated the associations between CV-e-GFR ratio and CI-AKI in 597 patients undergoing primary percutaneous coronary intervention (pPCI). An absolute ≥0.3 mg/dL increase in serum creatinine compared with baseline levels within 48 hours after the procedure was considered as CI-AKI; 78 (13.1%) of the 597 patients experienced CI-AKI. The amount of contrast during procedure was higher in the CI-AKI group than in those without CI-AKI (153 vs 135 mL, P = .003). The CV-e-GFR ratio was significantly higher in patients with CI-AKI than without (2.3 vs 1.5, P < .001). In multivariate analysis, independent predictors of CI-AKI were low left ventricular ejection fraction (P = .018, odds ratio [OR] = 0.966), e-GFR <60 mL/min (P = .012, OR = 2.558), and CV-e-GFR >2 (P < .001, OR = 5.917). In conclusion, CV-e-GFR ratio is significantly associated with CI-AKI after pPCI.
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Affiliation(s)
- Omer Celik
- Department of Cardiology, Mehmet Akif Ersoy Chest and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Derya Ozturk
- Department of Cardiology, Mehmet Akif Ersoy Chest and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Fatih Akin
- Department of Cardiology, Muğla Sitki Kocman University School of Medicine, Muğla, Turkey
| | - Burak Ayca
- Department of Cardiology, Bağcilar Education and Research Hospital, Istanbul, Turkey
| | - Ahmet Arif Yalcın
- Department of Cardiology, Mehmet Akif Ersoy Chest and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Mehmet Erturk
- Department of Cardiology, Mehmet Akif Ersoy Chest and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Ismail Bıyık
- Department of Cardiology, Mehmet Akif Ersoy Chest and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Ahmet Ayaz
- Department of Cardiology, Mehmet Akif Ersoy Chest and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Ibrahim Faruk Akturk
- Department of Cardiology, Mehmet Akif Ersoy Chest and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Asım Enhos
- Department of Cardiology, Mehmet Akif Ersoy Chest and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Serkan Aslan
- Department of Cardiology, Mehmet Akif Ersoy Chest and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
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9
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Lameire N. Contrast-induced nephropathy in the critically-ill patient: focus on emergency screening and prevention. Acta Clin Belg 2014; 62 Suppl 2:346-52. [PMID: 18283997 DOI: 10.1179/acb.2007.078] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- N Lameire
- Department of Nephrology, University Hospital Ghent, Belgium.
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10
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Thomsen HS, Stacul F, Webb JAW. Contrast Medium-Induced Nephropathy. MEDICAL RADIOLOGY 2014. [DOI: 10.1007/174_2013_902] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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11
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Kong JH, Baek KS, Kwun WH, Kim YH, Kim DS, Kim SW. Two-stage endovascular repair for concurrent penetrating atherosclerotic ulcers of the thoracic and abdominal aorta. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2013; 46:365-8. [PMID: 24175273 PMCID: PMC3810560 DOI: 10.5090/kjtcs.2013.46.5.365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 05/14/2013] [Accepted: 05/20/2013] [Indexed: 11/16/2022]
Abstract
We report a case of concurrent saccular aneurysms caused by a penetrating atherosclerotic ulcer of the thoracic and abdominal aorta that were successfully treated by staged endovascular repair. Even though surgical open repair or endovascular repair is the treatment option, use of endovascular repair is now accepted as an alternative treatment to surgery in selected patients. To prevent contrast medium-induced nephropathy and spinal cord ischemia caused by a simultaneous endovascular procedure, a saccular aneurysm of the descending thoracic aorta was excluded by stent graft, followed by the placement of a bifurcated stent graft in the infrarenal abdominal aorta one month later.
