Clinically overt contrast-induced nephropathy (CIN) is one of the most feared complications in patients exposed to iodinated contrast media and has been extensively studied over the years. Meanwhile, the incidence and evolution of subclinical contrast-induced kidney injury remain elusive. With the continuous increase in the number of patients that are repeatedly exposed to contrast media, elucidating these issues is of critical importance. Accordingly, we aimed to evaluate the incidence and the evolution of clinical and subclinical kidney injury in patients exposed to contrast media. A total of 178 patients who underwent elective percutaneous angioplasty procedures were evaluated prospectively. Serum creatinine and neutrophil gelatinase-associated lipocalin (NGAL) levels were evaluated pre-procedurally, 48 h and 1 month after administration of contrast media. The evolution of creatinine and NGAL levels was analyzed at the three time points, and the potential predictors of contrast-induced clinical and subclinical renal injury were evaluated. Clinically overt CIN occurred in 10 (5.6%) patients. Baseline serum creatinine and the volume of contrast media were the only independent predictors of CIN and in all 10 patients creatinine levels returned to baseline by 1 month (p = 0.32). Subclinical contrast-induced kidney injury was much more common, affecting 32 (17.9%) patients, was only predicted by the baseline serum creatinine, and persisted in 53.1% of patients after 1 month. This study showed that whereas clinically overt CIN is rather rare and regressive, subclinical contrast-induced kidney injury is considerably more frequent, affecting almost 18% of patients that receive intraarterial contrast media. More importantly, subclinical kidney injury persisted after 1 month in more than 50% of the initially affected patients, who may thus be at increased risk for further renal impairment, particularly if exposed to nephrotoxic agents or repeated administration of contrast media.
Background Estimated glomerular filtration rate (eGFR) is the most widely used biomarker of kidney function. However, measurement of biomarkers more sensitive than eGFR may be required to detect subtle renal changes and to identify additional predictors and consequences of kidney injury. In the present study, we aimed to identify predictors and consequences of subclinical renal impairment, as reflected by the levels of neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C. Methods A cross-sectional study was performed in 71 consecutive patients with vascular disease. Demographic and anthropometric data, medical history, and ongoing drug therapy were recorded for each patient. Total blood count, hemoglobin, plasma potassium, glucose, cholesterol, triglycerides, total protein, albumin, serum creatinine, uric acid, NGAL and cystatin C levels, and eGFR were evaluated in all patients. Potential predictors and consequences of increased NGAL and cystatin C levels were assessed. Results History of hypertension, diabetes, and ongoing diuretic therapy were the only independent predictors of decreased eGFR (all p < 0.01). Meanwhile, increased white blood cell count and diuretic usage were independently associated with higher NGAL and cystatin C levels, respectively, and increased uric acid levels were independently associated with higher levels of both biomarkers of kidney injury (all p < 0.05). At their turn, increased NGAL and cystatin C levels were independently associated with lower albumin and HDL-C levels, and increased cystatin C levels were also associated with higher serum potassium (all p < 0.05). Conclusions In this study, eGFR values were independently associated with widely known risk factors for impaired renal function. Meanwhile, NGAL and cystatin C evaluation identified more subtle hematologic and biochemical changes related to subclinical kidney injury. These data reinforce the role of NGAL and cystatin C as not only biomarkers of subclinical kidney injury, but also as predictors of subclinical kidney injury-related abnormalities.
Background Clinically overt contrast-induced nephropathy (CIN) is one of the most feared complications in patients exposed to iodinated contrast media and has been extensively studied over the years. Meanwhile, the incidence and evolution of subclinical contrast-induced kidney injury remain elusive. With the continuous increase in the number of patients that are repeatedly exposed to contrast media, elucidating these issues is of critical importance. Accordingly, we aimed to evaluate the incidence and the evolution of clinical and subclinical kidney injury in patients exposed to contrast media. Methods A total of 178 patients who underwent elective percutaneous angioplasty procedures were evaluated prospectively. Serum creatinine and neutrophil gelatinase-associated lipocalin (NGAL) levels were evaluated pre-procedurally, 48 hours and 1 month after administration of contrast media. The evolution of creatinine and NGAL levels was analyzed at the three time points, and the potential predictors of contrast-induced clinical and subclinical renal injury were evaluated. Results Clinically overt CIN occurred in 10 (5.6%) patients. Baseline serum creatinine and the volume of contrast media were the only independent predictors of CIN and in all 10 patients creatinine levels returned to baseline by 1 month (p = 0.32). Subclinical contrast-induced kidney injury was much more common, affecting 32 (17.9%) patients, was only predicted by the baseline serum creatinine, and persisted in 53.1% of patients after one month. Conclusions This study showed that whereas clinically overt CIN is rather rare and regressive, subclinical contrast-induced kidney injury is considerably more frequent, affecting almost 18% of patients that receive intraarterial contrast media. More importantly, subclinical kidney injury persisted after 1 month in more than 50% of the initially affected patients, who may thus be at increased risk for further renal impairment, particularly if exposed to nephrotoxic agents or repeated administration of contrast media.
Aim: Estimated glomerular filtration rate (eGFR) is the most widely used biomarker of kidney function. More sensitive biomarkers may be required to detect additional predictors and consequences of kidney injury. We aimed to identify predictors and consequences of subclinical renal impairment, as reflected by the levels of neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C. Methods: A cross-sectional study was performed in 71 patients with vascular disease. Demographic and anthropometric data, medical history, and ongoing drug therapy were recorded. Blood count, haemoglobin, plasma potassium, glucose, lipids, proteins, serum creatinine, uric acid, NGAL and cystatin C levels, and eGFR were evaluated. Potential predictors and consequences of increased NGAL and cystatin C levels were assessed. Results: Hypertension, diabetes, and diuretic therapy were the only independent predictors of decreased eGFR (all p<0.05). Meanwhile, increased white blood cell count and diuretic usage were independently associated with higher NGAL and cystatin C levels, respectively, and increased uric acid levels were independently associated with higher levels of both biomarkers of kidney injury (all p<0.05). At their turn, increased NGAL and cystatin C were independently associated with lower albumin and HDL-cholesterol levels, and increased cystatin C levels were also associated with higher serum potassium (all p<0.05). Conclusion: eGFR was associated with widely known risk factors for impaired renal function. Meanwhile, NGAL and cystatin C identified more subtle subclinical kidney injury-related hematologic and biochemical changes. These data reinforce the role of NGAL and cystatin C as biomarkers of subclinical kidney injury and predictors of subclinical kidney injury-related abnormalities.
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