Prevention Strategies for Contrast-Induced Nephropathy

Nursing diagnoses of patients with kidney disease undergoing hemodialysis: a cross-sectional study

ABSTRACT Objective: to identify Nursing Diagnoses of 5th stage chronic kidney disease patients undergoing hemodialysis. Method: cross-sectional, descriptive and quantitative study carried out with 151 patients undergoing hemodialysis in a clinic specialized in nephrology from the Northwest of the Paraná State. Nursing Diagnoses were determined through Nanda-I in which had the percentage greater than 50%. The analysis used was the simple statistics. Results: 17 Nursing Diagnoses were identified, emphasizing the risks present in 100% of patients: risks for electrolyte imbalance; ineffective kidney perfusion; infection: vascular injuries, adverse response to the iodine-based contrast-enhanced and impaired urinary elimination. Conclusion: the main diagnoses listed reflect the more frequent risks that patients undergoing hemodialysis are exposed to. Being aware of these risks allows the nursing planning with early interventions, in order to prevent complications related to the disease and to promote best life conditions.

Relaxin Attenuates Contrast-Induced Human Proximal Tubular Epithelial Cell Apoptosis by Activation of the PI3K/Akt Signaling Pathway In Vitro

Background. Contrast-induced acute kidney injury (CI-AKI) is one of the main causes of iatrogenic acute kidney injury (AKI); however, therapeutic strategies for AKI remain limited. This study aims to explore the effect of relaxin (RLX) on contrast-induced HK-2 apoptosis and its underlying mechanisms. Methods. Renal tubular epithelial cells (HK-2) were incubated either with or without ioversol, human H2 relaxin, and LY294002 (the inhibitor of the PI3K/Akt signal pathway). Cell viability was evaluated with a CCK-8 assay. Apoptotic morphologic alterations were observed using the Hoechst 33342 staining method. Apoptosis was detected with Annexin V staining. Western blot analysis was employed to measure the expression of pAkt (S473), Akt, cleaved caspase-3, Bcl-2, Bax, and actin proteins. Results. Ioversol reduced the viability of HK-2 cells. Western blotting results revealed decreased expression of phosphorylated Akt in cells treated with ioversol. The activities of caspase-3 and Bax protein increased, while the expression of Bcl-2 protein decreased. As a result, the Bax/Bcl-2 ratio increased after treatment with ioversol. These effects were reversed when HK-2 cells were cotreated with RLX. However, with preadministration of PI3K/Akt pathway inhibitor LY294002, the effect of RLX was blocked. Conclusion. Our study demonstrates that relaxin attenuates ioversol induced cell apoptosis via activation of the PI3K/Akt signaling pathway, suggesting that RLX might play a protective role in the treatment of CI-AKI.