Tubular Nephrotoxicity after Intravenous Urography with Ionic High-Osmolal and Nonionic Low-Osmolal Contrast Media in Patients with Chronic Renal Insufficiency

Cavaliere, G; Arrigo, Girolamo; D’Amico, Giuseppe; Bernasconi, P; Schiavina, G; Dellafiore, L; Vergnaghi, Daniele

doi:10.1159/000184327

Cited by 35 publications

(6 citation statements)

References 14 publications

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“…One unit of activity was defined as the amount of enzyme catalyzing the release of 1 µmol of hippuric acid from hippuryl- L -histidyl- L -leucine per minute at 37°C. Urinary GGT and NAG were measured according to the method previously described [8]. Enzyme activity was expressed in units per liter.…”

Section: Methodsmentioning

confidence: 99%

Assessment of Renal Function in the Early Stages of Nephrotoxicity Induced by Iodinated Contrast Media

Duan

Luo

et al. 1999

Nephron

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To determine whether there are early renal function parameters (RFP) which can be monitored to rapidly detect nephrotoxicity induced by contrast media (CM), we observed RFP in 16 patients with normal renal function before and after administration of CM. Forty-eight hours after diatrizoate meglumine administration, blood urea nitrogen (BUN) and serum creatinine (SCr) increased (p < 0.05). In all patients, acute tubular damage was revealed by early urinary RFP. Increases in levels of serum angiotensin-I-converting enzyme (ACE), β₂-microglobulin (β₂M) and urinary albumin (Alb) were associated with alterations in glomerular function. The changes in early RFP occurred earlier than those of BUN and SCr. The present study demonstrates that serum ACE, β₂M, urinary Alb, γ-glutamyl-transpeptidase and N-acetyl-β-D-glucosidase are sensitive parameters for the early assessment of subclinical nephrotoxicity induced by CM.

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Section: Methodsmentioning

confidence: 99%

Assessment of Renal Function in the Early Stages of Nephrotoxicity Induced by Iodinated Contrast Media

Duan

Luo

et al. 1999

Nephron

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“…Immediately after administration there is a rise in renal blood flow, which is followed by a strong vasoconstrictive phase causing a decrease of GFR and hypoxia (Bakris & Burnett 1985;Caldicott et al 1970;Katzberg et al 1983). Indeed, from the excretion patterns of brush border enzymes, nonionic contrast media appear to be less toxic than highly anionic preparations (Cavalieri et al 1987). Radiocontrast agents may also directly damage renal tubular cells, in particular the inner mitochondrial membrane, thus interfering with cellular oxidative.…”

Section: Radiocontrast Agentsmentioning

confidence: 99%

Drug-Induced Nephrotoxicity Aetiology, Clinical Features and Management

1991

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There is a growing number of hospitalised patients who develop a drug-induced renal problem because increasing numbers of potent drugs have been added to the therapeutic arsenal in recent years. The 3 clinical syndromes that can be recognised in drug-induced nephropathy are acute renal failure, chronic interstitial nephritis and the nephrotic syndrome. The first can be caused by prerenal problems, acute interstitial nephritis, acute tubular necrosis and intratubular obstruction. The most important drugs that cause prerenal failure are NSAIDs, captopril and cyclosporin. NSAIDs inhibit the synthesis of prostaglandins, and consequently vasoconstriction of the afferent arteriole leads to lowering of the glomerular filtration rate (GFR); captopril blocks the formation of angiotensin II (which also leads to a lower GFR), and should be used with caution in patients with stenotic renal arteries; cyclosporin causes vasoconstriction of the afferent arteriole, which is probably mediated by the sympathetic system. Combinations of these drugs result in increased nephrotoxicity. The drugs most likely to cause acute interstitial nephritis are antibiotics and NSAIDs. Normally, signs of an allergic reaction are also present. Acute interstitial nephritis is usually self-limiting, but in some studies it is claimed that steroids may promote recovery. Four important causal agents of acute tubular necrosis are aminoglycosides, amphotericin B, radiocontrast agents and cyclosporin. Approximately half of the cases of drug-induced renal failure are related to the use of aminoglycosides: generally, 10 days after start of treatment a nonoliguric renal failure develops, with recovery after withdrawal of the drug in almost all cases. The aminoglycosides are particularly nephrotoxic when combined with other nephrotoxic drugs. 80% of amphotericin B-treated patients develop renal insufficiency, a percentage that increases as the cumulative dose exceeds 5g. It is because of its unique antifungal properties that there are still some indications for the use of this highly nephrotoxic drug; the high percentage of nephrotoxicity can probably be prevented in part by sodium loading. The nephrotoxicity of radiocontrast agents is largely dependent on renal function: from 0.6% in patients with normal renal function to 100% in patients with a serum creatinine above 400 mumol/L. Diabetes mellitus does not add greatly to the risk of radiocontrast nephrotoxicity. The nephrotoxicity of cyclosporin is dose-dependent and reversible, although there are some reports of irreversibility after long term use. Cyclosporin can also result in nephrotoxicity in combination therapy.(ABSTRACT TRUNCATED AT 400 WORDS)

