Epidemiology of contrast material-induced nephropathy in the era of hydration.

NARCIS (Netherlands)

Balemans, C.E.A.; Reichert, L.J.M.; Schelven, B.I. van; Brand, A. van den; Wetzels, J.F.M.

2012-01-01

PURPOSE: To evaluate the incidence of contrast material-induced nephropathy (CIN) in patients with an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m(2) who received intravenous contrast media and underwent treatment in accordance with current guidelines and to determine

Risk of contrast-medium-induced nephropathy in high-risk patients undergoing MDCT - A pooled analysis of two randomized trials

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Thomsen, Henrik S. [University of Copenhagen, Department of Diagnostic Radiology, Copenhagen University Hospital Herlev, and Department of Diagnostic Sciences, Faculty of Health Sciences, Herlev (Denmark); Morcos, Sameh K. [University of Sheffield, Department of Diagnostic Imaging, Northern General Hospital, Sheffield (United Kingdom)

2009-04-15

The incidence of contrast-medium-induced nephropathy (CIN) following intravenous (IV) CM administration of contrast media to renally impaired patients undergoing multidetector computed tomography (MDCT) is not well characterized. Our objective was to investigate the incidence of CIN in patients with glomerular filtration rate (GFR) <60 ml/min undergoing contrast-enhanced MDCT examinations and to compare the rates of CIN following the IV administration of low-osmolar contrast media (LOCM, iopamidol and iomeprol) and an iso-osmolar contrast medium (IOCM, iodixanol). A total of 301 adult patients with moderate-to-severe renal failure received a similar IV contrast dose (40 gI). Serum creatinine (SCr) was measured at screening, baseline and 48-72 {+-} 6 h after the MDCT examination. Primary CIN outcome was an increase in SCr {>=}0.5 mg/dl ({>=}44.2 {mu}mol/l) from baseline. The CIN rates were 2.3% in the total population, 0.6% when GFR >40 ml/min, 4.6% when GFR <40 ml/min and 7.8% in patients with GFR <30 ml/min. The incidence of CIN was significantly higher after iodixanol than after LOCM (seven patients, 4.7% following IOCM, no CIN cases following the LOCM; p = 0.007). Significant differences in favor of the LOCM were also observed in patients with GFR <40 ml/min and GFR <30 ml/min. Following the IV administration of nonionic contrast agents in patients with moderate-to-severe renal insufficiency, the risk of significant CIN seems to be low. The IOCM iodixanol caused a higher rate of CIN than the LOCM iopamidol and iomeprol, especially in high-risk patients. Differences in osmolality between these LOCM and iodixanol do not play a role in the genesis of CIN. (orig.)

The affects of contrast medium on renal function in selective coronary angiography and intervention

International Nuclear Information System (INIS)

Chen Yueguang; Lv Baojing

2006-01-01

Selective coronary angiography and intervention with injection of contrast medium into the coronary arteries has become very common in dealing with coronary cardiac diseases. The excretion of contrast medium through kidneys may lead to acute renal functional insufficiency, especially for those suffering from chronic nephropathy, diabetes and cardiac functional disorder to form the so called 'contrast medium nephropathy' which is considered as the number second drug induced acute renal functional failure. Although routine preventive measure including low osmotic contrast medium and fine hydrotherapy have been taken, 14% incidences still occur with renal functional damage. The majority could be reversible but the minority needs emergent hemodialysis or even with persistent renal functional damage in a few ones. (authors)

Contrast-induced nephropathy following intravenous urography with Iopromid

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Krysteva, R.; Andreev, E.; Kirojcheva, M.; Kundurdzhiev, A.; Kiperova, B.

1997-01-01

In retrospective studies the incidence of contrast-induced nephropathy is less than 1 per cent, while in prospective ones it may reach up to 10 per cent. Thirty-nine patients (9 men and 30 women at mean age 46.6 ± 16.5 years, range 15 - 75) undergo prospective study by iv urography with Iopramid (Ultravist 370) administered at mean dose 0.9 ± 0.1 ml/kg b.w. The patients are distributed in 3 groups: group I - with normal renal function free of diabetes mellitus (33 cases), group II - with normal renal function and diabetes mellitus, group III - with renal failure free of diabetes mellitus (plasma creatinine concentration (Pcr) > 140 μmol/l). Pcr is evaluated prior to (baseline) and 48 hours after urography. Dehydration is precluded and none of the patients is given nephrotoxic drugs. In group I Pcr shows a more than 25 per cent increase in 4 patients, but remains below 140 μmol/l. In 2 patients of the same group Pcr levels exceed the reference values: from 51 to 205, and from 105 to 196 μmol/l in two women aged 70 and 74 years, respectively. Renal function impairment is reversible, with Pcr returning to normal within a week. In groups II and III no changes in Pcr level are noted. A slight elevation of serum creatinine pointing to contrast-induced nephrotoxicity is documented in 4 patients with previously normal renal function. A reversible renal failure is observed in two instances. The obtained results demonstrate an incidence rate of contrast-induced nephropathy amounting to 15.4 per cent, or in 6/39 patients (author)

Prevention of contrast induced nephropathy with sodium bicarbonate (the PROMEC study

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John Fredy Nieto-Ríos

2014-09-01

Full Text Available Introduction: Contrast-induced nephropathy is a common complication of radiographic procedures. Different measures have been used to avoid this damage, but the evidence is controversial. New investigations are required to clarify it. We investigated the efficacy and safety of sodium bicarbonate solution compared with sodium chloride solution to prevent contrast induced nephropathy in patients with or at risk of renal dysfunction. Methods: A prospective, single-center, randomized clinical trial conducted from May 1, 2007 to February 8, 2008. Inpatients in a tertiary center, scheduled to undergo a procedure with the nonionic radiographic contrast agent iohexol. There were 220 patients with serum creatinine levels of at least 1.2 mg/dL (106.1 µmol/L and/or type 2 diabetics, who were randomized to receive an infusion of sodium chloride (n = 113 or sodium bicarbonate (n = 107 before and after contrast dye administration. The intervention were "A" group received 1 ml/kg/hour of normal saline solution, starting 12 hours before and continuing 12 hours after iohexol contrast. "B" group received 3 ml/kg of sodium bicarbonate solution (150 mEq/L one hour prior to procedure and then drip rate was decreased to 1 ml/kg/hour until 6 hours post procedure. Our main outcome measure was change in serum creatinine. Results: The mean creatinine value after the procedure was 1.26 mg/dL in the saline group and 1.22 mg/dL in the bicarbonate group (mean difference: 0.036; CI 95%: -0.16 to 0.23, p = 0.865. The diagnosis of contrast-induced nephropathy, defined by increase in serum creatinine on 25% or more within 2 days after administration of radiographic contrast, was done in twelve patients (12% in the bicarbonate group and eighth patients (7.1% in the saline group (RR: 1.68, CI 95%: 0.72 to 3.94. Conclusion: Our investigation showed that there were no differences between normal saline solution (extended infusion vs. bicarbonate solution for nephroprotection.

Risk factors and incidence of contrast induced nephropathy following coronary intervention

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Yoga Yuniadi

2008-06-01

Full Text Available Contrast induced nephropathy (CIN is one of important complication of contrast media administration. Its incidence and risk factors among Indonesian patients undergoing coronary intervention has not been reported yet. CIN was defined as increasing of serum creatinine by 0.5 mg/dl or more in the third day following contrast media exposure. Of 312 patients undergoing coronary intervention, 25% developed CIN. Patient-related risk factors comprised of hypertension, diabetes mellitus, NYHA class, proteinuria, serum creatinine > 1.5 mg/dl and ejection fraction ≤ 35%. Contrast-related risk factors comprised of contrast media volume > 300 ml, contrast media type. However, our final model demonstrated that only hypertension [Hazard ratio (HR = 2.89, 95% confidence intrval (CI = 1.78 to 4.71, P = 0.000], diabetes mellitus (HR = 3.09, 95% CI = 1.89 to 5.06, P = 0.000, ejection fraction (EF ≤ 35% (HR = 2.92; 95% CI = 1.72 to 4.96; P = 0.000, total contrast volume > 300 ml (HR = 7.73; 95% CI = 3.09 to 19.37; P = 0.000 and proteinuria (HR = 14.96; 95% CI = 3.45 to 64.86; P = 0.000 were independent risk factors of CIN. In conclusion, CIN developed in 25% of patients undergoing coronary intervention. The independent risk factors of CIN included hypertension, diabetes mellitus, EF ≤ 35%, contrast volume > 300 ml and proteinuria. (Med J Indones 2008; 17: 131-7Keywords: contrast induced nephropathy, coronary intervention

The Effect of Hyperuricemia on the Rate of Contrast-Induced Nephropathy in Patients with Coronary Angiography

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Hossein Vakili

2016-10-01

Full Text Available Introduction: There is little information about the relationship between hyperuricemia and contrast induced nephropathy. The present study aimed to evaluate the relationship between hyperuricemia and contrast induced nephropathy among patients, who had undergone coronary angiography.Methods: In the current study, 200 consecutive patients with coronary artery disease, who underwent coronary angiography in Modarres hospital, were enrolled. According to the available data, the upper limit normal level of uric acid was defined as 7 mg/dl in males and 6.5 mg/dl in females. By increasing level of serum creatinine to 0.5 mg/dl (or 25% enhancement from basic level of creatinine during 48 hours of introduction of contrast agent, diagnosis of Contrast Induced Nephropathy (CIN was established. The relationship between hyperuricemia and CIN was then assessed.Results: There is a significant difference between normouricemic patients and hyperuricemic patients, in aspect of weight (P = 0.011 and uric acid (P = 0.001; however, other quantitative and qualitative variables including age, volume of contract agent, creatinine level after angiography, hemoglobin level, gender, arterial access type, number of involved vessels, were insignificant between the two groups (P > 0.05. Moreover, as an essential finding, CIN was shown in 9% of normouricemic patients and 10% of hyperuricemic  patients with no significant difference between the two groups (P = 0.6.Conclusions: Our study suggests that hyperuricemia may not significantly increase the rate of the contrast-induced nephropathy in patients, who had undergone angiography

Antithrombin III Protects Against Contrast-Induced Nephropathy

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Zeyuan Lu

2017-03-01

Full Text Available We previously reported that insufficiency of antithrombin III (ATIII, the major anti-coagulation molecule in vivo, exacerbated renal ischemia-reperfusion injury in animal models and possibly humans. In the present study, we investigated the relationship between ATIII level and contrast induced nephropathy (CIN in patients and examined therapeutic effect of ATIII on CIN in Sprague-Dawley rats. Patients with low ATIII activity presented a higher incidence of acute kidney injury (AKI following coronary angiography. ATIII (500 μg/kg was intravenously injected before or after the induction of AKI in rats. Our data demonstrated ATIII significantly attenuated the elevation of serum creatinine, blood urea nitrogen, and renal histological injury. The beneficial effects of ATIII were accompanied by diminished renal inflammatory response, oxidative stress, cell apoptosis and improved renal blood flow in rats. In conclusion, ATIII appears to attenuate CIN through inhibiting inflammation, oxidative stress, apoptosis and improving renal blood flow. ATIII administration may represent a promising strategy for the prevention and treatment of contrast-induced AKI.

Sodium bicarbonate versus isotonic saline solution to prevent contrast-induced nephropathy : a systematic review and meta-analysis.

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Zapata-Chica, Carlos Andres; Bello Marquez, Diana; Serna-Higuita, Lina Maria; Nieto-Ríos, John Fredy; Casas-Arroyave, Fabian David; Donado-Gómez, Jorge Hernando

2015-09-30

Contrast-induced nephropathy is one of the main causes of acute kidney injury and increased hospital-acquired morbidity and mortality. The use of sodium bicarbonate for nephroprotection has emerged as a preventative strategy; however, its efficacy is controversial compared to other strategies, such as hydration using 0.9% saline solution. To compare the effectiveness of sodium bicarbonate vs. hydration using 0.9% saline solution to prevent contrast-induced acute kidney injury. A systematic review of studies registered in the COCHRANE, PUBMED, MEDLINE, LILACS, SCIELO and EMBASE databases was conducted. Randomized controlled studies that evaluated the use of 0.9% saline solution vs. sodium bicarbonate to prevent contrast-induced nephropathy were included. A total of 22 studies (5,686 patients) were included. Sodium bicarbonate did not decrease the risk of contrast-induced nephropathy (RD= 0.00; 95% CI= -0.02 to 0.03; p= 0.83; I(2)= 0%). No significant differences were found in the demand for renal replacement therapy (RD= 0.00; 95% CI= -0.01 to 0-01; I(2)= 0%; p= 0.99) or in mortality (RD= -0.00; 95% CI= -0.001 to 0.001; I(2)= 0%; p= 0.51). Sodium bicarbonate administration is not superior to the use of 0.9% saline solution for preventing contrast-induced nephropathy in patients with risk factors, nor is it better at reducing mortality or the need for renal replacement therapy.