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Affiliation(s)
- Joon Hyuk Kong
- Department of Thoracic and Cardiovascular Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Korea
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12
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Sadick V, Trinh L, Fernandes G, Pau P, Spiteri M, Vu LA, Gurunathan P, Shoy VL, Robinson J. Does biplane imaging reduce contrast load, procedural and screening time compared to single-plane imaging in routine diagnostic coronary angiography? ACTA ACUST UNITED AC 2013. [DOI: 10.1002/j.2051-3909.2008.tb00079.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Victoria Sadick
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences; University of Sydney; Lidcombe New South Wales 2141 Australia
| | - Linda Trinh
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences; University of Sydney; Lidcombe New South Wales 2141 Australia
| | - Ginella Fernandes
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences; University of Sydney; Lidcombe New South Wales 2141 Australia
| | - Pedro Pau
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences; University of Sydney; Lidcombe New South Wales 2141 Australia
| | - Michael Spiteri
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences; University of Sydney; Lidcombe New South Wales 2141 Australia
| | - Lan Ahn Vu
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences; University of Sydney; Lidcombe New South Wales 2141 Australia
| | - Pratheesh Gurunathan
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences; University of Sydney; Lidcombe New South Wales 2141 Australia
| | - Victoria Lee Shoy
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences; University of Sydney; Lidcombe New South Wales 2141 Australia
| | - John Robinson
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences; University of Sydney; Lidcombe New South Wales 2141 Australia
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13
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Tehrani S, Laing C, Yellon DM, Hausenloy DJ. Contrast-induced acute kidney injury following PCI. Eur J Clin Invest 2013; 43:483-90. [PMID: 23441924 DOI: 10.1111/eci.12061] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 02/03/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Coronary revascularization using percutaneous coronary intervention (PCI) is one of the major treatments for patients with stable coronary artery disease, with approximately 1.5 million patients undergoing PCI in the United States and Europe every year. An important neglected complication of PCI is contrast-induced acute kidney injury (CI-AKI). DESIGN In this article, we review the definition, pathogenesis and management of CI-AKI and highlight potential therapeutic options for preventing CI-AKI in post-PCI patients. RESULTS CI-AKI is an important but underdiagnosed complication of PCI that is associated with increased in-hospital morbidity and mortality. Patients with pre-existing renal impairment and diabetes are particularly susceptible to this complication post-PCI. Optimization of the patients' circulating volume remains the mainstay for preventing CI-AKI, although the best strategy for achieving this is still controversial. CONCLUSION Following PCI, CI-AKI is an overlooked complication which is associated with significant morbidity and mortality. In this article, we review the pathophysiology of CI-AKI in patients undergoing PCI and discuss the potential therapeutic options for preventing it.
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Affiliation(s)
- Shana Tehrani
- The Hatter Cardiovascular Institute, University College London, London, UK
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14
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Franz RW, Hinze SS, Knapp ED, Jenkins JJ. Oral prostaglandin e1 in combination with sodium bicarbonate and normal saline in the prevention of contrast-induced nephropathy: a pilot study. Int J Angiol 2012. [PMID: 23204824 DOI: 10.1055/s-0031-1285104] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
The purpose of this study was to evaluate the use of prostaglandin E1 (PGE1) as a renal protective medication for patients exposed to contrast agents, as well as to demonstrate the safety, efficacy, and low side-effect profile of PGE1. A prospective, randomized, double-blind study was designed to compare combination of intravenous sodium bicarbonate, normal saline, and oral PGE1 200 μg versus the combination and placebo for renal protection from contrast agents. All patients receiving nonionic contrast during their interventional procedure were eligible for enrollment. Creatinine levels were recorded before and after the administration of contrast and renal protective medications. Contrast-induced nephrotoxicity (CIN) was defined as an increase of 0.5 mg/dL or greater in creatinine level, or an increase of 25% or more above baseline. Age, gender, total amount of contrast used, and incidence of renal failure requiring dialysis were recorded. We conducted the study on 41 patients. Of these, 20 patients received PGE1 and 21 received the placebo. The study group comprised 29 males and 12 females. Diabetes mellitus occurred in 41.5% of the cases (including 40% of PGE1 and 43% of placebo patients). Average contrast use was 77.2 mL (range, 15 to 200 mL). Mean age of the groups was 67.2 years. Average baseline creatinine level was 1.17. The differences between the groups were not statistically significant. CIN by definition occurred in one patient, who received the placebo. Incidence of new onset renal failure requiring dialysis was zero. Postcontrast change in creatinine level for the study was 0.11. There was a change in the creatinine level of 0.161 in the PGE1 group and 0.061 in the placebo group; an improvement of 0.10. PGE1 was not effective in significantly altering postcreatinine levels (p = 0.176). None of the patients enrolled in the study suffered any side effects from taking the PGE1 tablet. Although preliminary, this study shows that the addition of PGE1 for the prevention of CIN is well-tolerated by patients and is a safe modality. Additional studies are required to evaluate efficacy.
