The renal effects of radiocontrast administration during cardioangiography in two different groups with congenital heart disease

Abstract

Renal effects of the administration of contrast media during cardiac catheterisation were compared in two groups of patients with congenital heart diseases. Group A consisted of 21 patients with cardiac malformations, characterised primarily by left ventricular volume overload and known to be associated occasionally with left heart failure, such as: left to right shunts and left ventricular valvular defects. Group B consisted of 23 patients with lesions affecting the right ventricle which are rarely associated with left heart failure, such as: Tetralogy of Fallot and Pulmonic stenosis. Patients in Group A showed a significant increment in both plasma creatinine and uric acid levels in the 24 h following heart catheterisation. This observation was significantly more prominent in the older age group (above the age of 5 years). In Group B no changes in these parameters were encountered. Plasma renin activity and fractional sodium excretion increased and decreased respectively, by a similar degree in both groups in the 24 h following contrast media administration. No difference in renal tubular handling of uric acid was observed between both groups, nor did any of the patients studied demonstrate any degree of proteinuria or abnormality in the urine sediment, prior to or following heart catheterisation. We suggest that chronic pre-existing left ventricular overload should be considered a risk factor among the other known risk factors which promote the incidence of acute renal failure after contrast media administration.(ABSTRACT TRUNCATED AT 250 WORDS)

Short-term effects of catheter-based renal denervation on cardiac sympathetic drive and cardiac baroreflex function in heart failure

“…In line with these observations, in a subset of our animals we found that RDN caused a decrease in PRA despite a fall in BP, whereas an increase in PRA was observed in the sham group. Of note, the increase in PRA seen with sham denervation is not unexpected as previous studies in man have shown increases in PRA 24 hours after general anaesthesia and surgery [46] and radio-contrast administration [47]. Whether this small reduction in PRA, and thus circulating angiotensin II, following RDN is sufficient to account for the leftward shift of baroreflex control of CSNA is unclear, but we have reported similar changes after treatment with irbesartan in this model of HF [48].…”

Acute kidney injury following first-stage palliation in hypoplastic left heart syndrome: hybrid versus Norwood palliation

“…This analysis is important as the avoidance of cardiopulmonary bypass may be beneficial, whereas the intravenous contrast used as part of the Hybrid procedure may be detrimental to the kidneys. [9][10][11] Our study objective was to compare the prevalence of acute kidney injury following Hybrid procedure and after the Norwood operation in a cohort of neonates with a functionally univentricular heart. Further, we evaluated the risk factors for acute kidney injury and the association, if any, between acute kidney injury and shortterm outcomes in this population.…”

Cystatin C as biomarker of contrast-induced nephropathy in pediatric cardiac angiography

“…However, today pediatric angiography patients can be discharged within 24-48 h, with no CIN-induced mortality or morbidity being expected or reported (12). In the studies reporting postprocedural serum creatinine follow-ups in pediatric angiography patients, the patient groups were monitored for from 48 h to 2 weeks (9,12,(17)(18)(19)(20). Hirch et al regarded a 50% or greater increase in basal serum creatinine levels as significant and found that 12% their patients developed CIN (9).…”

“…Hirch et al regarded a 50% or greater increase in basal serum creatinine levels as significant and found that 12% their patients developed CIN (9). Sagy et al showed that, in the pediatric patients with cardiac angiography, left ventricular volume overload was observed, and that, in those suffering from right-toleft shunt congenital heart disease with clinical left-sided heart failure, serum creatinine and uric acid levels rose to a considerable extent (17). However, in other studies (18)(19)(20)(21), no change was observed in the serum creatinine levels after having implemented the procedure.…”