Clinical And Basic Studies On The Protection Of Shenkang Injection In Contrast Induced Nephropathy

BackgroundContrast media induced nephropathy(CFN) is a condition manifacting impairment in renal function without other know cause(an increase in serum creatinine by25%, or 44mmol/L) occuring within 72 hours after the intravascular administration of a contrast medium.In our country, as the age of the population is getting higher, the incidence is on the increase,among them chronic renal insufficiency, coronary heart disease, diabetes,affecting the elderly, and other diseases may exist at the same time, coronary heart disease has become a disease with high incidence and mortality.But minimal side affect to the patient has become a popular freatmemt procedure knowing effectPercutaneous coronary intervention.Contrast agent is an indispensible in achieving Percutaneous coronary intervention. However,more and more attention has beenpaid to the problem of contrast agent induced CIN.Contrast agent has become one of the three major risk factors of iatrogenic disease。Its pathogenesis is not clear and the change in renal hemodynamics, renal tubular cell toxicity,and oxidative stress has been considered as the pathogenetic factors.Cntrast media induced nephropathy, may result in renal insufficiency, renal failure,and death of the patients. Therefore it brings heavy burden and mental stress to the patients.the medical development still failed to find an effective prevention or aprodictive factor of the occourrence of CIN.In clinic, hydration, alkalization and hemodiafiltration has been used to prevent CIN.However,it calls for more experimental work to verify them.Chronic renal insufficiency is found to be an independent risk factor of CIN, A herb concoction Shenkang injection has been widely used in the clinical treatment of patients with chronic renal insufficiency, and a number of clinical reports that shenkang injection can treat chronic insufficiency.and other of themsuggested that the administration of shenkang injection can treat renal insufficiency.It has been also reported that herbs included rhubarb and Chuanxiong can inhibit the apoptosis of rat renal tubular epithelial cells induced by contrast agent, However experimental or clinical reports dealing with the curative effect of Shenkang Injection on chronic renal insufficiency are still lacking.Objectives1.Observe and compare the changes in blood biochemical indexes and glomerlar filtration rate of chronic renal insufficiency patients 1th day before and 5th day after PClwith the intervention of hydration,Shenkang+hydration,and Shenkang+hydration+dialysis, in order to investigate the effects of three kinds of preventive measures on the prevention of contrast induced nephropathy。2.Observing the change in contents of Scr, Bun,UA, hs-CRP,β2-MG, CycsCC, HCY and urinary mALB in rats after receiving of contrast agent and undergoing the treatment of Shenkang。MethodsClinical study:To observe the changes in blood biochemical indexes (serum creatinine (sCr), urea nitrogen (Bun), uric acid (UA), β2 microglobulin (β2-MG)、high senetive C React proten (hs-CRP)、Cystatin C (CycsC C)and serum homocysteine (HCY))and urinary index(urinary microalbumin (m-ALB)) in hydration group, hydration +Shenkang group and hydration+Shenkang+hemofiltration group respectively. On one day before injectionof contrast agent and days 1,3,5 after the injection of contrast agent.Animal study:Rats were divided into two groups:normal renal function group(N=65)and chronic renal insufficiency group (N=100),Every part were divided into 5 groups:control group(normal rats/renal insufficiency model rats), blank control group(2ml/kg 0.9% normal saline (0.9%NS)), small dose of Shenkang group (1 ml/kg), middle dose of Shenkang group (2ml/kg), and high dose of Shenkang group (4ml/kg) respectively.Three days before and after the injection of contrast agent, Shenkang injcection was given accordingly.Dynamic observe the changes in blood indexes (sCr、Bun、UA、hs-CRP、β2-MG、CycsC、HCY) on the time-points of 24h, 48h,72h after the injection of contrast agent.ResultsClinica 1 study:No CIN was observed after PCI,as sCr, hs-CRP,32-MG, CycsC, HCY shows no significant difference (P>0.05) in 0d,1d,3d 5d. The incidence of renal dysfunction before and after PCI shows no statistical significance in patients with mild renal dysfunction (P>0.05), Among patients with moderate renal insufficiency,the significance in lowering of the above parameters in results indicated that hydration +Shenkang group was statistically significance.(P<0.05).Animal study:According to the CIN diagnosfic crireria, the level of sCr in 4 groups of normal renal function were within the normal range.After the injection of contrast agent, the level of SCr, Bun were higher than that in rats with normal renal function at the time points of 24h,48h,72h, showing significant difference (P< 0.05), the mortality of the blank group and the small dose group rats was 13.3%, and the mortality of rats receiving high dose and middle dose was 6.7%,0 At the time-points of 24h,48h,72h, levels of sCr, Bun, UA, hs-CRP,32-MG, CycsC, HCY in chronic renal failure rats were higher than that of chronic renal failure rats model group (P< 0.05). the mortality of chronic renal failure rats:that of the blank group and the low dose group was 29.2%, and that of the middle dosage group was 25%, and the high dose group was 20.8%.ConclusionsFor elderly moderate chronic renal insufficiency patients with coronary heart disease, Hydration+Shenkang injection can protect renal function.Medium to large dose of Shenkang injection can reduce the level of creatinine in rats and protect renal function and decrease the mortality, medium (2ml/kg) and large dose(4ml/kg) of Shenkang injection can protect renal function in renal insufficiency rats.