Early detection of progressive renal dysfunction in patients with coronary artery disease

Fuiano, Giorgio; Mancuso, Domenico; Indolfi, Ciro; Mongiardo, Annalisa; Sabbatini, Massimo; Conte, Giuseppe; Nicola, Luca De; Minutolo, Roberto; Mazza, Giuseppe; Cianfrone, Paola; Andreucci, Michele

doi:10.1111/j.1523-1755.2005.00748.x

Cited by 27 publications

(18 citation statements)

References 39 publications

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“…According to Solomon [12] among all procedures utilizing contrast media for diagnostic or therapeutic purposes, coronary angiography and percutaneous coronary interventions (PCI) are associated with the highest rates of AKI [3] mainly related to the intra-arterial injection and to the high dosage of the contrast necessary, and also to the type of patients who have advanced age, one or more comorbid conditions, and more advanced vascular disease, hypertension, and diabetes [22]. …”

Section: Incidencementioning

confidence: 99%

Acute Kidney Injury by Radiographic Contrast Media: Pathogenesis and Prevention

Andreucci

Faga

Pisani

et al. 2014

BioMed Research International

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106

112

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It is well known that iodinated radiographic contrast media may cause kidney dysfunction, particularly in patients with preexisting renal impairment associated with diabetes. This dysfunction, when severe, will cause acute renal failure (ARF). We may define contrast-induced Acute Kidney Injury (AKI) as ARF occurring within 24–72 hrs after the intravascular injection of iodinated radiographic contrast media that cannot be attributed to other causes. The mechanisms underlying contrast media nephrotoxicity have not been fully elucidated and may be due to several factors, including renal ischaemia, particularly in the renal medulla, the formation of reactive oxygen species (ROS), reduction of nitric oxide (NO) production, and tubular epithelial and vascular endothelial injury. However, contrast-induced AKI can be prevented, but in order to do so, we need to know the risk factors. We have reviewed the risk factors for contrast-induced AKI and measures for its prevention, providing a long list of references enabling readers to deeply evaluate them both.

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Section: Incidencementioning

confidence: 99%

Acute Kidney Injury by Radiographic Contrast Media: Pathogenesis and Prevention

Andreucci

Faga

Pisani

et al. 2014

BioMed Research International

Self Cite

106

112

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“…1 The use of CM has risen in recent years due to an increase in radiographic procedures, and this coupled with an aging population already suffering from diabetes and cardiovascular/renal diseases (including chronic kidney disease, hypertension, hypotension, advanced congestive heart failure, and compromised left ventricular performance) has led to an increase in the incidence of CI-AKI. [2][3][4][5][6][7][8] CI-AKI…”

Section: Introductionmentioning

confidence: 99%

The potential use of biomarkers in predicting contrast-induced acute kidney injury

Andreucci¹,

Faga²,

Riccio³

et al. 2016

IJNRD

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Contrast-induced acute kidney injury (CI-AKI) is a problem associated with the use of iodinated contrast media, causing kidney dysfunction in patients with preexisting renal failure. It accounts for 12% of all hospital-acquired kidney failure and increases the length of hospitalization, a situation that is worsening with increasing numbers of patients with comorbidities, including those requiring cardiovascular interventional procedures. So far, its diagnosis has relied upon the rise in creatinine levels, which is a late marker of kidney damage and is believed to be inadequate. Therefore, there is an urgent need for biomarkers that can detect CI-AKI sooner and more reliably. In recent years, many new biomarkers have been characterized for AKI, and these are discussed particularly with their use in known CI-AKI models and studies and include neutrophil gelatinase-associated lipocalin, cystatin C (Cys-C), kidney injury molecule-1, interleukin-18, N-acetyl-β-d-glucosaminidase, and L-type fatty acid-binding protein (L-FABP). The potential of miRNA and metabolomic technology is also mentioned. Early detection of CI-AKI may lead to early intervention and therefore improve patient outcome, and in future any one or a combination of several of these markers together with development in technology for their analysis may prove effective in this respect.

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“…In particular, the older kidney, even in healthy subjects, has a reduced ability to vasodilate when maximally stimulated and a greater susceptibility to volume depletion [3, 4]. Also the frequent coexistence of pathologies predisposing to renal damage, such as hypertension, diabetes and atherosclerosis, and nephrotoxic drugs increase the risk of renal damage in the elderly [3, 4]. Therefore, all the measures potentially useful to improve renal perfusion during cardiac surgery should be adopted in the elderly patients.…”

Section: Introductionmentioning

confidence: 99%

Can Pulsatile Cardiopulmonary Bypass Prevent Perioperative Renal Dysfunction during Myocardial Revascularization in Elderly Patients?

et al. 2009

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Backgrounds/Aims: We recently demonstrated that pulsatile cardiopulmonary bypass (CPB) versus standard linear CPB is associated with better perioperative renal function. Since older subjects have a higher risk of acute renal failure, we have extended our study to evaluate the specific impact of pulsatile CPB on the perioperative renal function in elderly patients. Methods: We enrolled 50 patients with normal preoperative renal function: they were stratified by age (65–75 vs. 50–64 years) and randomized to nonpulsatile (group A) or pulsatile CPB (group B). Twenty-seven patients aged ≥50 years and <65 years were randomized to group A (n = 12) or to group B (n = 15) and 23, aged ≥65 years and ≤75 years, to group A (n = 13) or to group B (n = 10). Glomerular filtrate rate (GFR), daily diuresis, lactatemia and other parameters were measured during the pre- and perioperative period. Results: The percent perioperative decrease in GFR was lower in group A than in group B (p < 0.001), without differences between older and younger patients. By contrast, perioperative plasma lactate levels were higher in group A than in group B (p < 0.001), both in older and younger patients. No difference was observed for 24 h urine output and blood urea nitrogen. Conclusions: Pulsatile CPB preserves renal function better than standard CPB even in patients older than 65. CPB could be adopted as the procedure of choice in this subgroup of patients.

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Early detection of progressive renal dysfunction in patients with coronary artery disease

Abstract: In CAD patients with normal GFR, reduction in renal perfusion and absence of renal functional reserve likely represent early markers of progressive renal dysfunction.

Cited by 27 publications

References 39 publications

Acute Kidney Injury by Radiographic Contrast Media: Pathogenesis and Prevention

Acute Kidney Injury by Radiographic Contrast Media: Pathogenesis and Prevention

The potential use of biomarkers in predicting contrast-induced acute kidney injury

Can Pulsatile Cardiopulmonary Bypass Prevent Perioperative Renal Dysfunction during Myocardial Revascularization in Elderly Patients?

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