Urinary KIM-1in The Early Diagnosis Of CIN Clinical Significance

Objective:Coronary heart disease is a serious threat to people physicaland mental health, and its incidence is increasing year by year. Its highmorbidity and high mortality rate, not only to individuals, families and even tothe whole community have brought serious mental and economic burden.Coronary angiography as "The gold standard" of diagnosis of coronary heartdisease, because of its simple, less pain, rapid postoperative recovery, andtimely opening of blood vessels in case of an emergency, rapidly relievesymptoms and improve prognosis, etc. make it as an important way to therapid development of coronary heart disease diagnosis, treatment. Derived onthis basis, the percutaneous coronary intervention (PCI) with coronaryinterventional procedures widely carried out as well as the increasingpopularity and mature.When we clear contrast image accurately locate lesions and accuratetreatment to relieve the suffering of patients, at the same time, its side effectscaused by complications also increasingly prominent, and more and more theattention of the majority of medical workers, in which, contrast-inducednephropathy (CIN) is gradually being taken seriously, and now has becomethe most common complication of the percutaneous coronary intervention.According to epidemiological statistics, CIN has become the third cause ofhospital medical acute renal dysfunction. And a large number of studies haveshown that CIN has become after percutaneous coronary interventionindependent predictors of death, not only have an adverse effect on theprognosis of patients, and even increase the mortality.Today, medical technology is ever-changing, but the incidence of CIN isstill high, a very important reason is the lack of effective early diagnosticmarker, can not achieve early detection and early intervention, thereby delaying treatment. The most commonly used clinical indicators of detectingCIN is observe the changes in the concentrations of serum creatinine (Scr). Scrspecificity, however, is affected by the patient’s own body weight, thenutritional situation, race, gender, and many other non-renal factors and theScr have low sensitivity in diagnosis of renal function decline, so to someextent led to the bottleneck of the of CIN early diagnosis. Therefore, lookingfor a high-sensitivity, high-specificity for early diagnosis standards, theproblems to be solved, but also become a current research focus. With thecontinuous efforts of the scholars at home and abroad in recent years, anincreasing number of diagnostic markers was found early diagnosis of CIN. Aglycoprotein kidney injury molecule-1(KIM-1) is a new discovery in recentyears, is a specific expression after ischemic injury in renal proximal tubulemarkers, multiple studies have shown that in the assessment of early renaldamage the higher the sensitivity, specificity there are certain advantages, butthese studies are mostly limited to animal models and in vitro experiments,really used in clinical studies have reported relatively small.Detection underwent PCI in patients with preoperative and postoperative2h,6h,24h,48h urine KIM-1concentrations, and to explore the significanceof KIM-1after PCI in patients with CIN early diagnosis.Methods:Select the First Hospital of Shijiazhuang City, Department of Cardiology,May2011to June2012,180patients underwent coronary angiography andpercutaneous coronary intervention therapy (PCI) of adult patients will beselected,96men,84women. According to the contrast nephropathy diagnosisstandard, there were12patients in CIN, Patients in group CIN were2.5timesthe number of randomly selected never happened CIN cases, in the non CINgroup. All patients underwent coronary angiography and PCI, application ofnon-ionic and permeability contrast media (iohexol), and all patients24hpreoperative, postoperative24h and48h blood be used testing Scr, in thepreoperative and postoperative2h,6h,24h,48h urine was collected and theKIM-1detection. Exclusion criteria were: age greater than75years old, have a clear history of allergy to iodinated contrast media, severe renalinsufficiency patients (Scr>133μmmol/L), acute myocardial infarction, needpatients who underwent emergency PCI, using the total iodine contrast agentmore than5ml×body weight (kg)/baseline serum creatinine(mg/dl), NYHAclassification for class IV, echocardiography showed left ventricular ejectionfraction(LVEF)<35%, application of iodine contrast agent line angiographyand angiography in patients in14days, with type I diabetes, renal arterystenosis (more than70%unilateral stenosis, bilateral stenosis of more than50%) or the side of nephrectomy, serious abnormal liver function(ALT>120U/L), hyperthyroidism. The CIN diagnostic criteria: applic-ationintravascular contrast agent within72h, except for other causes of renaldysfunction, serum creatinine(Scr) an absolute increase44μmol/L or more th-an basis Scr levels increased by25%.Results:1The incidence rate of CIN was6.67%.2The CIN group of patients after PCI2h,6h,24h,48h urinary KIM-1concentration compared with preoperative urinary KIM-1concentration wassignificantly higher (P<0.05), peaked at24h. The non-CIN group of varioussegments of the urinary KIM-1concentration compared with preoperativeurinary KIM-1concentration was no significant difference (P>0.05).Conclusion:The urinary KIM-1in the patients with contrast-induced nephropathy asearly as the changes before Scr, Urine KIM-1can be used as a sensitivemarker for early diagnosis of CIN.