A.R. DUNAEVA², A.S. SHCHERBAKOVA¹, T.N. KHAFIZOV¹, N.SH. ZAGIDULLIN¹

¹Bashkir State Medical University, 3 Lenina St., Ufa, Russian Federation 450000

²Republican Cardiologic Dispensary of the Republic of Bashkortostan, 96 Kuvykina St., Ufa, Russian Federation 450106

Dunaeva A. R.—physician of endovascular methods of diagnosis and treatment № 1, tel. (347) 255-50-12, e-mail: dunaevaalinarailevna@gmail.com²

Shcherbakova E.S —postgraduate student at the Department of Propaedeutics of Internal Diseases, tel. (347) 246-53-97, e-mail: alenushka555@mail.ru¹

Khafizov T.N. — Candidate of Medical Science, associate professor at the Department of Hospital Surgery, tel. (347) 246-53 97, e-mail: sly79@list.ru¹

Zagidullin n.Sh — Dr. Med. Sc., Professor of the Department of Propaedeutics of Internal Diseases, tel.(347) 246-53-97, e-mail: znaufal@mail.ru¹

Contrast-induced nephropathy (CIN) is an acute kidney injury due to nephrotoxicity of iodinated contrast agent (CA). CIN is classically defined as relative (≥ 25%) or absolute (44 mmol/l ) increase of serum creatinine (SC) after injection of contrast agent in comparison with reference value. After coronary angiography (CAG) frequency of CIN varies from 0 to 24%, depending on the prevalence of risk factors and the definition used for CIN. Currently, this diagnosis is set in case of increase of SC, although it is relative late marker of acute kidney injury. In consideration of an increase in coronary angiography frequency, early detection of CIN is of great clinical relevance. On this point are studied some plasmatic and urinary biomarkers, whereof the most promising are plasmatic cystatin — C and lipocalin — 2. Since no special treatment was developed for CIN, the main goal for clinicians is its prevention. At the moment hydration is the only proven therapeutic strategy.

Key words: contrast-induced nephropathy, nephroprotection, coronary angiography, biomarker.

 

REFERENCES

1. Karlsberg R.P., Dohad S.Y., Sheng R. Contrast-induced acute kidney injury (CI-AKI) following intra-arterial administration of iodinated contrast media. J Nephrol., 2010, vol. 23 (6), pp. 658-66.

2. Radovanovic D., Urban P., Simon R. et al. Outcome of patients with acute coronary syndrome in hospitals of different sizes. A report from the AMIS Plus Registry. Swiss Med Wkly., 2010, vol. 140 (21-22), pp. 314-22.

3. Sandler C.M. Contrast-agent-induced acute renal dysfunction — is iodixanol the answer? N Engl J Med., 2003, vol. 348 (6), pp. 551-3.

4. Acetylcysteine for prevention of renal outcomes in patients undergoing coronary and peripheral vascular angiography: main results from the randomized Acetylcysteine for Contrast-induced nephropathy Trial (ACT). Circulation, 2011, vol. 124 (11), pp. 1250-9.

5. Bolognese L., Falsini G., Schwenke C. et al. Impact of iso-osmolar versus low-osmolar contrast agents on contrast-induced nephropathy and tissue reperfusion in unselected patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (from the Contrast Media and Nephrotoxicity Following Primary Angioplasty for Acute Myocardial Infarction [CONTRAST-AMI] Trial). Am J Cardiol., 2012, vol. 109 (1), pp. 67-74.

6. Brar S.S., Shen A.Y., Jorgensen M.B, et al. Sodium bicarbonate vs sodium chloride for the prevention of contrast medium-induced nephropathy in patients undergoing coronary angiography: a randomized trial. JAMA, 2008, vol. 300 (9), pp. 1038-46.

7. Briguori C., Airoldi F., D’Andrea D. et al. Renal Insufficiency Following Contrast Media Administration Trial (REMEDIAL): a randomized comparison of 3 preventive strategies. Circulation, 2007, vol. 115 (10), pp. 1211-7.

8. Rosenstock J.L., Bruno R., Kim J.K. et al. The effect of withdrawal of ACE inhibitors or angiotensin receptor blockers prior to coronary angiography on the incidence of contrast-induced nephropathy. Int Urol Nephrol., 2008, vol. 40 (3), pp. 749-55.

9. Thiele H., Hildebrand L., Schirdewahn C. et al. Impact of high-dose N-acetylcysteine versus placebo on contrastinduced nephropathy and myocardial reperfusion injury in unselected patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. The LIPSIA-N-ACC (Prospective, Single-Blind, Placebo-Controlled, Randomized Leipzig Immediate PercutaneouS Coronary Intervention Acute Myocardial Infarction N-ACC) Trial. J Am Coll Cardiol., 2010, vol. 55 (20), pp. 2201-9.

10. Coca S.G., Peixoto A.J., Garg A.X. et al. The prognostic importance of a small acute decrement in kidney function in hospitalized patients: a systematic review and meta-analysis. Am J Kidney Dis., 2007, vol. 50 (5), pp. 712-20.

