Contrast associated nephropathy: Presentation, pathophysiology and management

Porter, George A.; Kremer, D.

doi:10.1007/978-94-015-9088-4_24

Cited by 16 publications

(19 citation statements)

References 98 publications

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“…The striking increase in GFR observed in our studies after RC administration (Table 2) was also noted by others (4,7) but was disregarded by Vaamonde et al as being the results of an artifact (4). The increase in urine flow, urinary excretion of Na', K+, and in osmolar clearance (Table 2) were the result of the osmotic effect caused by the high osmolality of the RC.…”

Section: Discussionsupporting

confidence: 86%

“…The high osmolality of the RC and the single dose of RC administered in these studies were similar to those used by other investigators to induce RC-RD in the rat (4)(5)(6)(7)(8). The most important risk factor for RC-RD in humans is preexisting renal lesions (1-3).…”

Section: Discussionsupporting

confidence: 79%

“…In order to develop susceptibility, the animals had to be primed by several maneuvers prior to RC administration. These maneuvers included subjecting them to unilateral nephrectomy (4)(5)(6)(7), direct intraarterial injection of the RC agent into the remaining kidney made ischemic by constriction of the aorta above the renal artery (5), or stimulation of renin release and inhibition of production of prostaglandins and nitric oxide (6-8). Acute tubular necrosis (ATN) was induced in those studies which utilized the male Sprague-Dawley rat ( 5 ) or a Wistar-derived strain of rats (6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

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The SHR as a Small Animal Model for Radiocontrast Renal Failure. Relation of Nephrotoxicity to Animal's Age, Gender, Strain, and Dose of Radiocontrast

1997

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The male spontaneously hypertensive rat (SHR) Duarte, Zhang, and Ellis induced renal damage (RC-RD) increased as the animals aged. In addition, when the administered dose of RC was repeated a f e r a short interval of only 6 h, the degree of RC-RD increased greatly. In parallel control studies of the infruence of gender and strain on the response to &C in 12-month-old rats, neither hypertensive female SHR nor male normotensive Wstar-Kyoto (WKY) rats demonstrated signiJicant spontaneous renal pathology or the marked susceptibility to RC nephrotoxicity shown by their male SHR counterparts. This small animal model for RC-RD, the mature male SHR, has the distinct advantage that risk factors f o r RC-RD, similar to those characterized in humans for RC-RE develop spontaneously without requiring any special treatment or surgical intervention.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

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The SHR as a Small Animal Model for Radiocontrast Renal Failure. Relation of Nephrotoxicity to Animal's Age, Gender, Strain, and Dose of Radiocontrast

1997

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“…Among these risk factors, pre-existing renal dysfunction and large volume of RCM are particularly important. Porter (18) has reported that the incidence of radiocontrast nephropathy varies between 2% and 7%, but the rate is elevated by 5-to 10-fold in patients with pre-existing renal insufficiency (SCr >1.5 mg / dL). More recently, Rihal et al (19) have shown in a large scale study of 7,586 patients who undertook percutaneous transluminal coronary interventions in the Mayo Clinic that the incidence rate of radiocontrast nephropathy defined as the elevation of SCr by ³0.5 mg / dL is 3.3% (254 patients) as a whole, but much lower in patients with low baseline SCr (2.4% for 0 -1.1 mg / dL SCr and 2.5% for 1.2 -1.9 mg / dL SCr) than in those with high baseline SCr (22.4% for 2.0 -2.9 mg / dL SCr and 30.6% for >3.0 mg/ dL SCr).…”