Current concepts of contrast-induced nephropathy: A brief review

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Chao-Fu Chang

2013-12-01

Full Text Available Contrast-induced nephropathy (CIN is a common hospital-acquired acute kidney injury. Published studies on this condition have dramatically increased in recent years. This article aims to provide a brief literature review. English articles published from 1983 to 2012 were retrieved from PubMed by searching using the term “contrast-induced nephropathy.” Patients with CIN were associated with increased resource utilization, prolonged hospital stay, and increased long-term mortality. CIN is defined as a ≥0.5 mg/dL rise in serum creatinine or a 25% increase, assessed within 48–72 hours after administration of contrast medium (CM. All patients receiving CM should be evaluated for their CIN risk, especially preexisting kidney disease. The CM should be prewarmed to 37 °C and injected at the lowest possible dose. Repeat injection within 72 hours should be avoided. Either iso-osmolar CM or low-osmolar CM, except ioxaglate or iohexol, can be used in all patients. Iso-osmolar CM iodixanol may be a better choice for high-risk patients with chronic kidney disease requiring intra-arterial administration. Nephrotoxic drugs should be stopped 2 days prior to when the patient undergoes a procedure. All patients receiving CM should be at an optimal volume status. Parenteral isotonic saline without any diuretic should be started 12 hours prior to CM at a rate of 1 mL/kg/h and continued for 24 hours if there is no contraindication. In patients who require shorter volume supplement periods or are at a higher risk, bicarbonate infusion (154 mEq/L, 3 mL/kg/h for 1 hour bolus prior to CM, followed by 1 mL/kg/h for 6 hours may be used as an alternative to isotonic saline. Oral N-acetylcysteine (600 mg bid, starting on the day prior to the procedure together with parenteral hydration is suggested for patients at risk. Hemodialysis/hemofiltration is only considered in chronic kidney disease stage 4/5 patients when an access is available. The other medications

Contrast media-induced nephropathy: how has Italy contributed in the past 30 years? A systematic review

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Sessa M

2017-10-01

Full Text Available Maurizio Sessa,1,* Claudia Rossi,2,* Annamaria Mascolo,1 Cristina Scavone,1 Gabriella di Mauro,1 Roberto Grassi,2 Liberata Sportiello,1 Salvatore Cappabianca,2 Concetta Rafaniello1 1Section of Pharmacology “L Donatelli”, Department of Experimental Medicine, University of Campania “L Vanvitelli”, Naples, Italy; 2Section of Radiology and Radiotherapy, Department of Clinical and Experimental Medicine “Magrassi-Lanzara”, University of Campania “L Vanvitelli”, Naples, Italy *These authors contributed equally to this work Background and objective: The use of contrast media in Italy has exponentially increased in the past 3 decades. However, it is unknown whether there has been an increase in clinical research evaluating the risks associated with contrast media usage, especially regarding contrast-induced nephropathy. To fill this gap in knowledge, we performed a systematic review.Study eligibility criteria: Meta-analyses, observational studies, and clinical trials assessing contrast media-induced nephropathy as the safety outcome, in which at least one author was affiliated with an Italian university/health care structure, were eligble.Data sources: Ovid MEDLINE, Ovid Embase, Cochrane Methodology Register, and Web of Science were screened.Participants: Men and women exposed to contrast media.Results: In total, 60 original articles were retrieved with an incremental trend between 1990 and 2017. Cohort studies were the most common study design represented. In total, 45 of 60 (75.0% studies were monocenter studies and 41 of 60 (68.3% received no funding. In all, 91.7% of studies disclosed no conflicts of interest and 81.7% had no external collaboration. Most of the studies provided a level of evidence of III-2 (32/60; 53.3% and II (23/60; 38.3%. In total, 50 of 60 studies (83.3% were published in a scientific journal ranked in the first quartile of their subject area.Conclusion: There was an increased number of studies evaluating

Factors affecting the incidence of contrast-induced nephropathy in patients undergoing computed tomography.

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Heras Benito, M; Garrido Blázquez, M; Gómez Sanz, Y; Bernardez Mardomingo, M; Ruiz Cacho, J; Rodríguez Recio, F J; Fernández-Reyes Luis, M J

2018-05-17

To analyze the incidence of contrast-induced nephropathy in a cohort of patients undergoing computed tomography (CT) with intravenous iodinated contrast material. To evaluate the efficacy of N-acetylcysteine in preventing contrast-induced nephropathy. This prospective observational study was carried out in the months comprising March 2016 through July 2016. We selected the first five patients scheduled to undergo CT examination each day who agreed to participate and signed the informed consent form. We recorded patients' cardiovascular histories, chronic treatments, and indications for the CT examination. We measured blood levels of creatinine and urea before and after the CT examination. We used the Modification of Diet in Renal Disease (MDRD-4) equation to estimate the glomerular filtration rate. We analyzed the type and dose of contrast material. We recorded whether N-acetylcysteine was administered before the CT examination. We used SPSS 15.0 ® to compare means and proportions. Statistical significance was set at p < 0.05. No incidents of contrast-induced nephropathy were detected in any of the 202 patients included [mean age, 63.92 ± 12 years (range 22-87); 57.4% male; 21.8% diabetic; 39.6% hypertensive; 87.1% had MDRD4 ≥ 60 ml/min/1.73 m 2 (89.45 ± 14, range 62.36-134.14) and 12.9% had MDRD4 < 60 ml/min/1.73 m 2 (45.38 ± 11, range 9.16-58.90)]. The most common indication for CT examinations was oncologic (81.2%). The only contrast agent administered was iopamidol; the mean dose was 107.83 ± 11 ml (range 70-140). The mean interval between pre-CT and post-CT laboratory tests was 4.06 ± 1 days. Only 13 patients received N-acetylcysteine; 9 of these had MDRD < 60 ml/min/1.73 m 2 and 4 had MDRD4 ≥ 60 ml/min/1.73 m 2 (p = 0.000). The incidence of contrast-induced nephropathy was not significant in patients with glomerular filtration rates greater than 30 ml/min/1.73 m 2 : these favorable results might be due to

Prevenção de nefrotoxicidade por contraste com solução de bicarbonato: resultados preliminares e revisão da literatura Prevention of contrast-induced nephropathy by use of bicarbonate solution: preliminary results and literature review

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Ricardo Gonçalves da Silva

2010-09-01

contrast medium use in diagnostic and interventional procedures. The incidence of contrast-induced nephropathy in the general population is low, but increases exponentially in patients with risk factors, such as diabetes and chronic kidney disease. Several strategies have been used in order to prevent contrast-induced nephropathy. The most efficient strategies are saline hydration (0.9% or 0.45%, use of low-or iso-osmolality contrast medium, and sodium bicarbonate infusion. OBJECTIVE: The aim of this study was to review the pertinent literature and to assess the efficacy of hydration with 1.3% sodium bicarbonate compared with hydration with 0.9% saline solution in preventing contrastinduced nephropathy in high-risk patients. MATERIAL AND METHODS: A systematic search of the literature was conducted in PubMed by using the following keywords: bicarbonate, nephropathy, contrast medium, and acute kidney failure. In addition, 27 patients with diabetes and/or chronic kidney disease, diagnosed with some kind of cancer were randomized for study. RESULTS: None of the patients developed contrast-induced nephropathy characterized as a 0.5 mg/ dL-increase and/or a relative 25%-increase in baseline creatinine. CONCLUSIONS: The literature review strongly suggested that sodium bicarbonate is effective in preventing contrast-induced nephropathy. Regarding the randomized study, saline solution and bicarbonate solution had similar efficacy in preventing contrast-induced nephropathy. However, the small number of patients does not allow definite conclusions.

N-acetylcysteine and other preventive measures for contrast-induced nephropathy in the intensive care unit

NARCIS (Netherlands)

Schultz, Marcus J.; Baas, Marije C.; van der Sluijs, Hans P.; Stamkot, G. André; Smit, Watske

2006-01-01

The increase in diagnostic imaging procedures that require infusion of intravenous radiographic contrast has led to a parallel increase in the incidence of contrast-induced nephropathy (CIN). Since CIN accounts for a significant increase of hospital-acquired renal failure, length of stay and

Iodinated contrast agent-induced nephropathy

International Nuclear Information System (INIS)

Erley, C.

2007-01-01

Contrast-induced nephropathy (CIN) is a well-known complication of therapeutic and diagnostic procedures requiring contrast administration and accounts for 10% of acute renal failure in hospitalized patients. Although the incidence of this complication is relatively low, its consequences can be catastrophic. The development of CIN is associated with increased length of hospital stay, an increased requirement for acute dialysis, and an increased risk of death. Preexisting renal dysfunction, age, diabetes, congestive heart failure, and volume of administered contrast are all associated with a risk of developing CIN. Despite a large number of clinical trials that have evaluated prophylaxis strategies for CIN, no uniform strategies have been developed so far. The use of N-acetyl-L-cysteine (NAC) or theophylline in specific subgroups of patients has been shown to reduce dialysis requirement and mortality in patients undergoing angiographic procedures. Hemofiltration has also shown positive results. In this review we will discuss the epidemiology and the risk factors for CIN and the evidence for commonly employed prophylaxis strategies, and we will provide general recommendations with respect to CIN prevention and management. A practicable strategy to prevent CIN includes: correct identification of individuals at greatest risk, thorough evaluation of whether other diagnostic maneuvers could be employed instead (i.e., sonography), application of low-osmolar contrast media at the minimum acceptable dose, stopping potential nephrotoxic drugs (NSAID), hydration with sodium chloride 0.9% 1 ml/kg per h i.v. 12 h before and after CM application, administration of acetylcysteine 600 mg twice the day before and after (in cases of emergency investigation and high-risk patients 1200 mg i.v.), and theophylline (250-350 mg) the day before and the day after CM application (in cases of emergency investigation 5 mg/kg i.v.). (orig.) [de

Safety of contrast media. Focus on contrast-induced nephropathy (CIN)

International Nuclear Information System (INIS)

Kuwatsuru, Ryohei

2011-01-01

Despite advances in imaging diagnosis, contrast media still play an important role in diagnosing the existence of the disease, demonstrating the extent of disease, and determining the perfusion of the disease, which is important to make a differential diagnosis. However, the administration of contrast media may cause contrast-induced nephropathy (CIN), especially in patients with renal impairment. It is estimated that 20-30% of patients with renal impairment who received contrast media develop CIN. Though the precise cause of CIN currently remains unknown, almost all injected contrast media are excreted through the kidney and the effects of contrast media on the kidney are easily understood. As CIN is the most common cause of death due to complications after receiving contrast media, prevention of CIN is important. There are several known risk factors for CIN. Patients with renal impairment, diabetes mellitus, and dehydration are at high risk for CIN. Furthermore, a high osmolar contrast media, excessive amount of contrast media, and ionic contrast media are also risk factors for CIN. CIN can be prevented in several ways. Certain drugs seem to be useful to prevent CIN, while others are harmful. Hydration is useful to prevent CIN, although there is no widely acceptable hydration method to prevent CIN. Both sodium bicarbonate and N-acetylcysteine are promising candidates for prevention of CIN. There are few reports to study CIN after intravenous administration, although reports of CIN after percutaneous cardiac intervention (PCI) and angiography are well recognized. In clinical situations, intravenous administration of contrast media is common. Therefore, a study of CIN after intravenous administration of contrast media should be performed. (author)

Reducing the Risks for Contrast-Induced Nephropathy

International Nuclear Information System (INIS)

Stacul, Fulvio

2005-01-01

Contrast-induced nephropathy (CIN) is one of the most serious adverse events associated with the use of contrast media (CM). Patients who develop this complication can have increased morbidity, higher rates of mortality, lengthy hospital stays, and poor long-term outcomes. Although CIN cannot be eliminated, the chances of developing this condition can be reduced by using appropriate prevention strategies. An important first step to reduce the chance of CIN is to identify risk factors associated with this condition. Patients with a previously elevated serum creatinine level, especially when secondary to diabetic nephropathy, are at great risk for developing CIN. Other patient-related risk factors include concurrent use of nephrotoxic medications, dehydration, congestive heart failure, age greater than 70 years, and probably the presence of diabetes mellitus even if serum creatinine is normal. Adequate hydration is widely accepted as an important prophylactic measure for preventing CIN, but the optimal hydration regimen is still debatable. The risk of CIN increases with greater doses of CM, as well as with the type of CM used. A high-osmolar CM poses a greater risk of CIN than does a low-osmolar CM and, as recent but limited data suggest, the use of an iso-osmolar CM is less nephrotoxic than a low-osmolar CM in patients with renal impairment following intra-arterial procedures, although this finding needs to be verified in future clinical studies. Pharmacologic agents such as calcium channel blockers, dopamine, atrial natriuretic peptide, fenoldopam, prostaglandin E1, and endothelin receptor antagonist have not been proven effective against CIN development. Controversies still exist on the possible effectiveness of theophylline and N-acetylcysteine. Simple strategies for the prevention of CIN in at-risk patients are reviewed and unproven interventions are discussed

Iodinated contrast agent-induced nephropathy; Mit jodhaltigen Kontrastmitteln induzierte Nephropathie

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Erley, C. [St. Joseph-Krankenhaus Berlin, Berlin (Germany)