11. Lindsay J., Canos D.A., Apple S. et al. Causes of acute renal dysfunction after percutaneous coronary intervention and comparison of late mortality rates with postprocedure rise of creatine kinase-MB versus rise of serum creatinine. Am J Cardiol., 2004, vol. 94 (6), pp. 786-9.

12. Katzberg R.W. Urography into the 21st century: new contrast media, renal handling, imaging characteristics, and nephrotoxicity. Radiology, 1997, vol. 204 (2), pp. 297-312.

13. Tumlin J., Stacul F., Adam A. et al. Pathophysiology of contrast-induced nephropathy. Am J Cardiol., 2006, vol. 98 (6A), pp. 14K-20K.

14. Perrin T., Descombes E., Cook S. Contrast-induced nephropathy in invasive Cardiology. Incidence, pathophysiology, diagnosis, prevention and prognosis. Swiss Med Wkly., 2012, vol. 142, w13608.

15. Mehran R., Aymong E.D., Nikolsky E. et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol., 2004, vol. 44 (7). pp. 1393-9.

16. Tublin M.E., Murphy M.E., Tessler FN. Current concepts in contrast media-induced nephropathy. Am J Roentgenol., 1998, vol. 171 (4), pp. 933-9.

17. Haase M., Devarajan P., Haase-Fielitz A. et al. The outcome of neutrophil gelatinase-associated lipocalin-positive subclinical acute kidney injury: a multicenter pooled analysis of prospective studies. J Am Coll Cardiol., 2011, vol. 57 (17), pp. 1752-61.

18. Singer E., Elger A., Elitok S. et al. Urinary neutrophil gelatinase-associated lipocalin distinguishes prerenal from intrinsic renal failure and predicts outcomes. Kidney Int., 2011, vol. 80 (4), pp. 405-14.

19. Kunadian V., Zaman A., Spyridopoulos I., Qiu W. Sodium bicarbonate for the prevention of contrast induced nephropathy: a meta-analysis of published clinical trials. Eur J Radiol., 2011, vol. 79 (1), pp. 48-55.

20. Shcherbakova E.S., Dunaeva A.R., Zagidullin N.Sh. Ischemic preconditioning in internal medicine and vascular surgery. Meditsinskiy vestnik Bashkirii, 2014, no.1 (v pechati) (in Russ.).

21. Er F., Nia A.M., Dopp H. et al. Randomized Pilot RenPro Trial (Renal Protection Trial). Ischemic Preconditioning for Prevention of Contrast Medium-Induced Nephropathy. Circulation, 2012, vol. 126, pp. 296-303.

22. Tepel M., van der Giet M., Schwarzfeld C. et al. Prevention of radiographic-contrast-agent-induced reductions in renal function by acetylcysteine. N Engl J Med., 2000, vol. 343 (3), pp. 180-4.

23. Zhang T., Shen L.H., Hu L.H., He B. Statins for the prevention of contrast induced nephropathy: a systematic review and meta-analysis. Am J Nephrol., 2011, vol. 33 (4), pp. 344-51.

24. Koch J.A., Plum J., Grabensee B., Modder U. Prostaglandin E1: a new agent for the prevention of renal dysfunction in high risk patients caused by radiocontrast media? PGE1 Study Group. Nephrol Dial Transplant., 2000, vol. 15 (1), pp. 43-9.

25. Gare M., Haviv Y.S., Ben-Yehuda A. et al. The renal effect of low-dose dopamine in high-risk patients undergoing coronary angiography. J Am Coll Cardiol., 1999. vol. 34 (6), pp. 1682-8.

26. Erley C.M., Duda S.H., Schlepckow S. et al. Adenosine antagonist theophylline prevents the reduction of glomerular filtration rate after contrast media application. Kidney Int., 1994, vol. 45 (5), pp. 1425-31.

27. Matejka J., Varvarovsky I., Vojtisek P. et al. Prevention of contrast-induced acute kidney injury by theophylline in elderly patients with chronic kidney disease. Heart Vessels., 2010, vol. 25 (6), pp. 536-42.

28. Esnault VL. Radiocontrast media-induced nephrotoxicity in patients with renal failure: rationale for a new double-blind, prospective, randomized trial testing calcium channel antagonists. Nephrol Dial Transplant., 2002, vol. 17 (8), pp. 1362-4.

29. Neumayer H.H., Junge W., Kufner A., Wenning A. Prevention of radiocontrast-media-induced nephrotoxicity by the calcium channel blocker nitrendipine: a prospective randomised clinical trial. Nephrol Dial Transplant., 1989, vol. 4 (12), pp. 1030-6.

30. Carraro M., Mancini W., Artero M. et al. Dose effect of nitrendipine on urinary enzymes and microproteins following non-ionic radiocontrast administration. Nephrol Dial Transplant., 1996, vol. 11 (3), pp. 444-8.

31. Patel K., King C.A., Jovin I.S. Angiotensin-converting enzyme inhibitors and their effects on contrast-induced nephropathy after cardiac catheterization or percutaneous coronary intervention. Cardiovasc Revasc Med., 2011, vol. 12 (2), pp. 90-3.