Nephrotoxicity of High- and Low-Osmolality Contrast Media

Jevnikar, Anthony M.; Finnie, K. J. C.; Dennis, Bradley M.; Plummer, David T.; Avila, A.; Linton, A. L.

doi:10.1159/000184947

Cited by 51 publications

(14 citation statements)

References 15 publications

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“…However, patients' sus ceptibility to drug-induced toxic renal injury varied greatly [13,67], The excretion of tubular membrane pro teins in the urine after administration of low-osmolar nonionic X-ray contrast media (iopamidol 832 mosm/ kg) was significantly lower than after injection of highosmolar diatrizoate (2,100 mosm/kg) [69], This suggests that, aside from preexisting diseases and renal altera tions, the tubulotoxic effect of radiopaque contrast me dia depends mainly on their osmolality [65,70].…”

Section: Tubular Proteins In the Urine Of Patients Under Defined Clinmentioning

confidence: 99%

Urinary Proteins of Tubular Origin: Basic Immunochemical and Clinical Aspects

Scherberich¹

1990

Am J Nephrol

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A variety of tubular marker proteins, as compared to healthy controls, are excreted at an increased rate in the urine of patients with renal damage. Beside cytoplasmic glutathione-S-transferase and lysosomal β-N-acetyl-glucosaminidase (β-NAG) the majority of kidney-related urine proteins derives from membrane surface components of the most vulnerable proximal tubule epithelia, among them ala-(leu-gly)-aminopeptidase, γ-glutamyl transpeptidase (GGT), the tubular portion of angiotensinase A, the major brush border glycoprotein ‘SGP-240’ and adenosine-deaminase-binding protein. Urinary tissue proteins, e.g. brush border (BB) microvilli, are immunologically identical with those antigens prepared from cell membranes of the human kidney itself. BB antigens are shed into the urine of patients with glomerulonephritis, interstitial nephritis, systemic diseases, e.g. systemic lupus erythematosus (SLE), diabetes mellitus and multiple myeloma, arterial hypertension, infectious diseases (malaria, AIDS) and after operations, renal grafting and administration of X-ray contrast media, aminoglycosides or certain cytostatics (cz’s-platinum). Tissue proteinuria of tubular proteins is determined by enzyme-kinetic or quantitative immunological assays applying either poly- or monoclonal antikidney antibodies. Clinical, ultrastructural and histochemical studies support the idea that both ‘soluble’ and high-molecular-weight membrane particles (vacuolar blebs, > 10⁶ dalton) as well as microfilamental components of the epithelial cytoskeleton contribute to tubular ‘histuria’ which appears as a sensitive parameter in monitoring tubular damage under clinical conditions at a very early phase.

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Section: Tubular Proteins In the Urine Of Patients Under Defined Clinmentioning

confidence: 99%

Urinary Proteins of Tubular Origin: Basic Immunochemical and Clinical Aspects

Scherberich¹

1990

Am J Nephrol

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“…injections, and more than iothalamate or iopamidol (7,9). Coronary angiography with ioxaglate, iohexol, or diatrizoate produced the same pattern of lysosomal and brush-border enzymuria (12). In some reports the non-ionic CM seem to cause less change in the excretion of renal tubular enzymes than ionic contrast media (1, 4, 13, 19).…”

Section: Discussionmentioning

confidence: 84%

Renal Effects of Iopentol and Iohexol after Intravenous Injection

Jakobsen¹,

Kolbenstvedt²,

Berg³

1991

Acta Radiol

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Renal effects of the 2 non-ionic contrast media iopentol and iohexol were investigated and compared in a double-blind, randomized parallel study where 30 patients received iopentol, and 31 patients iohexol intravenously for abdominal CT. The dosage of contrast medium (350 mg Ijml) was 700 mg Ijkg body weight. Only one patient (in the iohexol group) had an increase in serum creatinine of more than 50%. Iopentol and iohexol had no effects on the mean serum values of creatinine, urea, and 0,-microglobulin (O,-MG) nor on creatinine clearance. The urinary excretion of albumin and B1-MG was also unchanged. The excretion of the proximal tubular enzymes alkaline phosphatase and N-acetyl-0-glucosaminidase was increased. No significant difference between iopentol and iohexol was found.

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“…Tubular toxicity of contrast media may occur without deterioration of the glomerular filtration rate [24,25]. Urinary tubular enzymes as markers of tubular damage may thus serve as additional sensitive indicators of CM nephrotoxicity; therefore, the 808 Fig.…”

Section: Discussionmentioning

confidence: 99%

Angiography for renal artery stenosis: no additional impairment of renal function by angioplasty

et al. 2001

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The aim of this study was to compare renal function between patients with renal angiography and patients with renal angiography and angioplasty (AP) for renal artery stenosis (RAS). Forty-seven patients with suspected RAS were prospectively investigated by digital subtraction angiography (DSA) using non-ionic low osmolar contrast media (CM). In 22 patients RAS was detected and in 16 cases an angioplasty was performed in the same session. The following parameters were determined 1 day prior to and after the DSA, respectively: serum creatinine (S-Crea, micromol/l) and single-shot inulin clearance (In-Cl, ml/min) for the evaluation of renal function; and urine alpha 1-microglobuline (AMG, microg/g Crea) and beta-N-acetyl-glucoseaminidase (beta-NAG, U/g Crea) as markers of tubular toxicity. Serum creatinine was measured additionally 2 days after CM had been injected. In both groups with and without AP 174+/-65 and 104+/-56 ml of CM ( p<0.0005) were used, respectively. There were no differences with regard to renal function or risk factors for CM nephrotoxicity between both groups. In the group with AP S-Crea and In-Cl (each: mean+/-SD) did not change significantly (before DSA: 171+/-158 and 61+/-24, after DSA: 189+/-177 and 61+/-25, respectively), beta-NAG (median) rose from 4 to 14 ( p<0.05) and AMG from 8 to 55 (n.s., because of high SD). In the group without AP S-Crea increased from 134+/-109 to 141+/-113 ( p<0.01), In-Cl dropped from 65+/-26 to 62+/-26 ( p<0,01), beta NAG (median) rose from 4 to 8 ( p=0.01), and AMG from 7 to 10 (n.s.). A rise in baseline S-Crea by more than 25% or 44 micromol/l occurred in 4 and 2 patients in the group with and without AP, respectively. Creatinine increase was reversible in all cases within 7 days. In this study using sensitive methods to detect changes of renal function and tubular toxicity no additional renal function impairment in DSA with angioplasty for RAS compared with DSA alone could be demonstrated. Our data suggest that AP performed for RAS has a beneficial effect on renal function.

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Nephrotoxicity of High- and Low-Osmolality Contrast Media

Cited by 51 publications

References 15 publications

Urinary Proteins of Tubular Origin: Basic Immunochemical and Clinical Aspects

Urinary Proteins of Tubular Origin: Basic Immunochemical and Clinical Aspects

Renal Effects of Iopentol and Iohexol after Intravenous Injection

Angiography for renal artery stenosis: no additional impairment of renal function by angioplasty

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