2007-09-15

Contrast-induced nephropathy (CIN) is a well-known complication of therapeutic and diagnostic procedures requiring contrast administration and accounts for 10% of acute renal failure in hospitalized patients. Although the incidence of this complication is relatively low, its consequences can be catastrophic. The development of CIN is associated with increased length of hospital stay, an increased requirement for acute dialysis, and an increased risk of death. Preexisting renal dysfunction, age, diabetes, congestive heart failure, and volume of administered contrast are all associated with a risk of developing CIN. Despite a large number of clinical trials that have evaluated prophylaxis strategies for CIN, no uniform strategies have been developed so far. The use of N-acetyl-L-cysteine (NAC) or theophylline in specific subgroups of patients has been shown to reduce dialysis requirement and mortality in patients undergoing angiographic procedures. Hemofiltration has also shown positive results. In this review we will discuss the epidemiology and the risk factors for CIN and the evidence for commonly employed prophylaxis strategies, and we will provide general recommendations with respect to CIN prevention and management. A practicable strategy to prevent CIN includes: correct identification of individuals at greatest risk, thorough evaluation of whether other diagnostic maneuvers could be employed instead (i.e., sonography), application of low-osmolar contrast media at the minimum acceptable dose, stopping potential nephrotoxic drugs (NSAID), hydration with sodium chloride 0.9% 1 ml/kg per h i.v. 12 h before and after CM application, administration of acetylcysteine 600 mg twice the day before and after (in cases of emergency investigation and high-risk patients 1200 mg i.v.), and theophylline (250-350 mg) the day before and the day after CM application (in cases of emergency investigation 5 mg/kg i.v.). (orig.) [German] Die Kontrastmittelnephropathie (contrast-induced

Recommendation to use iso-osmotic contrast medium in interventional treatment

International Nuclear Information System (INIS)

Zhou Bing; Cheng Yongde

2012-01-01

With the rapid development of imaging diagnostic and interventional therapeutic techniques, the contrast medium (CM) has been used more and more common in clinical practice, and meanwhile more and more attention has been paid to the CM-related adverse events. Contrast induced nephropathy (CN) is the most common CM-related adverse event, and CM-related neurotoxicity has already attracted the physicians' attention. The osmotic pressure of the iso-osmotic contrast medium (IOCM) is quite the same as that of the plasma, and therefore its safety is higher than that of low-osmotic contrast medium (LOCM), the patient's tolerance to IOCM is better than that to LOCM. For this reason, the use of IOCM should be strongly recommended in interventional procedures, which is of great significance to the reduction of the occurrence of CM-related adverse events. (authors)

[Vitamin C+sodium bicarbonate versus sodium bicarbonate alone in preventing contrast-induced nephropathy].

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Laroussi, L; Triki, M; Ibn Elhaj, Z; Ben Halima, A; Boukhris, M; Ben Amara, W; Keskes, H; Kraiem, S; Lahidheb, D; Marrakchi, S; Kammoun, I; Addad, F; Kachboura, S

2017-09-01

Contrast-induced nephropathy (CIN) is a common and severe complication in interventional cardiology. The aim of our study was to compare the incidence of contrast-induced nephropathy in two accelerated hydration protocols: the first one by the serum bicarbonate and the second combining the serum bicarbonate and oral vitamin C. This is a multicenter prospective, randomized study conducted between October 2012 and May 2013, including 160 patients. The mean age of our study population was 60.8±9.3 years (36-83 years). The two study groups were comparable in terms of cardiovascular risk factors, concomitant medication, and baseline serum creatinine. The CIN incidence was 6.3% in the vitamin C group and 10% in the control group (P=0.38). No significant difference was observed in terms of CIN incidence between the different subgroups analyzed. According to our study, ascorbic acid administered orally as part of an accelerated hydration protocol does not reduce the incidence of CIN. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Guideline adherence for identification and hydration of high-risk hospital patients for contrast-induced nephropathy.

NARCIS (Netherlands)

Schilp, J.; Blok, C. de; Langelaan, M.; Spreeuwenberg, P.; Wagner, C.

2014-01-01

Background: Contrast-induced nephropathy (CIN) is a common cause of acute renal failure in hospital patients. To prevent CIN, identification and hydration of high-risk patients is important. Prevention of CIN by hydration of high-risk patients was one of the themes to be implemented in the Dutch

Guideline adherence for identification and hydration of high-risk hospital patients for contrast-induced nephropathy

NARCIS (Netherlands)

Schilp, J.; de Blok, C.; Langelaan, M.; Spreeuwenberg, P.; Wagner, C.

2014-01-01

Background: Contrast-induced nephropathy (CIN) is a common cause of acute renal failure in hospital patients. To prevent CIN, identification and hydration of high-risk patients is important. Prevention of CIN by hydration of high-risk patients was one of the themes to be implemented in the Dutch

Contrast-Induced Nephropathy in Patients Undergoing Percutaneous Coronary Intervention

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Sana Shoukat

2010-01-01

Full Text Available Contrast Induced Nephropathy (CIN is a feared complication of numerous radiological procedures that expose patients to contrast media. The most notorious of these procedures is percutaneous coronary intervention (PCI. Not only is this a leading cause of morbidity and mortality, but it also adds to increased costs in high risk patients undergoing PCI. It is thought to result from direct cytotoxicity and hemodynamic challenge to renal tissue. CIN is defined as an increase in serum creatinine by either ≥0.5 mg/dL or by ≥25% from baseline within the first 2-3 days after contrast administration, after other causes of renal impairment have been excluded. The incidence is considerably higher in diabetics, elderly and patients with pre-existing renal disease when compared to the general population. The nephrotoxic potential of various contrast agents must be evaluated completely, with prevention as the mainstay of focus as no effective treatment exists. The purpose of this article is to examine the pathophysiology, risk factors, and clinical course of CIN, as well as the most recent studies dealing with its prevention and potential therapeutic interventions, especially during PCI. The role of gadolinium as an alternative to iodinated contrast is also discussed.

Nephrogenic systemic fibrosis versus contrast-induced nephropathy: risks and benefits of contrast-enhanced MR and CT in renally impaired patients

DEFF Research Database (Denmark)

Martin, Diego R; Semelka, Richard C; Chapman, Arlene

2009-01-01

-sectional imaging modality. Factors to consider include the relative risks of the contrast agent. Other factors include the relative procedural risks, including radiation risks and the relative expected diagnostic yield of the examination technique (12). In this review we describe both nephrogenic systemic fibrosis...... and contrast-induced nephropathy to compare the implications with regard to relative risks and benefits of contrast-enhanced MRI or CT in patients with impaired renal function. J. Magn. Reson. Imaging 2009;30:1350-1356. (c) 2009 Wiley-Liss, Inc....

Prevention of Contrast-Induced Nephropathy in STEMI Patients Undergoing Primary Percutaneous Coronary Intervention

DEFF Research Database (Denmark)

Busch, Sarah Victoria Ekeløf; Jensen, Svend Eggert; Rosenberg, Jacob

2012-01-01

-acetylcysteine, one study of early and late hydration regimens, one study of recombinant human brain natriuretic peptide and one study comparing a low-osmolar contrast agent with an iso-osmolar contrast agent. Results: Recombinant human brain natriuretic peptide and the regimens of hydration significantly reduced...... the incidence of CIN and administration of N-acetylcysteine in one of the six studies significantly reduced the occurrence of CIN. The iso-osmolar contrast agent was not proven to be superior to the low-osmolar contrast agent in terms of preventing CIN. Conclusion: Preliminary studies are promising but further......Objective: To evaluate the current prophylactic strategies against CIN in patients with STEMI treated by primary percutaneous coronary intervention. Background: Contrast-induced nephropathy (CIN) is the third leading course of acute renal failure and a recognized complication to cardiac...

Simvastatin Attenuates Contrast-Induced Nephropathy through Modulation of Oxidative Stress, Proinflammatory Myeloperoxidase, and Nitric Oxide

Directory of Open Access Journals (Sweden)

Ketab E. Al-Otaibi

2012-01-01

Full Text Available Contrast media- (CM- induced nephropathy is a serious complication of radiodiagnostic procedures. Available data suggests that the development of prophylaxis strategies is limited by poor understanding of pathophysiology of CM-induced nephropathy. Present study was designed to determine the role of oxidative stress, myeloperoxidase, and nitric oxide in the pathogenesis of iohexol model of nephropathy and its modification with simvastatin (SSTN. Adult Sprague Dawley rats were divided into seven groups. After 24 h of water deprivation, all the rats except in control and SSTN-only groups were injected (10 ml/kg with 25% glycerol. After 30 min, SSTN (15, 30, and 60 mg/kg was administered orally, daily for 4 days. Twenty-four hours after the glycerol injection, iohexol was infused (8 ml/kg through femoral vein over a period of 2 min. All the animals were sacrificed on day 5 and blood and kidneys were collected for biochemical and histological studies. The results showed that SSTN dose dependently attenuated CM-induced rise of creatinine, urea, and structural abnormalities suggesting its nephroprotective effect. A significant increase in oxidative stress (increased lipid hydroperoxides and reduced glutathione levels and myeloperoxidase (MPO and decreased nitric oxide in CM group were reversed by SSTN. These findings support the use of SSTN to combat CM-induced nephrotoxicity.

Preprocedural Prediction Model for Contrast-Induced Nephropathy Patients.

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Yin, Wen-Jun; Yi, Yi-Hu; Guan, Xiao-Feng; Zhou, Ling-Yun; Wang, Jiang-Lin; Li, Dai-Yang; Zuo, Xiao-Cong

2017-02-03

Several models have been developed for prediction of contrast-induced nephropathy (CIN); however, they only contain patients receiving intra-arterial contrast media for coronary angiographic procedures, which represent a small proportion of all contrast procedures. In addition, most of them evaluate radiological interventional procedure-related variables. So it is necessary for us to develop a model for prediction of CIN before radiological procedures among patients administered contrast media. A total of 8800 patients undergoing contrast administration were randomly assigned in a 4:1 ratio to development and validation data sets. CIN was defined as an increase of 25% and/or 0.5 mg/dL in serum creatinine within 72 hours above the baseline value. Preprocedural clinical variables were used to develop the prediction model from the training data set by the machine learning method of random forest, and 5-fold cross-validation was used to evaluate the prediction accuracies of the model. Finally we tested this model in the validation data set. The incidence of CIN was 13.38%. We built a prediction model with 13 preprocedural variables selected from 83 variables. The model obtained an area under the receiver-operating characteristic (ROC) curve (AUC) of 0.907 and gave prediction accuracy of 80.8%, sensitivity of 82.7%, specificity of 78.8%, and Matthews correlation coefficient of 61.5%. For the first time, 3 new factors are included in the model: the decreased sodium concentration, the INR value, and the preprocedural glucose level. The newly established model shows excellent predictive ability of CIN development and thereby provides preventative measures for CIN. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Contrast-induced nephropathy in patients with diabetes mellitus between iso- and low-osmolar contrast media: A meta-analysis of full-text prospective, randomized controlled trials.

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Han, Xiao-Fang; Zhang, Xin-Xiu; Liu, Ke-Mei; Tan, Hua; Zhang, Qiu

2018-01-01

This study was conducted to compare iso-osmolar contrast medium, iodixanol, with low-osmolar contrast media (LOCM) for assessing contrast-induced nephropathy (CIN) incidence, exclusively in the diabetic population. A systematic search was conducted for full-text, prospective, randomized controlled trials (RCTs). The primary outcome was incidence of CIN. Medline, Cochrane Central Register of Controlled Trials, and other sources were searched until May 31, 2017. Twelve RCTs finally met the search criteria. Iodixanol did not significantly reduce the risk of CIN (risk ratio [RR]: 0.72, 95% confidence interval (CI): [0.49, 1.04], p = 0.08). However, there was significantly reduced risk of CIN when iodixanol was compared to a LOCM agent iohexol (RR: 0.32, 95% CI [0.12, 0.89]). There were no differences between iodixanol and the other non-iohexol LOCM (RR: 0.92, 95% CI [0.68, 1.25]). In diabetic populations, iodixanol is not associated with a significant reduction of CIN risk. Iodixanol is associated with a reduced risk of CIN compared with iohexol, whereas no significant difference between iodixanol and other LOCM could be found.

High incidence of nephropathy in neurosurgical patients after intra-arterial administration of low-osmolar and iso-osmolar contrast media.

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Serafin, Zbigniew; Karolkiewicz, Maciej; Gruszka, Marzena; Strózecki, Pawel; Lasek, Wladyslaw; Odrowaz-Sypniewska, Grazyna; Manitius, Jacek; Beuth, Wojciech

2011-05-01

Percutaneous endovascular examinations and interventions require significant amounts of iodinated contrast media (CM) and have been reported to be complicated by an increased incidence of post-contrast nephropathy. To evaluate renal function, the incidence of post-contrast nephropathy, and risk factors after interventional procedures in neurosurgical patients after intra-arterial administration of a low-osmolar contrast medium (LOCM) versus an iso-osmolar contrast medium (IOCM). This single-center, prospective, randomized, double-blinded study included 92 patients in its final analysis (mean age 49.6 ± 12.6 years, 29.3% men, mean eGFR 97.8 ± 26.3 mL/min/1.73 m(2)). LOCM was used in 48 patients (52.2%) and IOCM in 44 patients (47.8%). The patients were given an average of 151.2 ± 52.1 mL of contrast medium intra-arterially. Serum creatinine (SCr), urinary N-acetyl-β-glucosaminidase (NAG) excretion, and creatinine clearance (CCr) were measured at baseline, and on days 1 and 3 after the procedure. Baseline risk factors, renal functional parameters, and average CM doses were not statistically different between the two groups. SCr, NAG, and CCr values did not differ significantly between the LOCM and IOCM groups on days 1 and 3 after CM administration. Nephropathy developed in 21 cases (22.8%): 13 (27.1%) after LOCM use and 8 (18.2%) after IOCM; (P = NS). The only significant risk factors of CIN were the diabetes (P = 0.0466) and atherosclerosis (P = 0.0498). We found a high incidence of nephropathy in neurosurgical patients after intra-arterial CM administration. The renal function values and incidence of nephropathy following LOCM administration were not statistically different from those following IOCM administration.