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“…The high osmolarity of the common contrast media is believed to contribute to their nephro toxicity and other side effects. Numerous studies in exper imental animals, healthy volunteers, and patients with normal or impaired renal function have suggested that the newly developed low-osmolar and nonionic contrast me- dia, such as iohexol and iopamidol, are less nephrotoxic and generally better tolerated than the conventional agents [2][3][4][5]. However, recent reports have shown that these new contrast media may also cause an impairment of the renal function [6,7], Severe reactions, including acute renal failure requiring dialysis, may develop after radiocontrast procedures, particularly in patients with advanced renal failure [8,9].…”

Section: Introductionmentioning

confidence: 99%

Hemodialysis for Elimination of the Nonionic Contrast Medium lohexol after Angiography in Patients with Impaired Renal Function

Moon

Bäck

Kurkus

et al. 1995

Nephron

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We examined the kinetics of contrast agent elimination during hemodialysis in 7 patients with end-stage renal disease on regular hemodialysis treatment (group I) and in 13 patients with impaired renal function (serum creatinine 214-657 μmol/l; group II). The nonionic agent iohexol was administered at a dose of 0.4-4.5 g/kg, and a 6-hour hemodialysis was performed with 1-18 h delay. This procedure removed 60-90% (mean 77%) of the iohexol present in the circulation at the start of dialysis treatment. The mean extraction ratio across the dialysis membrane was 0.47 and was inversely related to blood flow. The total clearance of iohexol was 70.4 ± 24.6 ml/min and was very close to dialyzer clearance, as estimated from blood flow and extraction ratio. The plasma iohexol level after dialysis was related to the dose administered, iohexol clearance, and the patients’ body weight. During peritoneal dialysis (36-60 liters dialysis fluid), 43-72% of the iohexol dose was removed from the patients’ circulation. In patients of group II no further impairment of the renal function (increase of serum creatinine) in conjunction with angiography was observed. We conclude that hemodialysis and peritoneal dialysis are effective methods for removal of iohexol. Our observations suggest also that accelerated elimination of contast media by prophylactic dialysis can be beneficial in preventing further reduction in renal function after angiographic procedures in high-risk patients.

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Tubular Nephrotoxicity after Intravenous Urography with Ionic High-Osmolal and Nonionic Low-Osmolal Contrast Media in Patients with Chronic Renal Insufficiency

Cited by 35 publications

References 14 publications

Assessment of Renal Function in the Early Stages of Nephrotoxicity Induced by Iodinated Contrast Media

Assessment of Renal Function in the Early Stages of Nephrotoxicity Induced by Iodinated Contrast Media

Drug-Induced Nephrotoxicity Aetiology, Clinical Features and Management

Hemodialysis for Elimination of the Nonionic Contrast Medium lohexol after Angiography in Patients with Impaired Renal Function

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