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Affiliation(s)
- Randall W Franz
- Grant Vascular and Vein Center at Grant Medical Center, Columbus, Ohio
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15
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Ehrmann S, Pajot O, Lakhal K. Néphropathie induite par les produits de contraste iodés en réanimation. MEDECINE INTENSIVE REANIMATION 2012. [DOI: 10.1007/s13546-011-0434-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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16
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Richenberg J. How to reduce nephropathy following contrast-enhanced CT: a lesson in policy implementation. Clin Radiol 2012; 67:1136-45. [PMID: 22717146 DOI: 10.1016/j.crad.2012.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 04/23/2012] [Accepted: 05/01/2012] [Indexed: 12/31/2022]
Abstract
In excess of 50 contrast-enhanced computed tomography (CT) examinations are typically undertaken in our tertiary hospital NHS Trust each weekday, approximately 13,000 each year. In the Department of Radiology alone, we inject more than 1300 l of iodinated contrast medium per annum. There is a real need to devise a policy to anticipate contrast medium-induced nephropathy (CIN) and minimize its effects, without disrupting the high-intensity CT service. Having written a comprehensive yet pragmatic policy to reduce the incidence of this iatrogenic condition, it seemed sensible to share it with the wider radiology community and share the experience and lessons learnt in engaging all the stakeholders, ushering in the change with as little fuss as possible. The ramifications on primary and secondary care had to be anticipated, resource implications managed, and staff trained. This review is therefore presented in four sections: framing the problem, assessing its size and nature; a succeeding section on the available guidelines and their uptake; the policy itself to reduce CIN in CT is presented in the third section; and crucially, a description of the policy introduction process in the last section.
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Affiliation(s)
- J Richenberg
- Radiology Department, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
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Abstract
Patients admitted with the diagnosis of "stroke" have a variety of different disorders that require specific treatment approaches in the critical care unit. Early thrombolysis for ischemic stroke and improvements in surgical and neurointerventional techniques for the treatment of aneurysms and arteriovenous malformations in patients with subarachnoid hemorrhage have been milestones in the past decade, but the evolvement of general management principles in critical care and the dedication of neurointensivists are equally important for improved outcomes. Strategies, which have been developed in other areas of intensive care medicine (eg, in patients with septic shock, acute respiratory distress syndrome, or trauma), need to be adopted and modified for the stroke patient. Prevention of iatrogenic complications and nosocomial infections is of utmost importance and requires sufficient numbers of trained personnel and high-quality equipment. Although the focus of attention in stroke patients is "brain resuscitation," comorbidities often limit the diagnostic and therapeutic options, and overall cardiopulmonary and metabolic functions need to be optimized in order to prevent secondary injury and allow the brain to recover. As part of a holistic approach to the rehabilitation process, psychologic and spiritual support for the patient must start early on in the intensive care unit, and family members should be involved in the patient's care and provided with special support as well.
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Kim KS, Kim K, Hwang SS, Jo YH, Lee CC, Kim TY, Rhee JE, Suh GJ, Singer AJ, Kim HD. Risk stratification nomogram for nephropathy after abdominal contrast-enhanced computed tomography. Am J Emerg Med 2011; 29:412-7. [DOI: 10.1016/j.ajem.2009.11.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Revised: 11/17/2009] [Accepted: 11/18/2009] [Indexed: 10/19/2022] Open
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Anderson SM, Park ZH, Patel RV. Intravenous N-Acetylcysteine in the Prevention of Contrast Media-Induced Nephropathy. Ann Pharmacother 2011; 45:101-7. [DOI: 10.1345/aph.1p275] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective Ti define the clinical role of intravenous N-acetylcysteine for prophylaxis of contrast-induced nephropathy (CIN). Data Sources: Randomized controlled clinical trials were identified using a search of MEDLINE (1990-September 2010) with the search terms acetylcysteine, N-acetylcysteine, NAC, intravenous, IV, nephropathy, nephrotoxic, radiocontrast, contrast, and media. The search was limited to studies published in English. Additional pertinent literature was retrieved by reviewing references of the articles obtained in the initial search. Data Synthesis: N-Acetylcysteine is a vasodilator and antioxidant that has been investigated for the prevention of CIN. In the majority of clinical trials, neither oral nor intravenous N-acetyIcysteine has demonstrated clinical benefits at preventing CIN. The pharmacodynamic and pharmacokinetic profiles of intravenous N-acetylcysteine are significantly different from those of the oral product in that intravenous administration bypasses extensive first-pass metabolism. Studies have suggested that N-acetylcysteine directly affects serum creatinine levels in a way that is not associated with improvement of kidney function. Only intravenous N-acetylcysteine doses that were higher than the oral doses showed potential benefits, but they were associated with significant adverse events. Furthermore, the study populations were heterogeneous, including patients with various levels of kidney function and other risk factors, and the clinical definition of CIN was not well established. Conclusions: NO conclusive evidence has shown that intravenous N-acetyl-cysteine is safe and effective in preventing CIN. Further clinical trials to define its role are warranted.
