An Uninvestigated Risk Factor for Contrast-Induced Nephropathy in Chronic Kidney Disease: Proteinuria

Abstract

Background: Contrast-induced nephropathy (CIN) is one of the most frequent causes of acute renal failure in hospitalized patients with the incremental use of contrast media. We aimed to investigate whether proteinuria may act as a risk factor for CIN in patients with chronic kidney disease. Methods: Seventy hospitalized patients (37 men, 33 women) with chronic kidney disease, proteinuria, and/or estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m 2 , who were exposed to contrast media were investigated prospectively. Thirty patients were diabetic. All patients received prophylaxis against CIN with acetylcysteine and 0.9% intravenous saline. CIN is defined as either a 25% higher increase in serum creatinine (sCr) from the baseline levels or a 0.5 mg/dL increase in sCr at 72 h after contrast media exposure. Results: CIN was detected in 26 (37.1%) patients. Advanced age, diabetes, heart failure, anemia, baseline sCr of >1.5 mg/dL, baseline eGFR of <60 mL/min/1.73 m 2 , proteinuria of !1 g/day, hypoalbuminemia, and the volume of contrast media of !100 mL correlated significantly with CIN. The frequency of CIN was significantly higher in patients with proteinuria of !1 g/day compared to patients with proteinuria of <1 g/day (p ¼ 0.009). Conclusion: Proteinuria may be a new risk factor for the development of CIN in patients with chronic kidney disease.

Predictors and Outcomes of Postcontrast Acute Kidney Injury after Endovascular Renal Artery Intervention

“…Subsequent studies implicated proteinuria as a risk factor of AKI after intra-arterial contrast administration in the settings of percutaneous coronary intervention and stroke intervention (21–23). Piskinpasa et al reported that PC-AKI was significantly higher when proteinuria exceeded 1 g/day (24). The authors of the Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) trial reported that patients had significantly better event-free survival, cardiovascular disease-related death, progressive renal insufficiency, and overall survival when the albumin/creatinine ratio was ≤ 22.5 mg/g (25).…”

Proteinuria as an independent risk factor for contrast-induced acute kidney injury and mortality in patients with stroke undergoing cerebral angiography

“…In addition, Han et al 17 also found that proteinuria increases the risk of AKI and also the risk of 3-year mortality in patients admitted to the intensive care unit. Recently, three studies found that proteinuria is also a risk factor for CI-AKI 20 29 30. However, these studies did not include patients with cerebrovascular disease and were of relatively lower power.…”

Development of Contrast-Induced Acute Kidney Injury after Elective Contrast Media Exposure in Patients with Type 2 Diabetes Mellitus: Effect of Albuminuria

“…Albumin is almost totally restricted by the glomerular barrier, filtered albumin is reabsorbed by the proximal tubular cells [22], degraded there, and brings about inflammatory and fibrogenic mediators resulting in inflammation and fibrosis, followed by loss of renal function [22], [23]. Albuminuria may contribute to the pathogenesis of CI-AKI/CIN by its toxic effects on the tubular system [24]. Albuminuria could activate Fas-mediated and peroxisome proliferator-activated receptor-γ-dependent apoptosis, and induce proinflammatory molecules, leading to apoptosis and damage of the renal tubular system [25]–[32].…”

“…Moreover, in animal models of massive proteinuria, excessive oxidative stress induced by oxidized fatty acid was noted in regions with renal tubular damage [34]. Albuminuria and contrast media may share similar effects on kidneys [24], and may coordinate with each other in the pathogenesis of CI-AKI/CIN.…”