Urinary enzyme changes in children undergoing cineangiographic evaluation using iopromid

Abstract

Nephropathy due to radiocontrast media presents with a wide spectrum of changes from reversible renal dysfunction to oliguria requiring dialysis. Nineteen patients (mean age 4.5 +/- 3.7 years) were included. Mean +/- SD values of the variables obtained before and 48 hours after angiography were the following: plasma creatinine: 0.6 +/- 0.10 and 0.6 +/- 0.16 mg/dl; endogenous creatinine clearance: 76.1 +/- 17.0 and 80.9 +/- 19.3 ml/min/1.73 m2; plasma osmolality: 279 +/- 23 and 298 +/- 39 mOsm/kg H2O; urine osmolality: 429 +/- 225 and 459 +/- 196 mOsm/kg H2O; fractional sodium excretion: 2.1 +/- 1.3% and 2.4 +/- 1.3%; plasma uric acid: 3.9 +/- 1.3 and 3.4 +/- 1.0 mg/dl; urinary AST/creatinine: 5.2 +/- 4.8 and 4.2 +/- 2.6 mU/mg; ALT/creatinine: 16.8 +/- 12.4 and 15.3 +/- 12.6 mU/mg; LDH/creatinine: 52.0 +/- 39.6 and 42.3 +/- 31.5 mU/mg; NAG/creatinine: 20.1 +/- 2.8 and 16.8 +/- 2.3 mU/mg, respectively. The changes in renal function parameters and urinary enzyme levels were insignificant statistically (p > 0.05). In conclusion, iopromid injection at maximum doses of 5 ml/kg does not result in injury to the tubular epithelium leading to increased urinary enzyme levels.

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

“…Kavukçu et al administered iopromide, in a maximum dose of 5 mL/kg with low osmolarity contrast media, to 19 children with congenital heart disease. In these patients, no significant difference was observed in the levels of serum creatinine, creatinine clearance, plasma uric acid, plasma osmolarity, urine osmolarity, fractional excretion of sodium, and urine N-acetyl-β-(D)-glucosaminidase prior to and 48 h after angiography (20). As reported by Noyan et al, in 17 cyanotic and 18 acyanotic children with congenital heart disease, nonionic low osmolarity iopamidol administration did not lead to CIN development (19).…”

“…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).…”

“…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. In our study, it has been shown that risk factors are not effective in terms of CIN development.…”