How to reduce nephropathy following contrast-enhanced CT: A lesson in policy implementation

International Nuclear Information System (INIS)

Richenberg, J.

2012-01-01

In excess of 50 contrast-enhanced computed tomography (CT) examinations are typically undertaken in our tertiary hospital NHS Trust each weekday, approximately 13,000 each year. In the Department of Radiology alone, we inject more than 1300 l of iodinated contrast medium per annum. There is a real need to devise a policy to anticipate contrast medium-induced nephropathy (CIN) and minimize its effects, without disrupting the high-intensity CT service. Having written a comprehensive yet pragmatic policy to reduce the incidence of this iatrogenic condition, it seemed sensible to share it with the wider radiology community and share the experience and lessons learnt in engaging all the stakeholders, ushering in the change with as little fuss as possible. The ramifications on primary and secondary care had to be anticipated, resource implications managed, and staff trained. This review is therefore presented in four sections: framing the problem, assessing its size and nature; a succeeding section on the available guidelines and their uptake; the policy itself to reduce CIN in CT is presented in the third section; and crucially, a description of the policy introduction process in the last section.

Lansoprazole halts contrast induced nephropathy through activation of Nrf2 pathway in rats.

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Khaleel, Sahar A; Alzokaky, Amany A; Raslan, Nahed A; Alwakeel, Asmaa I; Abd El-Aziz, Heba G; Abd-Allah, Adel R

2017-05-25

Contrast-induced nephropathy (CIN) is an important cause of acute kidney injury characterized by significant mortality and morbidity. To date, there is no successful protective regimen for CIN especially in poor kidney function patients. Lansoprazole has been shown to exert antioxidant action through induction of nuclear factor-erythroid 2-related factor 2 (Nrf2) pathway. The aim of the present study is to investigate the potential of lansoprazole to activate Nrf2 pathway in the kidney and consequently to protect against oxidative stress induced by iodinated contrast media. Lansoprazole, at a dose of 100 mg/kg, showed a significant induction of Nrf2 mRNA after 3 h. Administration of contrast media induced significant increase in serum creatinine and blood urea nitrogen, histological deterioration, and reduction in total antioxidant capacity. Moreover, it instigated the defensive Nrf2 gene expression and immunoreactivity. In addition, there were overexpression of HO-1, caspase 3, p53 and IL6 genes and downregulation of Bcl2 gene. Pre-treatment with lansoprazole (100 mg/kg) ameliorated the nephrotoxicity parameters and oxidative stress, improved histological lesions, and hijacked apoptotic and inflammatory markers that were provoked by contrast media. In conclusion, lansoprazole attenuates experimental CIN which might be due to activation of Nrf2 antioxidant defence pathway. These findings highlight the potential benefit of incorporating lansoprazole in the protective regimen against CIN especially for susceptible patients. Copyright © 2017 Elsevier B.V. All rights reserved.

Incidence of contrast-induced nephropathy in hospitalised patients with cancer

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Cicin, Irfan; Erdogan, Bulent; Gulsen, Emrah; Uzunoglu, Sernaz; Kodaz, Hilmi [Trakya University, Department of Medical Oncology, Faculty of Medicine, Edirne (Turkey); Sut, Necdet [Trakya University, Department of Biostatistics, Faculty of Medicine, Edirne (Turkey); Turkmen, Esma [Trakya University, Department of Medical Oncology, Faculty of Medicine, Edirne (Turkey); Trakya Ueniversitesi Hastanesi Medikal Onkoloji Bilim Dali, Edirne (Turkey); Ustundag, Sedat [Trakya University, Department of Nephrology, Faculty of Medicine, Edirne (Turkey)

2014-01-15

To determine the frequency of and possible factors related to contrast-induced nephropathy (CIN) in hospitalised patients with cancer. Ninety adult patients were enrolled. Patients with risk factors for acute renal failure were excluded. Blood samples were examined the day before contrast-enhanced computed tomography (CT) and serially for 3 days thereafter. CIN was defined as an increase in serum creatinine (Cr) of 0.5 mg/dl or more, or elevation of Cr to 25 % over baseline. Relationships between CIN and possible risk factors were investigated. CIN was detected in 18/90 (20 %) patients. CIN developed in 25.5 % patients who underwent chemotherapy and in 11 % patients who did not (P = 0.1). CIN more frequently developed in patients who had undergone CT within 45 days after the last chemotherapy (P = 0.005); it was also an independent risk factor (P = 0.017). CIN was significantly more after treatment with bevacizumab/irinotecan (P = 0.021) and in patients with hypertension (P = 0.044). The incidence of CIN after CT in hospitalised oncological patients was 20 %. CIN developed 4.5-times more frequently in patients with cancer who had undergone recent chemotherapy. Hypertension and the combination of bevacizumab/irinotecan may be additional risk factors for CIN development. (orig.)

Anemia and the risk of contrast-induced nephropathy in patients with renal insufficiency undergoing contrast-enhanced MDCT

International Nuclear Information System (INIS)

Murakami, Ryusuke; Kumita, Shin-ichiro; Hayashi, Hiromitsu; Sugizaki, Ken-ichi; Okazaki, Emi; Kiriyama, Tomonari; Hakozaki, Kenta; Tani, Hitomi; Miki, Izumi; Takeda, Minako

2013-01-01

Purpose: The purpose of this study was to assess the effect of anemia on the incidence of contrast-induced nephropathy (CIN) in patients with renal impairment undergoing MDCT. Materials and methods: Institutional review board approval was waived for this retrospective review of 843 patients with stable renal insufficiency (eGFR between 15 and 60 mL/min) who had undergone contrast-enhanced MDCT. Baseline hematocrit and hemoglobin values were measured. Serum creatinine (SCr) was assessed at the baseline and at 48–72 h after contrast administration. Results: The overall incidence of CIN in the patient population with renal insufficiency was 6.9%. CIN developed in 7.8% (54 of 695) of anemic patients, and in 2.8% (4 of 148) of non-anemic patients (P = .027). After adjustment for confounders, low hemoglobin and low hematocrit values remained independent predictors of CIN (odds ratio 4.6, 95% CI 1.0–20.5, P = .046). Conclusions: Anemia is associated with a higher incidence of CIN in patients with renal insufficiency. Anemia is a potentially modifiable risk factor for CIN, and has an unfavorable impact on prognosis in patients with renal insufficiency undergoing contrast-enhanced MDCT

Anemia and the risk of contrast-induced nephropathy in patients with renal insufficiency undergoing contrast-enhanced MDCT

Energy Technology Data Exchange (ETDEWEB)

Murakami, Ryusuke, E-mail: rywakana@nms.ac.jp; Kumita, Shin-ichiro; Hayashi, Hiromitsu; Sugizaki, Ken-ichi; Okazaki, Emi; Kiriyama, Tomonari; Hakozaki, Kenta; Tani, Hitomi; Miki, Izumi; Takeda, Minako

2013-10-01

Purpose: The purpose of this study was to assess the effect of anemia on the incidence of contrast-induced nephropathy (CIN) in patients with renal impairment undergoing MDCT. Materials and methods: Institutional review board approval was waived for this retrospective review of 843 patients with stable renal insufficiency (eGFR between 15 and 60 mL/min) who had undergone contrast-enhanced MDCT. Baseline hematocrit and hemoglobin values were measured. Serum creatinine (SCr) was assessed at the baseline and at 48–72 h after contrast administration. Results: The overall incidence of CIN in the patient population with renal insufficiency was 6.9%. CIN developed in 7.8% (54 of 695) of anemic patients, and in 2.8% (4 of 148) of non-anemic patients (P = .027). After adjustment for confounders, low hemoglobin and low hematocrit values remained independent predictors of CIN (odds ratio 4.6, 95% CI 1.0–20.5, P = .046). Conclusions: Anemia is associated with a higher incidence of CIN in patients with renal insufficiency. Anemia is a potentially modifiable risk factor for CIN, and has an unfavorable impact on prognosis in patients with renal insufficiency undergoing contrast-enhanced MDCT.

Na/K citrate versus sodium bicarbonate in prevention of contrast-induced nephropathy

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Sameh Mohamed Abouzeid

2016-01-01

Full Text Available Contrast-induced nephropathy (CIN is one of the important complications of radiographic procedures, especially in patients with chronic kidney disease. It is also one of the common causes of acute kidney injury. The pathogenesis is postulated to be the effect of oxygen- free radicals and hyperosmolar stress on the renal medulla. It is reported that the production of superoxide is most active at acid environment. K/Na citrate is well known as a urine alkalini- zation medium, and this has been evaluated earlier with standard hydration for reduction of CIN and was stated to be efficient. We aimed to determine the efficacy of Na/K citrate in reducing the frequency of CIN in comparison to sodium bicarbonate in patients after coronary angiography. Two hundred and ten patients with renal dysfunction [estimated glomerular filtration rate (eGFR, 60 mL/min/1.73 m2or less] who underwent elective or emergency coronary angiography (CAG with/without percutaneous coronary intervention (PCI at our institution were enrolled into the study. The patients were randomized into two groups, Group 1-Taking Na/K citrate and Group 2-Taking sodium bicarbonate. Radiographic contrast agent iohexol was used. Change in creatinine, percent change in creatinine, percent change in eGFR, change in serum potassium, and urine pH were all compared between the two groups. There was no significant difference for prevention of CIN when comparing the Na/K citrate with sodium bicarbonate solution in patients exposed to CAG with or without PCI. Mean absolute change in eGFR after 48 h after administration of contrast between sodium bicarbonate group and Na/K citrate group was −0.60 ± 1.58 versus −0.71 ± 1.38. Serum potassium decreased postprocedure in the sodium bicarbonate group than in the citrate group (3.90 ± 0.33 vs. 4.14 ± 0.39. Both agents are equally effective in reducing the incidence of CIN, but the citrate would possibly be a safer option for patients at risk of

Low incidence of nephropathy in surgical ICU patients receiving intravenous contrast : a retrospective analysis

NARCIS (Netherlands)

Haveman, Jan Willem; Gansevoort, Ron T.; Bongaerts, Alfons H. H.; Nijsten, Maarten W. N.

Objective: Various studies have documented a markedly high incidence of contrast-induced nephropathy (CIN). Most of these studies were conducted in patients not in the ICU. In ICU patients intravenous contrast may be withheld for fear of CIN. We investigated the incidence of CIN in ICU patients.

A network meta-analysis on randomized trials focusing on the preventive effect of statins on contrast-induced nephropathy

DEFF Research Database (Denmark)

Peruzzi, Mariangela; De Luca, Leonardo; Thomsen, Henrik S

2014-01-01

-analysis. Randomized trials focusing on statins were searched and pooled with random-effect odds ratios. A total of 14 trials (6,160 patients) were included, focusing on atorvastatin (high/low dose), rosuvastatin (high dose), simvastatin (high/low dose), and placebo or no statin therapy before contrast administration....... The risk of contrast-induced nephropathy was reduced by atorvastatin high dose and rosuvastatin high dose, with no difference between these two agents. Results for atorvastatin low dose and simvastatin (high/low dose) in comparison to placebo were inconclusive. Atorvastatin and rosuvastatin administered...

Contrast nephropathy in high-risk patients undergoing coronary angiography and intervention

International Nuclear Information System (INIS)

Uddin, M.A.; Rabbani, M.A.; Jafary, F.H.; Bhatti, M.A.; Islam, M.

2005-01-01

Objective: To determine the incidence of contrast nephropathy in high-risk patients undergoing coronary angiography and percutaneous coronary intervention (PCI), and to define the characteristics of this cohort. Design: Descriptive study. Place and Duration of Study: The Aga Khan University Hospital, Karachi from January to December 2002. Patients and Methods: One hundred and fifteen patients with serum creatinine greater than 1.4mg/dl who underwent coronary angiography or PCI were included. All patients received non-ionic contrast dye. Acute contrast nephropathy was defined as rise in serum creatinine of >0.5mg/dl within 48 hours following the index procedure. Means and standard deviations were calculated for continuous variables and frequencies for categorical variables. Results: Mean age of patients was 62.3 year + 8.83. Mean pre-contrast creatinine was 1.9+0.9mg/dl. Eleven (9.65%) patients developed contrast nephropathy. 4.4% of patients with serum creatinine 4.0(p-value 0.001). 11.9% diabetic patients developed nephropathy compared to 6.3% of non-diabetics (p-value 0.355). 11.4% of hypertensive and 3.7% of non-hypertensive patients developed contrast-nephropathy (p-value 0.454). 12.9% of low dose group ( 100ml) developed nephropathy (p-value 0.188). Mean serum creatinine in low dose group was higher (3.0mg/dl vs. 1.7 mg/dl). Conclusion: The incidence of contrast nephropathy in this study was similar to that reported in literature. Risk of CIN was found to be significantly proportional to the severity of baseline renal disease. Trends towards higher risk of CIN were seen in patients with diabetes and hypertension. Higher incidence of CIN in patients receiving low-dose contrast was confounded by higher baseline serum creatinine in that group. (author)

A prospective study on the risk of contrast induced nephropathy in the patients who underwent contrast-enhanced CT examination

International Nuclear Information System (INIS)

Zhang Baocui; Zhang Yudong; Zhao Kai; Wang Xiaoying; Jiang Xuexiang

2013-01-01

Objective: To investigate the incidence of contrast induced nephropathy (CIN) among different patient groups after contrast agent injection. Methods: A total of 1243 patients were included in this study (male = 694, female = 549). The SCr level one week before and 72 hours after the CT examination and the incidence of CIN were recorded and comparison was made among groups according to sex, age, body mass index (BMI), the history of high blood pressure (HBP), diabetes mellitus (DM), chronic kidney disease (CKD), chronic heart failure (CHF), tumor, nephrotoxicity drug (NTD) usage. The frequency, type, dose and injection velocity of the contrast media (CM) were also recorded. Multivariate predictors of CIN were identified by Logistic regression using step-wise selection with entry and exit criteria of P 1). Conclusion: Women, age ≥ 75 years, LOCM, NTD, tumor, and the frequency of using CM more than once per month were more likely to develop CIN. (authors)

Use of cystatin C and serum creatinine for the diagnosis of contrast-induced nephropathy in patients undergoing contrast-enhanced computed tomography at an oncology centre.

