Renal Effects of Cardiac Angiography With Different Low-Osmolar Contrast Media

Abstract

The aim of this study was to evaluate the renal effects of cardiac angiography performed with three low-osmolar contrast media (CM): iopromide (IPR), ioversol (IVR) and ioxaglate (IOX). IPR and IVR are non-ionic CM, IOX is an ionic CM. Different parameters of renal function were determined before and 6, 24, 48, 72 hrs after angiography in 45 patients: 15 patients were examined with IPR, 15 with IVR and 15 with IOX. Glomerular effects--Plasma creatinine increased slightly at the 24th hour after IVR and IOX and at 48 hours after IOP. A significant increase in plasma beta2-microglobulin was observed, at the same time, only after IOX. A significant decrease in creatinine clearance was found at 6 hours after IOX. No significant variations in glomerular filtration rate (GFR) and in effective renal plasma flow were found at 48 hours after cardiac angiography; while filtration fraction was significantly reduced after IOP and IOX. Tubular effects--A marked decrease in sodium clearance and a relevant increase of urinary activities of different tubular enzymes were found after cardiac angiography with all CM, but were more evident after the ionic CM IOX, than after the two non-ionic agents. These tubular effects reached the maximum between 6 and 24 hours and returned to baseline within 72 hrs after cardiac angiography. In conclusion, slight glomerular effects were observed mainly after IOX. A reversible tubular malfunction was found with the three low-osmolar CM and was more evident after ionic CM IOX. thus suggesting that other mechanisms, besides osmolarity, play a role in tubular toxicity due to CM. In no patient did the glomerular and tubular effects of CM have a clinical relevance.

Contrast Nephropathy After Coronary Angiography

“…50 A recent trial that included diabetic patients with preexisting renal disease undergoing coronary and aortic angiography supports the fact that the lowest-osmolality agents, ie, iso-osmolar agents (290 µOsm/kg), provide the best protection from CN. 8 Ionic Content.-One study in humans 51 has confirmed studies of animal models that demonstrated less renal tubular cytotoxicity associated with the use of nonionic contrast media compared with ionic contrast agents. Small clinical trials of low-risk patients undergoing coronary angiography have shown little difference in the risk of CN between the 2 types of medium.…”

Nephrotoxicity due to Combination Antibiotic Therapy with Vancomycin and Aminoglycosides in Septic Critically Ill Patients

“…Therefore, besides serum creatinine, according to Fauconneau et al [12] , Goren et al [10] and Rybak et al [4] , we measured the urinary excretion of enzymes and the low-molecular-weight protein ␤ 2M as early markers of damage due to toxic effects of drugs on renal tubular cells, which precedes the clinical impairment in renal function. The clinical relevance of increased excretion of these markers has not been completely elucidated, but data [24][25][26][27][28] indicate that the measurement of urinary excretion of tubular enzymes and the low-molecular-weight protein ␤ 2M may enable the early identifi cation even of mild and transient renal tubular damage, which is not detectable using more conservative criteria, e.g. serum creatinine and CL cr , which only spot signifi cant impairments in glomerular fi ltration rate.…”

Nephrotoxicity of Iso-osmolar Iodixanol Compared with Nonionic Low-osmolar Contrast Media: Meta-analysis of Randomized Controlled Trials

“…It was shown that there is no difference in the cytotoxicity of low-osmolar iomeprol and iso-osmolar iodixanol at equal iodine concentrations in renal proximal tubular cells in vitro, whereby the induced cytotoxicity may consist of a reversible part and an irreversible part. In addition, the viscosity of CM may play a clinically important role in CIN, especially for high-viscous iodixanol (60)(61)(62)(63)(64).…”