Section: Risk Factorsmentioning

confidence: 99%

Clinical and Experimental Evidence for Prevention of Acute Renal Failure Induced by Radiographic Contrast Media

et al. 2005

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Abstract. Acute renal failure still occurs as a complication after radiographic examination using iodinated radiocontrast medium. The incidence rate of radiocontrast medium-induced nephropathy (radiocontrast nephropathy) is low (2 -3%) in general. However, the rate is remarkably elevated in patients with pre-existing renal insufficiency. Radiocontrast nephropathy is associated with increased morbidity and mortality, particularly in patients with percutaneous coronary interventions. Although the reduction in renal blood flow and direct toxic action on renal tubular cells are considered to be involved, little is known about the etiology of radiocontrast nephropathy. A number of agents that improve renal circulation have been clinically tested for prevention of radiocontrast nephropathy, but none of them has succeeded. Protection of renal tubular cells against oxidative stress is another approach to avoid radiocontrast nephropathy. Prophylactic effects of antioxidants such as N-acetylcysteine and ascorbic acid have been reported by several investigators, although the effectiveness of these compounds is still a matter of debate. At present, hydration is regarded as the only effective, though incomplete, prophylactic regimen for radiocontrast nephropathy. Recently, we have shown that caspasedependent apoptosis is an important factor in the pathogenesis of radiocontrast nephropathy and clarified cellular mechanisms underlying the radiocontrast media-induced apoptosis. This review summarizes clinical and experimental evidence for the etiology and prevention of radiocontrast nephropathy.

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“…Factors involved in nephropathy are renal haemodynamic alterations, direct tubular cell injury and tubular obstruction (Bakris, 1993;Porter, 1994). Although nephrotoxicity has been shown to be more severe with the use of high-osmolar contrast agents (Thomsen et al, 1988), in patients with pre-existing renal failure the incidence of contrast nephropathy was not significantly different when comparing high and low osmolar media (Barrett et al, 1992).…”

mentioning

confidence: 99%

Glomerular filtration and saturable absorption of iohexol in the rat isolated perfused kidney

Masereeuw

Moons

Smits

et al. 1996

British J Pharmacology

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1 The renal handling of iohexol was examined in the rat isolated perfused kidney (IPK) over a perfusate concentration range of 5-20 Mg ml-'. 2 At a concentration of 5 Mg ml-', a ratio of renal clearance over clearance by glomerular filtration (CIR/GF) of 0.63 + 0.06 could be determined. This ratio increased until 1.02+0.06 at 20 Mg ml-, indicating that a saturable mechanism is involved in the luminal disappearance of the drug. 3 Pretreatment of the kidneys with polylysine, probenecid or diatrizoate resulted in a significantly enhanced clearance of iohexol, probably due to inhibition of membrane binding. Renal clearance data were fitted to a kinetic model including filtration into the primary urine followed by saturable absorption at the luminal membrane. An absorption constant, KA, of 7.3 + 1.3 Mg ml-', and a maximum rate of absorption, VA,MaX, of 1.4+0.1 Mg min-' were determined. 4 lohexol accumulated in kidney tissue, reaching a concentration of 2 to 7.5 times the perfusate concentration. In freshly isolated proximal tubular cells and kidney cortex mitochondria, iohexol reduced the uncoupled respiratory rate at a concentration comparable to the highest tissue concentration found in the IPK. 5 In conclusion, iohexol is not only filtered by the kidney but also reabsorbed via a saturable mechanism, which results in tubular accumulation. Intracellularly sequestered iohexol may affect mitochondrial oxidative metabolism. Our results indicate that iohexol is not a true filtration marker.

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Contrast associated nephropathy: Presentation, pathophysiology and management

Cited by 16 publications

References 98 publications

The SHR as a Small Animal Model for Radiocontrast Renal Failure. Relation of Nephrotoxicity to Animal's Age, Gender, Strain, and Dose of Radiocontrast

The SHR as a Small Animal Model for Radiocontrast Renal Failure. Relation of Nephrotoxicity to Animal's Age, Gender, Strain, and Dose of Radiocontrast

Clinical and Experimental Evidence for Prevention of Acute Renal Failure Induced by Radiographic Contrast Media

Glomerular filtration and saturable absorption of iohexol in the rat isolated perfused kidney

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