Analysis Of The Effects Of Contrast Media On Renal Functions Of The Patients Undergoing Coronary Angiography

Background and aims: With the increasing use of radiographic contrast media in diagnostic and interventional procedures, contrast-induced nephropathy (CIN) has become an important cause of acute renal impairment. CIN has been reported to be 3rd leading cause of acute renal failure in hospitalized patients, occurring at a rate of 1⁶% in unselected patient populations. Once it occurs, CIN is associated with an increase in morbidity and both inhospital and longterm mortality. So the importance of CIN has become more greatly appreciated. Domestic investigations are relatively deficient. CIN typically presents with an acute rise in serum creatinine 24 48h after the contrast study. It generally peaks at 3 5 days and returns to baseline values by 1 3 weeks. CIN is defined as an increase in serum creatinine, but creatinine has a thick skin to renal early damage. There are several studies suggesting that cystatin C might be a more sensitive marker of GFR than creatinine. Urinary microalbumin (mALB) and transferring (TRF) are sensitive markers to evaluate early renal glomerular damage . Urinary N-acetyl-beta-D-glucosaminidase ( NAG ) and alpha- 1-microglobulin ( α₁-MG ) are sensitive markers to evaluate early renal tubular damage . Diagnostic cardiac catheterization was performed via the percutaneous radial approach. Mean hospital stay after coronary angiography is 3 days. With the short-time renalmonitoring based on creatinine, the degree of CIN may be underestimated. So we should find a more accurate and earlier marker of contrast-induced early nephrotoxicity and CIN after elective coronary angiography and angioplasty.The purpose of this study was to investigate the effects of nonionic contrast media iohexol or iodixanol on the renal function of the patients undergoing coronary angiography, to perform linear regression analysis with the stepwise method to risk factors, and to evaluate whether serum cystatin C and urinary renal function indexes were sensitive markers of contrast-induced early nephrotoxicity and CIN or not.Subjects: 141 patients with normal serum creatinine (S_Cr< 1.5mg/dl) scheduled for elective coronary angiography were included in the study, among which 92 were male and 49 female, with mean age 63.33± 10.57 (y), ranging from 37 to 84 yr. 91 patients complicated with hypertension, 19 patients complicated with diabetes mellitus. Patients were studied because of symptomatic coronary ischemia. Criteria for exclusion were pregnancy, lactation, intravascular administration of an iodinated contrast medium within the previous seven days, treatment with metformin or nonsteroidal anti-inflammatory drugs within the previous 48 hours, intake of nephrotoxic drugs within the previous seven days, history of serious reactions to iodinated contrast mediums, newly discovered unstable diabetes, severe concomitant disease, renal transplantation, or end-stage renal disease necessitating dialysis and et al.Methods : Diagnostic cardiac catheterization was performed via the percutaneous radial approach.Coronary angiography was performed by a 6F Judkin cather. Serum creatinine, BUN, Na⁺, K⁺, Cl^- and cystatin C levels were assessed at start, 1 day and 2 days after the administration of a radiocontrast agent. Furthermore, urinary mALB, TRF, α₁|-MG, NAG and creatinine were checked for evidence of tubular or glomerular damage at start, 1 day and 2days after the administration of a radiocontrast agent. Serum cystatin C was measured using a latex particle-enhanced immunonephelometry (PENIA) method on an Olympus Au2700 analyser. Serumcreatinine was determined using a kinetic alkaline picrate method on an Olympus Au2700 analyser.BUN was measured using a UV-GLDH method on an Olympus Au2700 analyser. Urinary mALB> TRF, α₁-MG, NAG and creatinine were measured using a immunonephelometry method on a Beckman Array-360 analyser. Statistical analysis of the data was carried out using SPSS 10.0 statistical passage. The Kolmogorov-Smirnov test was applied to check for normality and test of homogeneity of variances was applied. R...