Effect of fluorescein angiography on renal functions in type 2 diabetes patients: A pilot study

Abstract

Fluorescein angiography (FA) is an important tool for the diagnosis and management of diabetic retinopathy. However, the safety of fluorescein sodium on renal functions is not fully understood. One hundred type 2 diabetes patients, within the Ophthalmology Outpatient Clinic at Alexandria Main University Hospital, Egypt, were enrolled in this prospective observational study to determine the safety of FA on renal function. Serum creatinine and cystatin C were measured pre- and 2 days post-FA. Urinary neutrophil gelatinase-associated lipocalin (uNGAL) was measured pre- and 4 hours post-FA. Renal injury was defined as a 25% increase in serum creatinine, cystatin C, or uNGAL. The study included 71 females and 29 males, with a mean age of 55.73 ± 7.29 years. Baseline serum cystatin C and uNGAL were 0.89 ± 0.34 mg/L and 21.7 ± 2.39 ng/mL, respectively. Serum cystatin C and uNGAL significantly increased after FA to 0.95 ± 0.36 and 27 ± 2.81, respectively (P <0.001). Eleven patients (11%) experienced more than a 25% rise in serum cystatin C from baseline, whereas 40 patients (40%) experienced more than a 25% increase in uNGAL levels after FA. However, the mean serum creatinine level did not change significantly after FA (P = 0.061). Only one patient experienced more than a 25% rise in serum creatinine from baseline. FA showed a significant increase in early sensitive acute kidney injury biomarkers (as serum cystatin C and uNGAL) in substantial number of patients, suggesting but still not proving, a potential harmful effect of FA on kidney functions. These findings were not demonstrated using ordinary serum creatinine.

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“…Still, the present study did not observe any significant adverse effects after fluorescein angiography in diabetes patients. Although, Kameda and colleagues used the estimated glomerular filtration rate to show renal injury secondary to fluorescein sodium and did not find any significant effects on renal function 8 . Similar results were observed by Chung and Lee 17 using serum creatinine.…”

“…According to the European Society of Urogenital Radiology (2011), CI-AKI is defined as an increase of 25% or more in serum creatinine or an absolute increase of 0.5 mg/dL or more from baseline value at 48-72 h following the exposure to intravascular contrast media (CM) 9,10 . This definition was criticized by lack of sensitivity and non-inclusion of urine output changes, as used in RIFLE, AKIN, and KDIGO 8,9,10 definitions. However, it is still the most acceptable and has the advantage of being widely used as an endpoint in many clinical trials, thus allowing comparison between different trials' results.…”

Renal Function following Fluorescein Angiography in Diabetic Patients with Chronic Kidney Disease

“…Fluorescein dye is metabolized by the kidneys and excreted in the urine during the first 48–72 hr after injection. [ 1 ] During this time, contrast-induced nephropathy usually manifests. [ 2 ]…”

“…Considering that concomitant diabetic nephropathy is possible in patients with DR, there is a concern as to whether fluorescein usage can deteriorate the kidney function further. [ 1 , 2 , 3 , 4 ] Chronic kidney disease (CKD) is defined as a gradual decline in renal function which is initially subclinical. Contrast-induced acute kidney injury (AKI) is defined by an increase in serum creatinine of 0.5 mg/dl or 25% from the baseline that occurs around 48 hr after contrast administration.…”

“…Contrast-induced acute kidney injury (AKI) is defined by an increase in serum creatinine of 0.5 mg/dl or 25% from the baseline that occurs around 48 hr after contrast administration. [ 1 ]…”