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Joao Italo Fortalesa Melo

Full Text Available Our aim was to assess renal function using as laboratory measurements serum creatinine and cystatin C concentrations before and after administration of low-osmolarity (nonionic iodinated contrast medium in patients with cancer undergoing computed tomography (CT.This prospective study included 400 oncologic outpatients. Serum creatinine and cystatin C concentrations were measured before and 72 h after contrast administration. Glomerular filtration rates (GFRs were estimated using serum creatinine-based [Modification of Diet in Renal Disease (MDRD and Cockroft-Gault and cystatin C based (Larsson equations. Exploratory data analysis was performed. The nonparametric Wilcoxon test was used to compare pre and post contrast of test results and estimated clearance. The confidence interval used in the analysis was 95%.Compared with the pre-contrast values, the mean serum creatinine concentration was significantly higher and average GFRs estimated using MDRD and Cockcroft-Gault equations were significantly lower after the administration of contrast (p <0.001. It was also observed a significant increase after contrast in the concentration of Cystatin C (p = 0.015. In addition, a decrease in GFR estimated using the average Larsson (p = 0.021 was observed between time points. However, none of the patients presented clinically significant nephropathy.Assessment using serum creatinine and cystatin C concentrations showed changes in renal function among patients with cancer undergoing contrast-enhanced CT examination in this study. No significant renal damage related to the use of low-osmolarity iodinated contrast medium of the type and dosage employed in this study was observed. This contrast medium is thus safe for use in patients with cancer.

Contrast induced nephropathy in hypertensive patients after elective percutaneous coronary intervention

Science.gov (United States)

Aryfa Andra, Cut; Khairul, Andi; Aria Arina, Cut; Mukhtar, Zulfikri; Nyak Kaoy, Isfanuddin

2018-03-01

Contrast induced nephropathy (CIN) is the third lead cause of hospital acquired renal failure and was associated with significant morbidity and mortality. We hypothesized that hypertension is an independent risk factor for the development of CIN in patients undergoing elective percutaneous coronary intervention (PCI). The case-control method was used, 138 patients scheduled for elective PCI. We measured serum creatinine at baseline and after 24 hours of the procedure. CIN was defined as arising in serum creatinine of at least 44 μmol/l (0,5 mg/dl) or 25% rise from baseline. All patients received low osmolality nonionic contrast during PCI. Hypertension was defined as self-reported a history of treated or untreated diagnosed high blood pressure. One hundred thirty-eight patients (74,6%) were male, and 35 patients (25,4%) were female. Among the 138 patients, 86 (62,3%) were hypertensive patients whereas 52 (37,7%) were nonhypertensive patients. There was no difference in baseline serum creatinine levels and the amount of contrast media in patient with and without CIN. CIN developed in 42 patients, 39 patients (92,9%) were hypertensive compared to 3 patients (7,1%) without hypertension with p value < 0,05. (Odds ratio 16,8, 95% CI 4.542 - 62,412). This study showed that hypertension was a risk factor for the development of CIN

Contrast induced nephropathy in patients undergoing intravenous (IV) contrast enhanced computed tomography (CECT) and the relationship with risk factors: a meta-analysis.

Science.gov (United States)

Moos, Shira I; van Vemde, David N H; Stoker, Jaap; Bipat, Shandra

2013-09-01

To summarize the incidence of contrast-induced nephropathy (CIN) and associations between CIN incidence and risk factors in patients undergoing intravenous contrast-enhanced computed tomography (CECT) with low- or iso-osmolar iodinated contrast medium. This review is performed in accordance with the preferred reporting items in systematic reviews and meta-analysis (PRISMA) guidelines. We searched the MEDLINE, EMBASE and Cochrane databases from 2002 till November 2012. Two reviewers included papers and extracted data. The pooled data were analysed by either fixed or random-effects approach depending on heterogeneity defined as the I(2) index. 42 articles with 18,790 patients (mean age 61.5 years (range: 38-83 years)) were included. The mean baseline eGFR was 59.8 mL/min and ranged from 4 to 256 mL/min. Of all patients 45.0% had an estimated glomerular filtration rate (eGFR)65 years and use of non-steroidal anti-inflammatory drugs (NSAID's) with odds ratios of 1.73 (95%CI: 1.06-2.82), 1.87 (95%CI: 1.55-2.26), 1.79 (95%CI: 1.03-3.11), 1.95 (95%CI: 1.02-3.70) and 2.32 (95%CI: 1.04-5.19), respectively while hypertension, anaemia and CFH were not associated (p=0.13, p=0.38, p=0.40). The mean incidence of CIN after intravenous iodinated CECT was low and associated with renal insufficiency, diabetes, presence of malignancy, old age and NSAID's use. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

The use of nitrates in the prevention of contrast-induced nephropathy in patients hospitalized after undergoing percutaneous coronary intervention.

Science.gov (United States)

Peguero, Julio G; Cornielle, Vertilio; Gomez, Sabas I; Issa, Omar M; Heimowitz, Todd B; Santana, Orlando; Goldszer, Robert C; Lamas, Gervasio A

2014-05-01

Contrast-induced nephropathy (CIN) is a significant cause of morbidity and mortality and effective strategies for its prevention are greatly needed. The purpose of this retrospective, single-center study was to investigate whether nitrate use during percutaneous coronary artery intervention reduces the incidence of CIN. Chart review of all individuals who underwent percutaneous coronary intervention (PCI) from April 2010 to March 2011 was done. Included in the study were patients who were admitted to the hospital after percutaneous coronary artery intervention and had baseline and follow-up creatinine measured. Patients with end-stage renal disease requiring dialysis and those patients with insufficient information to calculate Mehran score were excluded. There were 199 patients who met the eligibility criteria for inclusion in this study. In the identified population, postprocedure renal function was compared between 112 patients who received nitrates prior to coronary intervention and 87 who did not. Baseline characteristics were similar between the 2 groups. Contrast-induced nephropathy was defined as either a 25% or a 0.5 mg/dL, or greater, increase in serum creatinine during the first 48 to 72 hours after contrast exposure. Overall, 43 (21.6%) patients developed CIN post-PCI. Of the patients who received nitrates, 15.2% developed renal impairment when compared to 29.9% in those who did not (odds ratio [OR] = 0.42, 95% confidence interval [CI] 0.21-0.84, P = .014). Multivariate logistic regression analysis demonstrated that nitrate use was independently correlated with a reduction in the development of contrast nephropathy (OR = 0.334, 95% CI 0.157-0.709, P = .004). Additionally, of the various methods of nitrate administration, intravenous infusion was shown to be the most efficacious route in preventing renal impairment (OR = 0.42, 95% CI 0.20-0.90, P = .03). In conclusion, the use of nitrates prior to PCI, particularly intravenous nitroglycerin infusion, may

The role of theophylline in prevention of radiocontrast media-induced nephropathy

Directory of Open Access Journals (Sweden)

Malhis Mahmoud

2010-01-01

Full Text Available Contrast media induced nephropathy (CIN results in significant morbidity and mortality. We therefore investigated whether theophylline (adenosine antagonist reduces the inci-dence of contrast media induced nephropathy. Two hundred and eighty patients were randomly assigned to prophylactic administration of hydration with sodium bicarbonate plus theophylline (either orally or intravenously (n=128 or hydration with sodium bicarbonate only (n=152. Blood Urea, creatinine, and glomerular filtration rate (MDRD were measured before and after administration of contrast media. Both groups were similar in clinical characteristics and amount of contrast used. Theophylline prophylaxis significantly reduced the incidence of CIN (1.6% vs 7.9%; P= 0.015. Compared to low-risk patients, Theophylline prophylaxis significantly reduced the incidence of CIN in moderate and high-risk patients (0% vs 8.8%; P= 0.022 and 9.1% vs 42.1%; P= 0.014 respectively. In conclusion, prophylactic administration of theophylline re-duces the incidence of CIN in moderate and high-risk patients for CIN.

Is hypoalbuminemia a prognostic risk factor for contrast-induced nephropathy in peritoneal dialysis patients?

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Hassan K

2014-10-01

Full Text Available Kamal Hassan,1,2 Hassan Fadi3 1Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel; 2Peritoneal Dialysis Unit, Galilee Medical Center, Nahariya, Israel; 3Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Objective: Residual renal function (RRF is an important predictor of outcome in peritoneal dialysis (PD patients. Hypoalbuminemia was found to be an independent risk factor for the development of acute kidney injury. We investigated the possibility of an association between serum albumin levels and the development of iodine contrast media-induced nephropathy (CIN in PD patients.Methods: A total of 103 PD patients who underwent invasive angiographies with exposure to iodine contrast media (ICM were reviewed retrospectively. All patients received 0.9% saline intravenously at a rate of 75 mL per hour for 12 hours prior, during, and 12 hours after exposure to ICM. Acetylcysteine was given orally at a dose of 600 mg twice daily, on the day before and on the day of exposure to ICM. The nonionic, low-osmolar contrast agent iopromide was used at a mean dose of 75.0±15.2 mL. The changes in RRF from baseline to 1 week and 4 weeks after exposure to ICM were recorded. Outcomes of patients with serum albumin levels <3.8 g/dL and those with serum albumin levels ≥3.8 g/dL were compared. A reduction >30% in RRF at 7 days after exposure to ICM was considered CIN.Results: CIN developed in 27.2% (28/103 of patients. Of the 103 patients, 59.2% (61 had serum albumin levels <3.8 g/dL. Of those, 37.7% (23/61 developed CIN, compared with 11.9% (5/42 of those with serum albumin levels ≥3.8 g/dL (P=0.004. After adjustment for all tested variables in a logistic regression with a stepwise selection model, serum albumin level at exposure to ICM was found to be the most powerful predictor of the development of CIN (odds ratio =4.5; confidence interval =1.5–13.0; P=0.006.Conclusion: PD patients with serum albumin levels <3.8 g

Risk score for contrast induced nephropathy following percutaneous coronary intervention

International Nuclear Information System (INIS)

Ghani, Amal Abdel; Tohamy, Khalid Y.

2009-01-01

Contrast-induced nephropathy (CIN) is an important cause of acute renal failure. Identification of risk factors of CIN and creating a simple risk scoring for CIN after percutaneous coronary intervention (PCI) is important. A prospective single center study was conducted in Kuwait chest disease hospital. All patients admitted to chest disease hospital for PCI from March to May 2005 were included in the study. Total of 247 patients were randomly assigned for the development dataset and 100 for the validation set using the simple random method. The overall occurrence of CIN in the development set was 5.52%. Using multivariate analysis; basal Serum creatinine, shock, female gender, multivessel PCI, and diabetes mellitus were identified as risk factors. Scores assigned to different variables yielded basal creatinine > 115 micron mol/L with the highest score(7), followed by shock (3), female gender, multivessel PCI and diabetes mellitus had the same score (2). Patients were further risk stratified into low risk score ( 1 2). The developed CIN model demonstrated good discriminative power in the validation population. In conclusion, use of a simple risk score for CIN can predict the probability of CIN after PCI; this however needs further validation in larger multicenter trials. (author)

A randomized controlled trial comparing hydration therapy to additional hemodialysis or N-acetylcysteine for the prevention of contrast medium-induced nephropathy: the Dialysis-versus-Diuresis (DVD) Trial.

Science.gov (United States)

Reinecke, H; Fobker, M; Wellmann, J; Becke, B; Fleiter, J; Heitmeyer, C; Breithardt, G; Hense, H-W; Schaefer, R M

2007-03-01

Contrast medium-induced nephropathy (CIN) is a serious complication with increasing frequency and an unfavorable prognosis. Previous analyses of surrogate parameters have suggested beneficial effects of hemodialysis that are assessed in this randomized clinical trial. We performed a prospective single-center trial in 424 consecutive patients with serum creatinine concentrations between 1.3- 3.5 mg/dl who underwent elective coronary angiography. Patients were randomized to one of three treatment strategies with all patients receiving pre- and postprocedural hydration: One group received no additional therapy, patients in the second group were hemodialyzed once, and the third group received oral N-acetylcysteine. The frequency of CIN (defined as an increase in serum creatinine>or=0.5 mg/dl) from 48 to 72 h after catheterization was 6.1% in the hydration-only group, 15.9% with hemodialysis treatment, and 5.3% in the N-ACC group (intention-to-treat analysis; P=0.008). There were no differences between the treatment groups with regard to increased (>or=0.5 mg/dl) serum creatinine concentrations after 30-60 days (4.8%, 5.1%, and 3.1%, respectively; P=0.700). Analyses of long-term follow-up (range 63 to 1316 days) by Cox regressions models of the study groups found quite similar survival rates (P=0.500). In contrast to other (retrospective) studies, long-term survival of patients with vs those without CIN within 72 h was not different, but patients who still had elevated creatinine concentrations at 30-60 days suffered from a markedly higher 2-year mortality (46% vs 17%, P=0.002). In conclusion, hemodialysis in addition to hydration therapy for the prevention of CIN provided no evidence for any outcome benefit but evidence for probable harm. Increased creatinine concentrations at 30-60 days, but not within 72 h, were associated with markedly reduced long-term survival.