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Affiliation(s)
- Spencer M Anderson
- Molecular Pharmacology and Biological Chemistry, Northwestern University, Argonne, IL; School of Pharmacy and Health Professions, Creighton University, Omaha, NE
| | - Zoon H Park
- Department of Pharmacy Services, Swedish Covenant Hospital, Chicago, IL
| | - Ramesh V Patel
- Department of Pharmacy Services, Swedish Covenant Hospital
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Meschi M, Detrenis S, Saccò M, Bertorelli M, Fiaccadori E, Caiazza A, Savazzi G. Il paziente a rischio di nefropatia da mezzi di contrasto iodati. ITALIAN JOURNAL OF MEDICINE 2010. [DOI: 10.1016/j.itjm.2010.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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22
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Yoshida S, Kamihata H, Nakamura S, Senoo T, Manabe K, Motohiro M, Sugiura T, Iwasaka T. Prevention of contrast-induced nephropathy by chronic pravastatin treatment in patients with cardiovascular disease and renal insufficiency. J Cardiol 2009; 54:192-8. [DOI: 10.1016/j.jjcc.2009.05.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Revised: 04/29/2009] [Accepted: 05/08/2009] [Indexed: 10/20/2022]
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Madrazo González Z, Arias Guillén M. Nefropatía por contraste. Revisión y profilaxis. Rev Clin Esp 2008; 208:517-9. [DOI: 10.1157/13128677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Butin-Israeli V, Uzi D, Abd-El-Latif M, Pizov G, Eden A, Haviv YS, Oppenheim A. DNA-free recombinant SV40 capsids protect mice from acute renal failure by inducing stress response, survival pathway and apoptotic arrest. PLoS One 2008; 3:e2998. [PMID: 18714386 PMCID: PMC2515219 DOI: 10.1371/journal.pone.0002998] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Accepted: 07/22/2008] [Indexed: 01/17/2023] Open
Abstract
Viruses induce signaling and host defense during infection. Employing these natural trigger mechanisms to combat organ or tissue failure is hampered by harmful effects of most viruses. Here we demonstrate that SV40 empty capsids (Virus Like Particles-VLPs), with no DNA, induce host Hsp/c70 and Akt-1 survival pathways, key players in cellular survival mechanisms. We postulated that this signaling might protect against organ damage in vivo. Acute kidney injury (AKI) was chosen as target. AKI is critical, prevalent disorder in humans, caused by nephrotoxic agents, sepsis or ischemia, via apoptosis/necrosis of renal tubular cells, with high morbidity and mortality. Systemic administration of VLPs activated Akt-1 and upregulated Hsp/c70 in vivo. Experiments in mercury-induced AKI mouse model demonstrated that apoptosis, oxidative stress and toxic renal failure were significantly attenuated by pretreatment with capsids prior to the mercury insult. Survival rate increased from 12% to >60%, with wide dose response. This study demonstrates that SV40 VLPs, devoid of DNA, may potentially be used as prophylactic agent for AKI. We anticipate that these finding may be projected to a wide range of organ failure, using empty capsids of SV40 as well as other viruses.
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Affiliation(s)
| | - Dotan Uzi
- Department of Hematology, Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Mahmoud Abd-El-Latif
- Department of Hematology, Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Galina Pizov
- Department of Pathology, Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Arieh Eden
- Department of Anesthesiology and Critical Care Medicine, Carmel Lady Davis Medical Center, Haifa, Israel
| | - Yosef S. Haviv
- Department of Nephrology, Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Ariella Oppenheim
- Department of Hematology, Hebrew University-Hadassah Medical School, Jerusalem, Israel
- * E-mail:
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Diehm N, Pena C, Benenati JF, Tsoukas AI, Katzen BT. Adequacy of an early arterial phase low-volume contrast protocol in 64-detector computed tomography angiography for aortoiliac aneurysms. J Vasc Surg 2008; 47:492-8. [DOI: 10.1016/j.jvs.2007.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Revised: 11/02/2007] [Accepted: 11/03/2007] [Indexed: 10/22/2022]
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Affiliation(s)
- Cindy Kohtz
- Saint Francis Medical Center College of Nursing, Peoria, IL, USA.
