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The gene expression of adenosine receptors in the processes of contrast induced nephropathy in mouse kidney  [PDF]
Luyu Yao, Cynthia Zhao, Xin Gu, Gopi K. Kolluru, Christopher G. Kevil, Wayne W. Zhang
World Journal of Cardiovascular Diseases (WJCD) , 2013, DOI: 10.4236/wjcd.2013.39088
Abstract:

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 A

N-acetylcysteine does not prevent contrast-induced nephropathy after cardiac catheterization in patients with diabetes mellitus and chronic kidney disease: a randomized clinical trial
Manouchehr Amini, Mojtaba Salarifar, Alireza Amirbaigloo, Farzad Masoudkabir, Fatemeh Esfahani
Trials , 2009, DOI: 10.1186/1745-6215-10-45
Abstract: In a prospective, double-blind, placebo controlled, randomized clinical trial, we studied 90 patients undergoing elective diagnostic coronary angiography with DM and CKD (serum creatinine ≥ 1.5 mg/dL for men and ≥ 1.4 mg/dL for women). The patients were randomly assigned to receive either oral NAC (600 mg BID, starting 24 h before the procedure) or placebo, in adjunct to hydration. Serum creatinine was measured prior to and 48 h after coronary angiography. The primary end-point was the occurrence of CIN, defined as an increase in serum creatinine ≥ 0.5 mg/dL (44.2 μmol/L) or ≥ 25% above baseline at 48 h after exposure to contrast medium.Complete data on the outcomes were available on 87 patients, 45 of whom had received NAC. There were no significant differences between the NAC and placebo groups in baseline characteristics, amount of hydration, or type and volume of contrast used, except in gender (male/female, 20/25 and 34/11, respectively; P = 0.005) and the use of statins (62.2% and 37.8%, respectively; P = 0.034). CIN occurred in 5 out of 45 (11.1%) patients in the NAC group and 6 out of 42 (14.3%) patients in the placebo group (P = 0.656).There was no detectable benefit for the prophylactic administration of oral NAC over an aggressive hydration protocol in patients with DM and CKD.NCT00808795Contrast-induced nephropathy (CIN) is the third most common cause of hospital acquired acute kidney injury, accounting for 10% of all cases[1]. With the increasing use of contrast media in diagnostic and interventional procedures, it has become one of the major challenges encountered during routine cardiovascular practice. Generally, this form of acute kidney injury follows a benign course and only rarely necessitates use of dialysis [2-4]. Nevertheless, use of radiocontrast media has been associated with increased in-hospital morbidity, mortality, and costs of medical care, long admission, especially in patients needing dialysis [5-8]. Patients at the greatest risk for C
Risk of contrast induced nephropathy in the critically ill: a prospective, case matched study
Cynthia M Cely, Roland MH Schein, Andrew A Quartin
Critical Care , 2012, DOI: 10.1186/cc11317
Abstract: A prospective matched cohort study was conducted of patients scanned with or without radiocontrast enhancement while receiving intensive care in a Veterans Affairs Medical Center. Patients were matched for pre-scan measured creatinine clearance, diabetes, mechanical ventilation, and vasopressor use. Measured clearance was followed for three days after scanning. Evolution of nephropathy, as determined by change in measured clearance, was compared within matched pairs.Fifty-three pairs of patients satisfied matching criteria. Unmatched characteristics were similar among the pairs, including serum creatinine variability during the week preceding scanning (67 ± 85% among contrast recipients, 63 ± 62% among others) and clinical risk factors for renal failure. In 29 pairs, pre-scan measured clearances were less than 60 mL/minute/1.73 m2. Following scanning, measured clearance declined by at least 33% in 14 contrast and 19 non-contrast patients (95% confidence interval for contrast associated difference in nephropathy rates -27% to 9%), while a 50% reduction in clearance persisted three days after scanning in three contrast and nine non-contrast patients (95% confidence interval for difference in rates -25% to 2%).Among established intensive care unit patients declines in glomerular filtration following contrast-enhanced scanning are common, but these changes are far more likely to be attributable to factors other than the contrast exposure itself. The upper bound for the incidence of contrast induced renal injury lasting even three days was 2% in the population studied.Computerized tomography (CT) is invaluable for the management of critically ill patients. While the intravenous administration of iodinated radiographic contrast media (RCM) may be helpful or essential for adequate imaging, the potential complication of contrast induced nephropathy (CIN) is a significant concern. While it has no universally accepted definition, CIN typically refers to an at least modest dec
Low Incidence of Contrast Induced Nephropathy after Coronary Angiography in Patients with Advanced Chronic Kidney Disease Treated with Prophylactic Continuous Veno-venous Hemofiltration
A Ghani, N Hussain, B Helal