Nefropatía por contraste en el síndrome coronario agudo Contrast induced nephropathy in acute coronary syndrome

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Mariana Carnevalini

2011-10-01

Full Text Available La nefropatía inducida por contraste (NIC es una de las causas más frecuentes de insuficiencia renal en pacientes internados. En el síndrome coronario agudo (SCA, la presencia de NIC aumenta la morbimortalidad. Las medidas de profilaxis y los factores de riesgo intervinientes de NIC en SCA no han sido determinados con exactitud. El objetivo de este estudio fue evaluar la incidencia de NIC y los factores asociados a su desarrollo en pacientes ingresados en unidad coronaria con requerimiento de cinecoronariografía (CCG. Se realizó un estudio de cohorte retrospectivo. Se incluyeron pacientes consecutivos cursando SCA estudiados con CCG dentro de las 72 horas de su admisión. Se definió NIC al aumento del 25% del valor de creatinina a las 48 h sobre el nivel basal de ingreso. El período de inclusión fue entre el 1° de enero de 2004 hasta el 30 de junio de 2010. Se analizaron 125 casos. La incidencia de NIC fue del 10.4% (n = 13. En el análisis multivariado, los factores asociados independientemente a su desarrollo fueron la edad [OR 1.05 (IC 95% 1.004 - 1.11 p = 0.034], la angioplastia a múltiple vaso [OR 2.2 (IC 95% 1.07 - 4.8, p = 0.03] y el volumen de contraste utilizado [OR 1.007 (IC 95% 1.001 - 1.01, p = 0.014].Contrast induced nephropathy (CIN is one of the most frequent causes of acute renal failure in hospitalized patients. It is associated with an increase in morbidity and mortality in patients hospitalized for acute coronary syndrome (ACS undergoing percutaneous coronary intervention (PCI. Risk factors and prevention strategies are not well defined. The aim of this study was to assess the incidence and clinical risk factors associated to the development of contrast induced nephropathy in patients hospitalized for ACS. In a retrospective cohort we analyzed consecutive patients hospitalized for ACS undergoing urgent PCI within 72 hours from the admission. CIN was defined as a 25% increase of creatinine levels from baseline at 48

Evaluation of N-acetylcysteine for the prevention of contrast-induced nephropathy

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Sara K. Richter

2015-06-01

Full Text Available Background: Contrast-induced nephropathy (CIN remains a leading cause of acute renal failure in hospitalized patients. N-Acetylcysteine has been studied previously for the prevention of CIN, resulting in mixed findings. Objective: The objective of this study was to determine the impact of N-acetylcysteine on the development of CIN in order to guide its use at community, teaching hospitals. Methods: Patients admitted between January 1 and December 31, 2011, receiving intravenous radiocontrast dye were included if they were compliant with two or more of the following conditions: baseline serum creatinine >1.2 mg/dL or estimated creatinine clearance <50 mL/min, age ≥75 years, diabetes mellitus, heart failure, or hypertension. The primary outcome was the difference in the proportion of patients in each group (N-acetylcysteine or no N-acetylcysteine who developed CIN, which was defined as a ≥0.5 mg/dL increase in serum creatinine or a ≥25% increase in serum creatinine within 12–96 hours post-exposure to contrast. Results: A total of 302 patients were included, 151 who received N-acetylcysteine and 151 who did not receive N-acetylcysteine. Patients who received N-acetylcysteine had significantly worse renal function at baseline than those who did not receive N-acetylcysteine (mean pre-contrast serum creatinine, 1.41 vs. 0.95 mg/dL, p<0.0001. A lower proportion of patients developing CIN was observed between those who received N-acetylcysteine and those who did not receive N-acetylcysteine (10.2% vs. 21.8%, p=0.0428. Conclusions: The use of N-acetylcysteine was likely associated with a reduced incidence of CIN in patients at risk for CIN development. Based on these results, hospitals may benefit from the development of a protocol to guide the appropriate use of N-acetylcysteine.

Nephropathy after administration of iso-osmolar and low-osmolar contrast media

DEFF Research Database (Denmark)

Biondi-Zoccai, Giuseppe; Lotrionte, Marzia; Thomsen, Henrik S

2014-01-01

BACKGROUND/OBJECTIVES: Contrast-induced nephropathy (CIN) may be a severe complication to the administration of iodine-based contrast media for diagnostic or interventional procedure using radiation exposure. Whether there is a difference in nephrotoxic potential between the various agents...... is uncertain. We aimed to perform a systematic review and network meta-analysis of randomized trials on iodine-based contrast agents. METHODS: Randomized trials of low-osmolar or iso-osmolar contrast media were searched in CENTRAL, Google Scholar, MEDLINE/PubMed, and Scopus. Risk of CIN was appraised within...... a hierarchical Bayesian model computing absolute rates (AR) and odds ratios (OR) with 95% credibility intervals, and probability of being best (Pbest) for each agent. RESULTS: A total of 42 trials (10048 patients) were included focusing on 7 different iodine-based contrast media. Risk of CIN was similarly low...

Risk factors for contrast-induced nephropathy and their association with mortality in patients with blunt splenic injuries.

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Hsieh, Ting-Min; Tsai, Tzu-Hsien; Liu, Yueh-Wei; Hsieh, Ching-Hua

2016-11-01

Although angioembolization increases the success rate of non-operative management in patients with blunt splenic injuries (BSI), the issue of contrast-induced nephropathy (CIN) due to serial administration of contrast medium remains unclear. We aimed to examine the risk factors of CIN and their clinical effect on mortality in patients with BSI. We retrospectively studied the complete data on 377 trauma patients with BSI who survived more than 48 h between July 2003 and June 2015. CIN was defined as the relative (≥25%) or absolute (≥0.5 mg/dL) increase in serum creatinine within 48 h after contrast administration. A multivariate logistic regression analysis was conducted to identify the independent predictors of CIN and mortality. CIN was independently associated with body mass index (BMI) ≥ 30 kg/m 2 (odds ratio [OR]: 3.25, 95% confidence interval [CI]: 1.20-8.76), injury severity score (ISS) ≥ 25 (OR: 6.08, 95% CI: 2.76-13.53), and 24-h hemoglobin (Hb) < 10 g/dL (OR: 3.16, 95% CI: 1.46-6.81). CIN (OR: 19.04, 95% CI: 6.15-58.94) and diabetes (OR: 3.43, 95% CI: 1.04-11.26) were also identified as independent predictors for mortality. In this study, we found that BMI ≥ 30 kg/m 2 , ISS ≥ 25, and 24-h Hb < 10 g/dL were independent risk factors for the occurrence of CIN in patients with BSI. However, angioembolization was not identified to be an independent risk factor for CIN. In addition, CIN and diabetes mellitus were identified as independent risk factors for mortality in patients with BSI. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Contrast-induced nephropathy and its prevention: What do we really know from evidence-based findings?

LENUS (Irish Health Repository)

Reddan, Donald

2010-03-12

INTRODUCTION: Contrast-induced acute kidney injury, also referred to as contrast-induced nephropathy (CIN), is a potentially serious renal complication associated with the use of iodinated contrast media (CM) in patients at risk. With the dramatic growth in contrast-enhanced imaging services worldwide, including procedures involving exposure to iodinated CM, efforts to reduce the occurrence of CIN have received considerable attention in recent years. To date, these efforts have met with little success since the 12% prevalence of CIN today remains unchanged from 2 decades ago. METHODS: We conducted a systematic literature review of the most recent evidence available from published reports of contemporary (2000-2008) prospective, randomized, controlled trials that have investigated CIN either by comparing CM or by comparing preventive strategies. The objective was to critically review the findings in light of several aspects of study design and then to establish a set of parameters for consideration in the planning of future CIN trials so as to optimize the strength of evidence obtained. RESULTS: Whether future CIN trials are investigating comparative CM nephrotoxicity or dealing with prophylactic strategies for risk reduction, the complexities that must be addressed include a standardized definition of CIN, appropriate timing of SCr measurements with timing standardized for all subjects in a given study population, awareness of study population risk profile, hydration protocols, and pharmacological prophylactic strategies. CONCLUSIONS: Large, well-designed trials (ideally with hard clinical outcome measures) that consider all the complexities involved in CIN and its prevention are needed before the clinical community has the evidence-based direction required for optimized patient care.

Sodium bicarbonate for the prevention of contrast induced nephropathy: A meta-analysis of published clinical trials

International Nuclear Information System (INIS)

Kunadian, Vijayalakshmi; Zaman, Azfar; Spyridopoulos, Ioakim; Qiu, Weiliang

2011-01-01

Background: Contrast induced nephropathy (CIN) is a serious but rare complication following contrast based procedures. Sodium bicarbonate (NaHCO 3 ) has been postulated to prevent CIN by various mechanisms. However, the outcomes following sodium bicarbonate administration to prevent CIN have been inconsistent. Methods: A meta-analysis of published randomized clinical trials to determine if the administration of sodium bicarbonate is superior to sodium chloride among patients with chronic renal failure undergoing catheterization and interventional procedures in preventing CIN was performed. Results: Data were combined across seven published clinical trials consisting of 1734 patients. There were no significant differences in the baseline characteristics between the NaHCO 3 and NaCl groups except patients in the bicarbonate group were heavier (P = 0.04). The odds ratio (OR) for the development of contrast nephropathy for NaHCO 3 versus NaCl was 0.33 (95% confidence interval [CI] 0.16-0.69; P = 0.003). Heterogeneity and publication bias were detectable with P-values 0.01 and 0.0005 respectively. There was no difference between the NaHCO 3 group and the NaCl group in the occurrence of death [OR 0.6; 95% CI (0.26-1.41); P = 0.24], congestive heart failure [OR 0.85; 95% CI (0.32-2.24); P = 0.74] and the requirement for renal replacement therapy [OR 0.56; 95% CI (0.22-1.41); P = 0.22]. Conclusion: This meta-analysis demonstrates that based on currently available randomized trials, the administration of NaHCO 3 is superior to the administration of NaCl alone in the prevention of CIN among patients with moderate to severe chronic kidney disease. However, further controlled clinical trials are needed due to significant study heterogeneity and publication bias.

Sodium bicarbonate for the prevention of contrast induced nephropathy: A meta-analysis of published clinical trials

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Kunadian, Vijayalakshmi, E-mail: kunadianvijay@aol.com [Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals, NHS Foundation Trust/Newcastle University, Newcastle upon Tyne (United Kingdom); Zaman, Azfar, E-mail: Azfar.Zaman@nuth.nhs.uk [Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals, NHS Foundation Trust/Newcastle University, Newcastle upon Tyne (United Kingdom); Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne (United Kingdom); Spyridopoulos, Ioakim [Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals, NHS Foundation Trust/Newcastle University, Newcastle upon Tyne (United Kingdom); Institute of Human Genetics, Newcastle University, Newcastle upon Tyne (United Kingdom); Qiu, Weiliang [Channing Laboratory, Department of Medicine, Brigham and Women' s Hospital/Harvard Medical School, Boston, MA, United States of America (United States)

2011-07-15

Background: Contrast induced nephropathy (CIN) is a serious but rare complication following contrast based procedures. Sodium bicarbonate (NaHCO{sub 3}) has been postulated to prevent CIN by various mechanisms. However, the outcomes following sodium bicarbonate administration to prevent CIN have been inconsistent. Methods: A meta-analysis of published randomized clinical trials to determine if the administration of sodium bicarbonate is superior to sodium chloride among patients with chronic renal failure undergoing catheterization and interventional procedures in preventing CIN was performed. Results: Data were combined across seven published clinical trials consisting of 1734 patients. There were no significant differences in the baseline characteristics between the NaHCO{sub 3} and NaCl groups except patients in the bicarbonate group were heavier (P = 0.04). The odds ratio (OR) for the development of contrast nephropathy for NaHCO{sub 3} versus NaCl was 0.33 (95% confidence interval [CI] 0.16-0.69; P = 0.003). Heterogeneity and publication bias were detectable with P-values 0.01 and 0.0005 respectively. There was no difference between the NaHCO{sub 3} group and the NaCl group in the occurrence of death [OR 0.6; 95% CI (0.26-1.41); P = 0.24], congestive heart failure [OR 0.85; 95% CI (0.32-2.24); P = 0.74] and the requirement for renal replacement therapy [OR 0.56; 95% CI (0.22-1.41); P = 0.22]. Conclusion: This meta-analysis demonstrates that based on currently available randomized trials, the administration of NaHCO{sub 3} is superior to the administration of NaCl alone in the prevention of CIN among patients with moderate to severe chronic kidney disease. However, further controlled clinical trials are needed due to significant study heterogeneity and publication bias.

