Lights and shadows on the pathogenesis of contrast-induced nephropathy: state of the art

Detrenis, Simona; Meschi, Michele; Musini, Sabrina; Savazzi, G

doi:10.1093/ndt/gfh868

Cited by 146 publications

(155 citation statements)

References 50 publications

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“…Interestingly, in animal studies, both intravenous contrast dye 37,38 and highdose vancomycin 15,16 have been demonstrated to promote free radical formation within renal tissue, which is hypothesized to cause tubular damage primarily through vascular endothelial dysfunction, vasoconstriction, and subsequent reperfusion injury. N-acetylcysteine is frequently administered to patients about to receive intravenous contrast dye (although its benefit remains controversial 37,39 ); N-acetylcysteine has also been shown in an animal model to attenuate vancomycin-induced renal injury. 40 Receipt of concomitant aminoglycosides was not significantly associated with nephrotoxicity, in contrast with previous studies.…”

Section: Discussionmentioning

confidence: 99%

Elevated vancomycin trough is not associated with nephrotoxicity among inpatient veterans

Prabaker

Tran

Pratummas

et al. 2011

Journal of Hospital Medicine

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BACKGROUND:Vancomycin troughs of 15‐20 mg/L are recommended in the treatment of invasive staphylococcal disease, higher levels than previously recommended.OBJECTIVE/SETTING:We sought to determine if there was an association between vancomycin trough and nephrotoxicity, defined as 0.5 mg/L or 50% increase in serum creatinine, at a large Veterans Affairs medical center.PATIENTS AND METHODS:We reviewed records of 348 inpatients at our institution who received ≥5 days of vancomycin during 2 time periods when vancomycin dosing protocols differed (May 2005‐April 2006 and January 2007‐December 2007). Potential risk factors for nephrotoxicity were collected prior to nephrotoxicity onset, and all patients with nephrotoxicity events occurring within 5 days of starting vancomycin were excluded.RESULTS:Overall incidence of nephrotoxicity was 31/348 patients (8.9%). A similar percentage of patients experienced nephrotoxicity in 2005‐2006 versus 2007 (16/201 vs 15/147, respectively; P = 0.57), despite a rise in mean (9.7 mg/L in 2005‐2006 vs 13.2 mg/L in 2007; P < 0.0001) and highest (11.8 mg/L in 2005‐2006 vs 15.7 mg/L in 2007; P < 0.0001) vancomycin trough levels achieved. In a multivariate logistic regression model, only receipt of intravenous contrast dye was significantly associated with nephrotoxicity (OR 4.01, P < 0.001), though there was a trend toward an association between maximum vancomycin trough ≥15 mg/L and nephrotoxicity (OR 2.05, P = 0.082). Overall reversibility of nephrotoxicity either prior to or within 72 hours of vancomycin discontinuation was 77.8%.CONCLUSIONS:We conclude that nephrotoxicity, with higher trough levels occurring at ≥5 days of vancomycin therapy, was uncommon at our institution and typically reversible. Journal of Hospital Medicine 2012;. © 2011 Society of Hospital Medicine

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Section: Discussionmentioning

confidence: 99%

Elevated vancomycin trough is not associated with nephrotoxicity among inpatient veterans

Prabaker

Tran

Pratummas

et al. 2011

Journal of Hospital Medicine

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“…Probably the most frequent under-estimated factor which contributes to acute renal dysfunction after cardiac cathetherism is cholesterol embolism, often asymptomatic, but present in up to 50% of cases [13]. [14,15]. Briefly, there is a determinant contribution of hemodynamic alterations, endothelial dysfunction, vasoactive mediators, rheologic factors, free oxygen radicals release, immunological mechanisms, direct tubular toxicity and other mechanisms.…”

Section: Risk Factors For Radiocontrast-induced Nephropathymentioning

confidence: 99%

Is radiocontrast-induced nephropathy avoidable? The scientific evidence in 2006

2006

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AbstractDue to the wide use of radiocontrast agents (RCA) in modern radiology and interventional cardiology, the incidence of radiocontrast-induced nephropathy (RCIN) is increasing. The risk factors for RCIN are primarily pre-existing (even mild) renal dysfunction, diabetes mellitus, absolute or relative hypovolemia, nephrotoxic drugs, etc., particularly in elderly patients. The presence of these risk factors seems to be more important than the type of contrast agent used. To date, there are several certainties and controversies in the prevention of RCIN. Hydration with normal saline and/or bicarbonate administration pre-and post-intervention is certainly useful. Though controversial, N-Acetylcysteine administration may be still advisable. Recent investigations showed the benefits of aminophylline/theophylline administration in RCA-induced renal tubular toxicity. Conventional hemodialysis cannot prevent RCIN, but may potentially aggravate renal dysfunction through hemodynamic instability. “High-flux” hemodialysis and hemodiafiltration may contribute efficiently to RCIN prevention, but systematic use of these modern dialysis techniques is limited by high costs and availability. The authors review — in a systematic manner, and in the perspective of evidence-based medicine — the most important data from literature concerning the prevention of RCIN.

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“…For this reason, taking the appropriate prophylactic regimens is important in reducing CIN. [1] It had been postulated that antioxidant N-acetylcysteine (NAC) might scavenge oxygen free radicals and thus attenuate the cytotoxic effects of contrast media. [2,3] Tepel et al evaluated the effects of NAC (600 mg orally twice daily), at first time, in 83 patients undergoing computed tomography.…”

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confidence: 99%

“…While many trials have shown benefit, more recent investigation has found conflicting results of the effect of NAC on prevention of CIN. [1][2][3] In most of the NAC studies, a rise in serum creatinine by ≥ 0.5 mg/dL or ≥ 25% above baseline at 48-72 h after contrast exposure was used as the primary outcome. Due to dietary creatinine intake, tubularly secretion of creatinine, and variations in the patient's muscle mass, the use of serum creatinine may inaccurately estimate the glomerular filtration rate (GFR).…”

mentioning

confidence: 99%

“…For this reason, the effect of NAC on oxidative stress can be changed in hypovolemia. [1,7] The assessment of volume status by inferior vena cava collapse index, mean atrial pressure, and noninvasive pulmonary-capillary wedge pressure provides important information for volume status. [7] The combination of clinical parameters and any of these methods may accomplish more accurate evaluation of the hydration in CIN studies patient.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Letter to the Editor: “Interactions between Serum Creatinine, Volume Status, N-Acetylcysteine, and Contrast-Induced Nephropathy”

Toprak

2006

Renal Failure

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Lights and shadows on the pathogenesis of contrast-induced nephropathy: state of the art

Cited by 146 publications

References 50 publications

Elevated vancomycin trough is not associated with nephrotoxicity among inpatient veterans

Elevated vancomycin trough is not associated with nephrotoxicity among inpatient veterans

Is radiocontrast-induced nephropathy avoidable? The scientific evidence in 2006

Letter to the Editor: “Interactions between Serum Creatinine, Volume Status, N-Acetylcysteine, and Contrast-Induced Nephropathy”

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