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Detrenis S, Meschi M, del Mar Jordana Sanchez M, Savazzi G. Contrast medium induced nephropathy in urological practice. J Urol 2007; 178:1164-70. [PMID: 17698088 DOI: 10.1016/j.juro.2007.05.133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE Contrast medium induced nephropathy is the third cause of in-hospital acute renal failure. The first studies in this area were done with reference to urological practice only. Although various guidelines on the management of contrast medium induced nephropathy were provided by the European Society of Urogenital Radiology, more recently many investigators have focused their attention on contrast medium use in interventional vascular radiology and cardiology. We critically reviewed the literature to clarify the impact of contrast medium induced nephropathy in urology and the possible prophylactic measures against it. MATERIALS AND METHODS A MEDLINE/PubMed, EMBASE and Cochrane Library search for 1971 to 2006 was performed. All articles related to the use of contrast medium in urological practice and contrast medium induced nephropathy were reviewed. RESULTS Many pathological conditions frequently seen by urologists are diagnosed by imaging requiring contrast medium. A basic understanding of the risk factors for contrast medium induced nephropathy and the strategies for its prevention are useful to prepare urological patients for these procedures. Prophylaxis includes the discontinuation of potentially nephrotoxic drugs and the use of protocols for periprocedural hydration. CONCLUSIONS The general approach to the recognition and prevention of contrast medium induced nephropathy in patients at risk should be extended to urological clinical practice since no definitive evidence based data are available regarding contrast medium induced nephropathy management in urological patients. Moreover, these patients can frequently present with the most significant risk factor for contrast medium mediated kidney damage, that is preexisting acute or chronic renal failure. Controlled trials are needed to establish the incidence of contrast medium induced nephropathy in diagnostic or interventional procedures in uroradiology.
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Affiliation(s)
- Simona Detrenis
- Department of Internal Medicine and Nephrology, University of Parma, Italy
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Detrenis S, Meschi M, Savazzi G. Contrast nephropathy: isosmolar and low-osmolar contrast media. J Am Coll Cardiol 2007; 49:922; author reply 922-3. [PMID: 17320755 DOI: 10.1016/j.jacc.2006.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2007. [DOI: 10.1002/pds.1368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
Contrast-induced nephropathy (CIN) is a well-recognized complication of radiographic contrast administration and is the third leading cause of hospital-acquired renal insufficiency. The use of contrast media is increasing, particularly in the area of endovascular therapy. Vascular interventionists need to be aware of strategies to reduce the risk of CIN. Numerous trials, meta-analyses, and expert guidelines for the prevention of CIN have been published between 1966 and 2006, but the majority of studies have been conducted on patients undergoing coronary interventions; few have involved vascular surgical population. The literature suggests that adequate hydration is essential in all patients due to receive contrast. No pharmacological agents have been shown to conclusively reduce the risk. Forced diuresis is harmful, and there is insufficient evidence to support routine use of hemodialysis or hemofiltration. Well conducted studies of other potential prophylactic techniques are needed in vascular populations.
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Affiliation(s)
- Stewart R Walsh
- Cambridge Vascular Research Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Detrenis S, Meschi M, Bertolini L, Savazzi G. Contrast Medium Administration in the Elderly Patient: Is Advancing Age an Independent Risk Factor for Contrast Nephropathy after Angiographic Procedures? J Vasc Interv Radiol 2007; 18:177-85; quiz 185. [PMID: 17327549 DOI: 10.1016/j.jvir.2006.12.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Contrast medium-induced nephropathy (CMIN) is the third leading cause of hospital-acquired acute renal dysfunction. Even if the number of patients over 75 years of age undergoing diagnostic and/or interventional procedures and requiring administration of contrast medium (CM) is growing constantly, at present there is no definitive consensus regarding the role of advancing age and related morphologic or functional renal changes as an independent risk factor for CMIN. The authors review the evidence from recent medical literature on the definition, pathophysiology, and clinical presentation of CMIN as well as therapeutic approaches to its prophylaxis. Attention is focused on advancing age as a preexisting physiologic condition that is, per se, able to predispose the patient to CM-induced renal impairment, assuming that every elderly patient is potentially at risk for CMIN.
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Affiliation(s)
- Simona Detrenis
- Department of Internal Medicine and Nephrology, University of Parma, viale Antonio Gramsci 14, I-43100 Parma, Italy
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