Contrast-Induced Nephropathy Is Less Common in Patients with Good Coronary Collateral Circulation.

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Avci, Eyup; Yildirim, Tarik; Kadi, Hasan

2017-10-01

Contrast-induced nephropathy (CIN) is a typically reversible type of acute renal failure that develops after exposure to contrast agents; underlying endothelial dysfunction is thought to be an important risk factor for CIN. Although the mechanism of coronary collateral circulation (CCC) is not fully understood, a pivotal role of the endothelium has been reported in many studies. The aim of this study was to investigate whether there is a relationship between CCC and CIN. Patients with at least one occluded major coronary artery and blood creatinine analyses performed before and on the second day after angiography were included in the study. CIN was defined as a 25% or greater elevation of creatinine on the second day after exposure to the contrast agent. Collateral grading was performed according to the Rentrop classification. Patients were grouped according to whether they developed CIN or not, i.e., CIN(-) and CIN(+) group. A total of 214 patients who met the inclusion criteria were included in the study. CIN was diagnosed in 43 patients (20.1%) in the study population. Good CCC was identified in 112 patients (65.5%) in the CIN(-) group, whereas it was identified in 13 patients (30.2%) in the CIN(+) group. In the CIN(-) group, good CCC was significantly more frequent ( p Good collateral circulation was associated with a lower frequency of CIN, and poor collateral circulation was an independent predictor of CIN.

Comparative Effect of Contrast Media Type on the Incidence of Contrast-Induced Nephropathy: A Systematic Review and Meta-analysis.

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Eng, John; Wilson, Renee F; Subramaniam, Rathan M; Zhang, Allen; Suarez-Cuervo, Catalina; Turban, Sharon; Choi, Michael J; Sherrod, Cheryl; Hutfless, Susan; Iyoha, Emmanuel E; Bass, Eric B

2016-03-15

Iodine contrast media are essential components of many imaging procedures. An important potential side effect is contrast-induced nephropathy (CIN). To compare CIN risk for contrast media within and between osmolality classes in patients receiving diagnostic or therapeutic imaging procedures. PubMed, EMBASE, Cochrane Library, Clinical Trials.gov, and Scopus through June 2015. Randomized, controlled trials that reported CIN-related outcomes in patients receiving low-osmolar contrast media (LOCM) or iso-osmolar contrast media for imaging. Independent study selection and quality assessment by 2 reviewers and dual extraction of study characteristics and results. None of the 5 studies that compared types of LOCM reported a statistically significant or clinically important difference among study groups, but the strength of evidence was low. Twenty-five randomized, controlled trials found a slight reduction in CIN risk with the iso-osmolar contrast media agent iodixanol compared with a diverse group of LOCM that just reached statistical significance in a meta-analysis (pooled relative risk, 0.80 [95% CI, 0.65 to 0.99]; P = 0.045). This comparison's strength of evidence was moderate. In a meta regression of randomized, controlled trials of iodixanol, no relationship was found between route of administration and comparative CIN risk. Few studies compared LOCM. Procedural details about contrast administration were not uniformly reported. Few studies specified clinical indications or severity of baseline renal impairment. No differences were found in CIN risk among types of LOCM. Iodixanol had a slightly lower risk for CIN than LOCM, but the lower risk did not exceed a criterion for clinical importance. Agency for Healthcare Research and Quality.

Contrast induced nephropathy in patients undergoing intravenous (IV) contrast enhanced computed tomography (CECT) and the relationship with risk factors: A meta-analysis

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Moos, Shira I., E-mail: s.i.moos@amc.uva.nl; Vemde, David N.H. van; Stoker, Jaap; Bipat, Shandra

2013-09-15

Purpose: To summarize the incidence of contrast-induced nephropathy (CIN) and associations between CIN incidence and risk factors in patients undergoing intravenous contrast-enhanced computed tomography (CECT) with low- or iso-osmolar iodinated contrast medium. Methods: This review is performed in accordance with the preferred reporting items in systematic reviews and meta-analysis (PRISMA) guidelines. We searched the MEDLINE, EMBASE and Cochrane databases from 2002 till November 2012. Two reviewers included papers and extracted data. The pooled data were analysed by either fixed or random-effects approach depending on heterogeneity defined as the I{sup 2} index. Results: 42 articles with 18,790 patients (mean age 61.5 years (range: 38–83 years)) were included. The mean baseline eGFR was 59.8 mL/min and ranged from 4 to 256 mL/min. Of all patients 45.0% had an estimated glomerular filtration rate (eGFR) < 60 mL/min, 55.2% had hypertension; 20.2% had diabetes mellitus (DM) and 6.5% had congestive heart failure (CHF). The overall pooled CIN incidence, defined as a SCr increase of ≥25% or ≥0.5 mg/dL, was 4.96% (95%CI: 3.79–6.47). Data analysis showed associations between CIN and the presence of renal insufficiency, DM, malignancy, age > 65 years and use of non-steroidal anti-inflammatory drugs (NSAID's) with odds ratios of 1.73 (95%CI: 1.06–2.82), 1.87 (95%CI: 1.55–2.26), 1.79 (95%CI: 1.03–3.11), 1.95 (95%CI: 1.02–3.70) and 2.32 (95%CI: 1.04–5.19), respectively while hypertension, anaemia and CFH were not associated (p = 0.13, p = 0.38, p = 0.40). Conclusion: The mean incidence of CIN after intravenous iodinated CECT was low and associated with renal insufficiency, diabetes, presence of malignancy, old age and NSAID's use.

Dual Energy CT Angiography of Peripheral Arterial Disease: Feasibility of Using Lower Contrast Medium Volume.

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Abdulrahman Almutairi

Full Text Available One of the main drawbacks associated with Dual Energy Computed Tomography Angiography (DECTA is the risk of developing contrast medium-induced nephropathy (CIN. The aim of the present study was firstly, to design an optimal CT imaging protocol by determining the feasibility of using a reduced contrast medium volume in peripheral arterial DECTA, and secondly, to compare the results with those obtained from using routine contrast medium volume.Thirty four patients underwent DECTA for the diagnosis of peripheral arterial disease. They were randomly divided into two groups: Group 1 (routine contrast volume group with n = 17, injection rate 4-5 ml/s, and 1.5 ml/kg of contrast medium, and Group 2 ((low contrast volume group, with n = 17, injection rate 4-5ml/s, and contrast medium volume 0.75 ml/kg. A fast kilovoltage-switching 64-slice CT scanner in the dual-energy mode was employed for the study. A total of 6 datasets of monochromatic images at 50, 55, 60, 65, 70 and 75 keV levels were reconstructed with adaptive statistical iterative reconstruction (ASIR at 50%. A 4-point scale was the tool for qualitative analysis of results. The two groups were compared and assessed quantitatively for image quality on the basis of signal-to-noise ratio (SNR and contrast-to-noise-ratio (CNR. Radiation and contrast medium doses were also compared.The overall mean CT attenuation and mean noise for all lower extremity body parts was significantly lower for the low volume contrast group (p<0.001, and varied significantly between groups (p = 0.001, body parts (p<0.001 and keVs (p<0.001. The interaction between group body parts was significant with CT attenuation and CNR (p = 0.002 and 0.003 respectively, and marginally significant with SNR (p = 0.047, with minimal changes noticed between the two groups. Group 2 (low contrast volume group displayed the lowest image noise between 65 and 70 keV, recorded the highest SNR and CNR at 65 keV, and produced significantly lower

Atorvastatin and prevention of contrast induced nephropathy following coronary angiography

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Peyman Bidram

2015-01-01

Full Text Available Background: Contrast induced nephropathy (CIN is one of the most common complications after radiographic procedures using intravascular radiocontrast media. The aim of the current study was to assess the effect of atorvastatin on prevention of CIN in patients undergoing coronary angiography. Materials and Methods: In a clinical trial study, 200 patients referred for angiography were randomly divided into two groups of using 80 mg atorvastatin and placebo before the procedure. Furthermore, 100 patients who were under chronic treatment of statins were included as the third group. Serum creatinine (Scr levels before and after the procedure were evaluated and incidence of CIN (post-procedural Scr of >0.5 mg/dl or >25% from baseline was assessed. Results: Mean age of the participants was 60.06 ± 0.69 years and 276 (92% were male. There were no significant differences between group with respect to age and gender. In pre-operation atorvastatin, placebo and long term statin groups, the incidence of CIN was 1%, 2% and 1%, and mean changes of Glomerular filtration rate (GFR was 3.68 ± 1.32, −0.77 ± 1.21 and 1.37 ± 0.86; and mean changes of creatinine (Cr was −0.05 ± 0.02, 0.02 ± 0.02 and −0.01 ± 0.01 respectively. (P = 0.776, 0.026 and 0.041 respectively. In pre-operation atorvastatin group, Cr decreased, and GFR increased significantly (P = 0.019 and 0.007 respectively. Conclusion: pre-operation short term high dose atorvastatin use was associated with a significant decrease in serum Cr level and increase in GFR after angiography.

Short term high dose atorvastatin for the prevention of contrast-induced nephropathy in patients undergoing computed tomography angiography

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Hamid Sanei

2014-09-01

Full Text Available BACKGROUND: Statins are shown effective by some studies in preventing contrast-induced nephropathy (CIN. We evaluated the effectiveness of atorvastatin in the prevention of CIN in computed tomography angiography (CTA candidates. METHODS: This study was conducted on patients referring for elective CTA with normal renal function. Patients received atorvastatin (80 mg/day or placebo from 24 h before to 48 h after administration of the contrast material. Serum creatinine was measured before and 48 h after contrast material injection. CIN was defined as an increase in serum creatinine level of ≥ 0.5 mg/dl or ≥ 25% of the baseline creatinine. RESULTS: A total of 236 patients completed the study; 115 atorvastatin, 121 placebo, mean age = 58.40 ± 9.80 year, 68.6% male. Serum creatinine increased after contrast material injection in both the atorvastatin (1.00 ± 0.16-1.02 ± 0.15 mg/dl, P = 0.017 and placebo groups (1.03 ± 0.17-1.08 ± 0.18 mg/dl, P < 0.001. Controlling for age, gender, comorbidities, drug history, and baseline serum creatinine level, patients who received atorvastatin experienced less increase in serum creatinine after contrast material injection (beta = 0.127, P = 0.034. However, there was no difference between the atorvastatin and placebo groups in the incidence of CIN (4.3 vs. 5.0%, P = 0.535. CONCLUSION: In patients undergoing CTA, a short-term treatment with high dose atorvastatin is effective in preventing contrast-induced renal dysfunction, in terms of less increase in serum creatinine level after contrast material injection. Further trials including larger sample of patients and longer follow-ups are warranted.   Keywords: Kidney Diseases, Multidetector Computed Tomography, Contrast Media, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Atorvastatin 

[Protective effect of sodium bicarbonate on radiological contrast medium-induced nephropathy in rats].

Science.gov (United States)

Vattimo, Maria deFátima Fernandes; dos Santos, Juliana Guareschi

2013-06-01

Radiological iodinated contrasts (IC) agents cause acute kidney injury (AKI). To evaluate the renoprotective effect of sodium bicarbonate (Bic) on renal function (creatinine clearance [Clcr], Jaffé, and Clcr mLmin -1 x100 g-1) and the oxidative profile (peroxide excretion, urinary peroxides, urinary malondialdehyde, FOX-2 expression, and thiobarbituric acid reactive substance [TBARS; nmol/mg Cr]) in rats treated with an IC agent. Adult male Wistar rats weighing 250-300 g were treated once daily for 5 days with one of the following treatments: saline (0.9%, 3 mL.kg-1xday-1 intraperitoneally [i.p.]), IC agent (sodium and meglumine ioxitalamate, 3 mL/kg, i.p.), Bic + Saline (3-mL/kg Bic, i.p., 1 h before and after saline treatment), and Bic + IC (3-ml/kg Bic, i.p., 1 h before and after the IC treatment). The IC agent induced AKI, and the antioxidant renoprotective effect of Bic was confirmed (Clcr/TBARS/urinary peroxide: saline group, 0.59+/- 0.03/0.11 +/-0.02/1.29+/- 0.24; Bic+Saline group, 0.58 +/-0.03/0.13+/- 0.02/1.32+/- 0.64; IC group, 0.22 +/- 0.02/0.19 +/- 0.02/4.77 +/- 0.24; Bic +Clgroup, 0.51+/- 0.04/0.13+/- 0.3/1.80+/- 0.04; p<0.05). The protective effect of Bic in the IC-induced AKI was confirmed; hence, Bic administration may be considered as a therapeutic option for patients undergoing IC-enhanced radiography.

In which patients should serum creatinine be measured before iodinated contrast medium administration?

International Nuclear Information System (INIS)

Thomsen, Henrik S.

2005-01-01

Routine measurement of serum creatinine before injection of intravascular iodinated contrast material in all patients would be cumbersome and have an associated cost. There is doubt about whether serum creatinine should be measured routinely in all patients or selectively. The Contrast Media Safety Committee of the European Society of Urogenital Radiology decided to review the literature and draw up guidelines on this important practical issue. A literature search was carried out and summarized in a report. Based on the available information and discussions amongst the members of the Committee, guidelines were produced. The report and guidelines were discussed at the 11th European Symposium on Urogenital Radiology in Santiago de Compostela, Spain. The practice for identifying patients at risk of contrast medium induced nephropathy varies considerably from one institution to another. Patients at risk constitute only a small percentage of all cases referred for contrast enhanced imaging examination. However, it is important to identify them and take the necessary precautions. Recent serum creatinine level should be available in patients with an increased probability of a raised serum creatinine level (renal disease, renal surgery, proteinuria, diabetes mellitus, hypertension, gout, current intake of nephrotoxic drugs). A simple guideline has been produced. (orig.)

