Relationship of Renal Hemodynamic and Functional Changes Following Intravascular Contrast to the Renin–Angiotensin System and Renal Prostacyclin in the Dog

Workman, Robert J.; Shaff, Max I.; Jackson, Richard V.; Diggs, J; Frazer, Marshall G.; Briscoe, Cheryl

doi:10.1097/00004424-198303000-00012

Cited by 79 publications

(38 citation statements)

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“…Indeed, after a brief transient increase in renal blood flow after the administration of radiocontrast, a prolonged decline of 10 to 25% below baseline is noted (20). The fall in medullary oxygenation cannot be attributed to this modest decline in total renal blood flow per se, because the latter predominantly reflects changes in cortical flow, whereas medullary flow, representing only 10% of renal blood flow, is usually preserved (21).…”

Section: Radiocontrast-induced Decrease In Renal Oxygen Supplymentioning

confidence: 99%

Renal Parenchymal Hypoxia, Hypoxia Adaptation, and the Pathogenesis of Radiocontrast Nephropathy

Heyman¹,

Rosen²,

Rosenberger³

2008

Clinical Journal of the American Society of Nephrology

209

164

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Background and objectives: Renal parenchymal PO 2 declines after the administration of iodinated radiocontrast agents, reaching critically low levels of approximately 10 mmHg in medullary structures.Design, setting, participants, & measurements: In this review, the causes of renal parenchymal hypoxia and its potential role in the pathogenesis of contrast nephropathy are appraised.Results: Commonly associated predisposing factors are associated with a propensity to enhance renal hypoxia. Indeed, animal models of radiocontrast nephropathy require the induction of such predisposing factors, mimicking clinical scenarios that lead to contrast nephropathy in high-risk individuals. In these models, in association with medullary hypoxic damage, a transient local cellular hypoxia response is noted, initiated at least in part by hypoxia-inducible factors. Some predisposing conditions that are distinguished by chronically aggravated medullary hypoxia, such as tubulointerstitial disease and diabetes, are characterized by a priori upregulation of hypoxia-inducible factors, which seems to confer tolerance against radiocontrastrelated hypoxic tubular damage. Renal dysfunction under such circumstances likely reflects to some extent altered intrarenal hemodynamics, rather than acute tubular injury.Conclusions: Real-time, noninvasive novel methods may help to differentiate between evolving tubular damage and altered hemodynamics and in the design of appropriate preventive interventions.

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Section: Radiocontrast-induced Decrease In Renal Oxygen Supplymentioning

confidence: 99%

Renal Parenchymal Hypoxia, Hypoxia Adaptation, and the Pathogenesis of Radiocontrast Nephropathy

Heyman¹,

Rosen²,

Rosenberger³

2008

Clinical Journal of the American Society of Nephrology

209

164

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“…32 Certain observations suggest that suppression of prostacyclin, rather than activation of the renin-angiotensin system, is the principal cause of CIN; administration of contrast media in dogs has been shown to cause an initial brief increase followed by a sustained 20% decrease in renal blood flow and creatinine clearance, no significant changes in angiotensin II and renin levels, and a significant decline in the renal secretory rate of 6-keto-PGF 1a , a PGI 2 metabolite. 33 In particular, contrast media have been shown to increase release of PGEs but to decrease release of PGI 2 from the kidney. 12 In vitro and in vivo studies in rats have shown that prostaglandins (PGE 1 , PGE 2 , and PGI 2 ) protect the kidneys against ischemic and toxic injury by means of a cellular effect.…”

mentioning

confidence: 99%

Iloprost Prevents Contrast-Induced Nephropathy in Patients With Renal Dysfunction Undergoing Coronary Angiography or Intervention

et al. 2009

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Background-The prevention of contrast-induced nephropathy, which accounts for considerable morbidity and mortality, remains a vexing problem. Contrast-induced renal vasoconstriction is believed to play a pivotal role in the pathogenesis of contrast-induced nephropathy. The aim of this study was to examine the efficacy of the prostacyclin analog iloprost in preventing contrast-induced nephropathy in patients with renal dysfunction undergoing a coronary procedure. Methods and Results-We conducted a randomized, double-blind, placebo-controlled trial of iloprost in 208 patients with a serum creatinine concentration Ն1.4 mg/dL who underwent coronary angiography and/or intervention. Iloprost 1 ng · kg Ϫ1 · min Ϫ1 or placebo was administered intravenously beginning 30 to 90 minutes before and ending 4 hours after the procedure. Contrast-induced nephropathy was defined by an absolute increase in serum creatinine Ն0.5 mg/dL or a relative increase Ն25% measured 2 to 5 days after the procedure. Contrast-induced nephropathy occurred in 23 of the 105 patients (22%) in the control group and in 8 of the 103 patients (8%) in the iloprost group (odds ratio, 0.29; 95% confidence interval, 0.12 to 0.69; Pϭ0.005). In the control group, the estimated glomerular filtration rate declined from 49.7Ϯ15.5 to 46.6Ϯ16.6 mL · min Ϫ1 · 1.73 m Ϫ2 (Pϭ0.01). In the iloprost group, the estimated glomerular filtration rate increased marginally from 47.5Ϯ14.5 to 48.6Ϯ16.1 mL · min Ϫ1 · 1.73 m Ϫ2 (Pϭ0.26). The mean absolute estimated glomerular filtration rate decline in the control group was greater than its change in the iloprost group (difference, 4.2 mL · min Ϫ1 · 1.73 m Ϫ2; 95% confidence interval, 1.1 to 7.3; Pϭ0.008). Conclusion-Prophylactic

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“…Dehydration activates the renin-angiotensin system (17), causing consequent vasoconstriction and probably making the kidney more susceptible to any further direct circulatory strain induced by CM. It has been shown that, after infusion, CM not only act as vasoconstrictors (4, 31) but also suppress the synthesis of vasodilative prostaglandins (34).…”

Section: Discussionmentioning

confidence: 99%

Effects of Mannitol and Iohexol Infusions on the Renal Cortical Blood Flow in Dehydrated Mice

Högström¹,

Hietala²,

Rooth³

1996

Acta Radiol

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Relationship of Renal Hemodynamic and Functional Changes Following Intravascular Contrast to the Renin–Angiotensin System and Renal Prostacyclin in the Dog

Cited by 79 publications

References 0 publications

Renal Parenchymal Hypoxia, Hypoxia Adaptation, and the Pathogenesis of Radiocontrast Nephropathy

Renal Parenchymal Hypoxia, Hypoxia Adaptation, and the Pathogenesis of Radiocontrast Nephropathy

Iloprost Prevents Contrast-Induced Nephropathy in Patients With Renal Dysfunction Undergoing Coronary Angiography or Intervention

Effects of Mannitol and Iohexol Infusions on the Renal Cortical Blood Flow in Dehydrated Mice

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