Arab Journal of Nephrology and Transplantation , 2009,
Abstract: Introduction: Contrast-induced nephropathy (CIN) is associated with increased risk of in-hospital morbidity and mortality. The purpose of this study was to find out whether continuous venovenous hemofiltration (CVVH) after coronary angiography in chronic kidney disease (CKD) patients is associated with a lower incidence of CIN than that reported in the literature. Methods: All patients with CKD who underwent coronary angiography in the Chest Disease Hospital, Kuwait, between January 2004 and December 2005 were treated by CVVH after the procedure. Renal function was assessed before and after the procedure. Results: A total of 98 patients were enrolled in the study, 52 (53.1%) of whom were males. Their mean age was 60.7 years. Before the procedure, the mean serum creatinine level was 4.65 mg/dl and the mean creatinine clearance (Cr Cl) was 18.04 ml/min. Patients underwent CVVH for a mean duration of 21.3 hours, after a mean time-interval of 44.3 min. Their mean serum creatinine was 4.57 mg/dl at discharge (within the first week after the procedure) and 4.78 mg/dl at 15 days after the procedure. Mean Cr Cl was 18.52 ml/min at discharge and 17.62 ml/min at 15 days after the procedure. There was no statistically significant difference between the mean serum creatinine and Cr Cl values before and after the procedure. However, one patient (1.02%) developed CIN and ended on regular hemodialysis. The in-hospital mortality was 0%. Conclusion: Patients with advanced CKD who undergo coronary angiography may be protected from further deterioration in their renal function after exposure to radiological contrast material if the procedure is immediately followed by CVVH. A randomized controlled clinical trial is needed to verify our encouraging results.
Can continuous venovenous hemofiltration prevent contrast-agent induced nephropathy in patients with advanced chronic kidney disease after coronary angiography?  [cached]
Ghani Amal,Hussain Naser,Al Helal Bassam
Saudi Journal of Kidney Diseases and Transplantation , 2011,
Abstract: To determine whether contrast induced nephropathy (CIN) post coronary angio-graphy procedure can be prevented in chronic kidney disease (CKD) patients by continuous venovenous hemofiltration (CVVH), we evaluated 98 CKD patients [52 (53.1%) were males, the mean age was 60.7 ± 11.0 years] who underwent coronary angiography from January 2004 to December 2006. Serum creatinine (Cr) before the procedure was 411 ± 79.9 μmol/L and crea-tinine clearance (Cr Cl) was 18.04 ± 4.26 mL/min. All patients underwent post procedure CVVH for 21.34 ± 2.12 hours. The mean time interval between the procedure and the start of CVVH was 44.3 ± 18.8 min. The mean serum Cr at discharge was 403 ± 88.4 μmol/L (Cr Cl 18.5 ± 4.61 mL/min) and was 423 ± 88.9 μmol/L (Cr Cl17.6 ± 4.27 mL/min) 15 days after the procedure. One patient (1.02%) developed worsening of renal functions that required repeated CVVH during hospitalization and ended up on regular hemodialysis. There was no in-hospital mortality. We conclude that CVVH is effective in preventing CIN after coronary angiography in CKD patients.
Obesity is not associated with contrast nephropathy
Navin Jaipaul,Rendell Manalo,Seyed-Ali Sadjadi,et al
Therapeutics and Clinical Risk Management , 2010,
Abstract: Navin Jaipaul1, Rendell Manalo2, Seyed-Ali Sadjadi1, James McMillan11Section of Nephrology, VA Loma Linda Healthcare System, 2Department of Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USABackground: Exposure to radiocontrast media may result in acute kidney injury (AKI) or traditionally defined contrast nephropathy (CN), both of which may lead to increased morbidity and mortality. The pathogenesis of both these variants of contrast-induced nephropathy (CIN) may involve inflammatory mediators that lead to renal impairment. A link between obesity and inflammation has been clearly established, but whether obesity is independently associated with CIN is unknown.Objective: To determine whether obesity, when stratified by body mass index (BMI), is a risk factor for CIN in a large and hemodynamically stable population of hospitalized United States veterans.Design: Retrospective chart review.Measurements: Presence or absence of AKI or CN after intravenous radiocontrast administration and comparison of patient characteristics between those with versus without AKI or CN.Results: The overall prevalence of AKI and CN was 16.1% and 12.6%, respectively. Patients with AKI or CN were comparable to those without radiocontrast injury, except that affected patients tended to be older and diabetic. When stratified by BMI, obesity was not found to be associated with the development of AKI or CN after exposure to radiocontrast.Conclusion: Obesity does not appear to be an independent risk factor for AKI or CN after exposure to radiocontrast.Keywords: obesity, contrast nephropathy, kidney injury
Obesity is not associated with contrast nephropathy
Navin Jaipaul, Rendell Manalo, Seyed-Ali Sadjadi, et al
Therapeutics and Clinical Risk Management , 2010, DOI: http://dx.doi.org/10.2147/TCRM.S10198
Abstract: esity is not associated with contrast nephropathy Original Research (3328) Total Article Views Authors: Navin Jaipaul, Rendell Manalo, Seyed-Ali Sadjadi, et al Published Date May 2010 Volume 2010:6 Pages 213 - 217 DOI: http://dx.doi.org/10.2147/TCRM.S10198 Navin Jaipaul1, Rendell Manalo2, Seyed-Ali Sadjadi1, James McMillan1 1Section of Nephrology, VA Loma Linda Healthcare System, 2Department of Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA Background: Exposure to radiocontrast media may result in acute kidney injury (AKI) or traditionally defined contrast nephropathy (CN), both of which may lead to increased morbidity and mortality. The pathogenesis of both these variants of contrast-induced nephropathy (CIN) may involve inflammatory mediators that lead to renal impairment. A link between obesity and inflammation has been clearly established, but whether obesity is independently associated with CIN is unknown. Objective: To determine whether obesity, when stratified by body mass index (BMI), is a risk factor for CIN in a large and hemodynamically stable population of hospitalized United States veterans. Design: Retrospective chart review. Measurements: Presence or absence of AKI or CN after intravenous radiocontrast administration and comparison of patient characteristics between those with versus without AKI or CN. Results: The overall prevalence of AKI and CN was 16.1% and 12.6%, respectively. Patients with AKI or CN were comparable to those without radiocontrast injury, except that affected patients tended to be older and diabetic. When stratified by BMI, obesity was not found to be associated with the development of AKI or CN after exposure to radiocontrast. Conclusion: Obesity does not appear to be an independent risk factor for AKI or CN after exposure to radiocontrast.
Contrast induced nephropathy - cardiologist perspective  [PDF]
Sanjib Kumar Sharma,Laxman Dubey,Sogunuru Guruprasad,Gangapatnam Subramanyam
Nepalese Heart Journal , 2013, DOI: 10.3126/njh.v10i1.9745
Abstract: Use of contrast media for cardiovascular intervention is associated with risk of contrast induced nephropathy. Contrast induced nephropathy is associated with increased morbidity, prolonged hospitalization, potential need for dialysis and increased mortality rate. Although the consequences of contrast induced nephropathy are well known, the prospective identification of patient at risk for nephropathy has been inconsistent. The mechanism of contrast induced nephropathy is complex and not fully understood. Direct tubular toxicity and disturbances of renal hemodynamic with altered glomerular filtration and renal medullary ischemia are the most important path-physiological mechanism. Prevention of contrast induced nephropathy is address in numerous studies. The most attractive agents include hydration, N-acetylcysteine, and infusion of sodium bicarbonate. This review focuses on the definition, pathophysiology and prevention of contrast induced nephropathy. Nepalese Heart Journal | Volume 10 | No.1 | November 2013| Pages 30-37 DOI: http://dx.doi.org/10.3126/njh.v10i1.9745
Lead nephropathy: revisiting an overlooked cause of kidney disease  [cached]
Datonye Dennis Alasia
Nephrology Reviews , 2010, DOI: 10.4081/nr.2010.e8
Abstract: Despite the recognition of lead nephropathy as a consequence of environmental and occupational lead exposure, lead nephropathy still appears to be underrecognized by physicians as a cause and promoter of chronic kidney disease (CKD), especially in people with more apparent causative factors such as diabetes and hypertension. This review focuses on the clinical, pathophysiological and epidemiological perspectives of lead nephropathy with the objective of promoting the awareness of this important but overlooked cause of CKD among physicians. Literature was reviewed using available medical journals and online literature search through Google, Pubmed, Medline, Medscape and HINARI databases. The key words employed were: Lead Nephropathy, Environmental and Occupational lead exposure and chronic kidney disease. Lead nephropathy which is a tubulointerstitial nephritis, may present acutely or chronically in association with hypertension. The clinical diagnosis of lead nephropathy is complex, because the symptoms are varied and non-specific especially with subclinical nephrotoxicity. The recognition of lead nephropathy can be enhanced if physicians have a high index of suspicion in the assessment of patients with renal disease. It is recommended that the evaluation of environmental and occupational nephrotoxins like lead be incorporated into programs for the prevention of CKD, especially in developing countries where lead exposure and toxicity still remain largely unchecked and the prevalence and burden of CKD is increasing.
Contrast Agents and Contrast-Induced Nephropathy  [PDF]
Mohammad Hassan Ghadiani, Pooneh Dehghan
International Journal of Clinical Medicine (IJCM) , 2015, DOI: 10.4236/ijcm.2015.67059
Abstract:
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.
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