In which patients should serum creatinine be measured before iodinated contrast medium administration?

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Thomsen, Henrik S. [Copenhagen University Hospital, Herlev (Denmark). Department of Diagnostic Radiology; Morcos, Sameh K. [Northern General Hospital, Department of Diagnostic Imaging, Sheffield Teaching Hospitals NHS Trust, Sheffield (United Kingdom)

2005-04-01

Routine measurement of serum creatinine before injection of intravascular iodinated contrast material in all patients would be cumbersome and have an associated cost. There is doubt about whether serum creatinine should be measured routinely in all patients or selectively. The Contrast Media Safety Committee of the European Society of Urogenital Radiology decided to review the literature and draw up guidelines on this important practical issue. A literature search was carried out and summarized in a report. Based on the available information and discussions amongst the members of the Committee, guidelines were produced. The report and guidelines were discussed at the 11th European Symposium on Urogenital Radiology in Santiago de Compostela, Spain. The practice for identifying patients at risk of contrast medium induced nephropathy varies considerably from one institution to another. Patients at risk constitute only a small percentage of all cases referred for contrast enhanced imaging examination. However, it is important to identify them and take the necessary precautions. Recent serum creatinine level should be available in patients with an increased probability of a raised serum creatinine level (renal disease, renal surgery, proteinuria, diabetes mellitus, hypertension, gout, current intake of nephrotoxic drugs). A simple guideline has been produced. (orig.)

Risk of application of contrast medium in computed tomography

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Wende, S.; Speck, U.

1981-06-01

The paper deals with the risk associated with the application of contrast medium in CT. The risk is to be seen in intolerance reactions, such as allergic or circulatory reactions and neurotoxic side-effects. In this paper the problems of renal failure caused by the injection of contrast medium are given special attention. Furthermore an iodine-induced hyperthyreosis might result. Especially the possible disturbance of the kidney function means that contrast medium should not be applied arbitrarily and that the examination should be done only by experienced staff. Furthermore the indication for the application of contrast medium in CT should be strictly qualified.

Risk of application of contrast medium in computed tomography

International Nuclear Information System (INIS)

Wende, S.; Speck, U.; Schering A.G., Berlin

1981-01-01

The paper deals with the risk associated with the application of contrast medium in CT. The risk is to be seen in intolerance reactions, such as allergic or circulatory reactions and neurotoxic side-effects. In this paper the problems of renal failure caused by the injection of contrast medium are given special attention. Furthermore an iodine-induced hyperthyreosis might result. Especially the possible disturbance of the kidney function means that contrast medium should not be applied arbitrarily and that the examination should be done only by experienced staff. Furthermore the indication for the application of contrast medium in CT should be strictly qualified. (orig.) [de

A comparison of definitions of contrast-induced nephropathy in patients with normal serum creatinine

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Mohammad Reza Khatami

2016-01-01

Full Text Available Contrast-induced nephropathy (CIN is the third leading cause of acute kidney injury in hospitalized patients. The prevalence of CIN is reported to range from 0% to 50%, depending not only on patient condition and the procedure used but also the definition of CIN applied. We aimed to determine the best diagnostic indicator of CIN in patients with normal serum creatinine. This study included 206 patients with normal serum creatinine who underwent coronary angiography/angioplasty. Serum creatinine level and glomerular filtration rate (GFR were measured before and on the second and fifth days after contrast administration. The incidence of CIN based on a 25% increase in serum creatinine was calculated and compared with the incidence based on a 25% decrease in GFR or an increase of at least 0.5 mg/dL in serum creatinine. Of 206 patients, 127 were male (61.7% and 79 were female (38.3%; the mean age was 59.56 ± 10.3 years. The prevalence of CIN was 30% based on a 25% increase in serum creatinine, 23% based on a 25% decrease in GFR (P <0.012 and 3.8% based on a serum creatinine increase of at least 0.5 mg/dL (P <0.0001. The serum creatinine levels remained within the normal range in the majority of patients with CIN based on the different definitions. In patients with normal serum creatinine, the absolute increase in serum creatinine may describe the prevalence of CIN more accurately than the relative increase in serum creatinine or relative decrease in GFR.

Intravenous Contrast Medium Administration for Computed Tomography Scan in Emergency: A Possible Cause of Contrast-Induced Nephropathy

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Sonhaye, Lantam; Kolou, Bérésa; Tchaou, Mazamaesso; Amadou, Abdoulatif; Assih, Kouméabalo; N'Timon, Bidamin; Adambounou, Kokou; Agoda-Koussema, Lama; Adjenou, Komlavi; N'Dakena, Koffi

2015-01-01

The goal of this study was to assess risk for CIN after CT Scan during an emergency and to identify risk factors for the patient. Prospective review of all patients admitted to the emergency room (ER) of the Teaching Hospital of Lomé (Togo) during a 2-year period. CIN was defined as an increase in serum creatinine by 0.5 mg/dL from admission after undergoing CT Scan with intravenous contrast. A total of 620 patients underwent a CT Scan in the emergency room using intravenous contrast and 672 patients took the CT Scan without intravenous contrast. Out of the patients who received intravenous contrast for CT Scan, three percent of them developed CIN during their admission. Moreover, upon discharge no patient had continued renal impairment. No patient required dialysis during their admission. The multivariate analysis of all patients who had serial creatinine levels (including those who did not receive any contrast load) shows no increased risk for acute kidney injury associated intravenous contrast (odds ratio = 0.619, p value = 0.886); only diabetes remains independent risk factor of acute kidney injury (odds ratio = 6.26, p value = 0.031)

Contrast-induced nephropathy in patients with chronic kidney disease and peripheral arterial disease

International Nuclear Information System (INIS)

Kroneberger, Christian; Enzweiler, Christian N; Schmidt-Lucke, Andre; Rückert, Ralph-Ingo; Teichgräber, Ulf; Franiel, Tobias

2015-01-01

The risk for contrast-induced nephropathy (CIN) after intra-arterial application of an iodine-based contrast material is unknown for patients with chronic kidney disease (CKD) and peripheral arterial disease (PAD). To investigate the incidence of CIN in patients with CKD and PAD. This retrospective study was approved by the local ethics committee. One hundred and twenty patients with 128 procedures (73 with baseline eGFR in the range of 45–60 mL/min/1.73m 2 , 55 with eGFR < 45 mL/min/1.73m 2 ) were evaluated. All patients received intra-arterially an iodine-based low-osmolar contrast material (CM) after adequate intravenous hydration with isotonic NaCl 0.9% solution. CIN was defined as an increase in serum creatinine of more than 44 μmol/L within 4 days. The influence of patient-related risk factors (age, weight, body mass index, eGFR, serum creatinine, hypertension, diabetes mellitus, coronary heart disease, heart failure) and therapy-related risk factors (amount of CM, nephrotoxic drugs, number of CM applications) on CIN were examined. CIN developed in 0% (0/73) of procedures in patients with PAD and an eGFR in the range of 45–60 mL/min/1.73m 2 and in 10.9% (6/55) of procedures in patients with an eGFR <45 mL/min/1.73m 2 . No risk factor significantly influenced the development of CIN, although baseline serum creatinine (P = 0.06) and baseline eGFR (P = 0.10) showed a considerable dependency. Patients with an eGFR in the range of 45–60 mL/min/1.73m 2 and PAD seem not at risk for CIN after intra-arterial CM application and adequate hydration. Whereas, an eGFR < 45 mL/min/1.73m 2 correlated with a risk of 10.9% for a CIN

Assessing the Risk of Contrast-Induced Nephropathy Using a Finger Stick Analysis in Recalls from Breast Screening: The CINFIBS Explorative Study.

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Houben, I P L; van Berlo, C J L Y; Bekers, O; Nijssen, E C; Lobbes, M B I; Wildberger, J E

2017-01-01

To evaluate whether a handheld point-of-care (POC) device is able to predict and discriminate patients at potential risk of contrast-induced nephropathy (CIN) prior to iodine-based contrast media delivery. Between December 2014 and June 2016, women undergoing contrast-enhanced spectral mammography (CESM) with an iodine-based contrast agent were asked to have their risk of CIN assessed by a dedicated POC device (StatSensor CREAT) and a risk factor questionnaire based on national guidelines. Prior to contrast injection, a venous blood sample was drawn to compare the results of POC with regular laboratory testing. A total of 351 patients were included; 344 were finally categorized as low risk patients by blood creatinine evaluation. Seven patients had a eGFR below 60 ml/min/1.73 m 2 , necessitating additional preparation prior to contrast delivery. The POC device failed to categorize six out of seven patients (86%), leading to (at that stage) unwanted contrast administration. Two patients subsequently developed CIN after 2-5 days, which was self-limiting after 30 days. The POC device tested was not able to reliably assess impairment of renal function in our patient cohort undergoing CESM. Consequently, we still consider classic clinical laboratory testing preferable in patients at potential risk for developing CIN.

Comparison of renal toxicity after injection of CT contrast medium and MR contrast medium: change of renal function in acute renal failure rat models

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Han, Young min; Lee, Young Hwan; Kim, Sang Won; Jin, Kong Young; Kim, Won; Chung, Gyung Ho

2002-01-01

To determine renal toxicity through changes in renal function after the injection of CT and MRI contrast media into rats in which acute renal failure (ARF) was induced. To cause acute renal failure, the abdominal cavity of 110 male rats each weighing 250-300 gm was opened via a midline incision under anesthesia. Microvascular clamps were placed on both renal arteries and veins to completely block renal blood flow for 45 minutes, and were then removed, allowing blood flow to return to the kidneys. ARF, defined as a two-fold difference in the creatinine level before ARF and 48 hours after, was successfully induced in 60 of the rats. These were divided into two groups: one was injected with CT contrast medium and the other with MRI contrast medium. Each CT and MRI group was divided into a low dose (0.5 cc/kg, 0.2 ml/kg), standard dose (2 cc/kg, 0.8 ml/kg), and high dose (8 cc/kg, 3.2 ml/kg) sub-group; thus, there was a total of six groups with ten rats in each. Blood samples were obtained before ARF, 48 hours after, and 48 hours after contrast injection, and CT scanning and MRI were performed after blood sampling at 48 hours. In each group, creatinine levels 48 hours after contrast injection were compared by means of the ANOVA test. There were no significant differences in creatinine levels between the CT and MRI contrast medium groups (p=0.116), nor between the animals to which different doses of CT and MRI contrast medium, were administered. After both standard and high doses, CT and MRI provided good images. In rats in which acute renal failure was induced, renal function did not change according to whether CT or MRI contrast medium was injected. Thus, the two media induce similar levels of toxicity

Coronary artery calcification scores improve contrast-induced nephropathy risk assessment in chronic kidney disease patients.

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Osugi, Naohiro; Suzuki, Susumu; Shibata, Yohei; Tatami, Yosuke; Harata, Shingo; Ota, Tomoyuki; Hayashi, Mutsuharu; Yasuda, Yoshinari; Ishii, Hideki; Shimizu, Atsuya; Murohara, Toyoaki

2017-06-01

Coronary artery calcification (CAC) is an independent predictor of cardiovascular morbidity and mortality in chronic kidney disease (CKD) patients. The aim of the present study was to evaluate the predictive value of CAC scores for the incidence of contrast-induced nephropathy (CIN) after cardiac catheterization in non-dialyzed CKD patients. The present study evaluated a total of 140 CKD patients who underwent cardiac catheterization. Patients were stratified into two groups based on the optimal cut-off value of the CAC score, which was graded by a non-triggered, routine diagnostic chest computed tomography scan: CAC score ≥8 (high CAC group); and CAC score 10 % in the baseline serum cystatin C level at 24 h after contrast administration. The mean estimated glomerular filtration rate levels were 41.1 mL/min/1.73 m 2 , and the mean contrast dose administered was 37.5 mL. Patients with high CAC scores exhibited a higher incidence of CIN than patients with low CAC scores (25.5 vs. 3.2 %, p < 0.001). After multivariate adjustment for confounders, the CAC score predicted CIN (odds ratio 1.68, 95 % confidence interval 1.28-2.21, p < 0.001). Moreover, the C-index for CIN prediction significantly increased when the CAC scores were added to the Mehran risk score (0.855 vs. 0.760, p = 0.023). CAC scores, as evaluated using semi-quantitative methods, are a simple and powerful predictor of CIN. Incorporating the CAC score in the Mehran risk score significantly improved the predictive ability to predict CIN incidence.

Assessing the Risk of Contrast-Induced Nephropathy Using a Finger Stick Analysis in Recalls from Breast Screening: The CINFIBS Explorative Study

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I. P. L. Houben

2017-01-01

Full Text Available Purpose. To evaluate whether a handheld point-of-care (POC device is able to predict and discriminate patients at potential risk of contrast-induced nephropathy (CIN prior to iodine-based contrast media delivery. Methods and Materials. Between December 2014 and June 2016, women undergoing contrast-enhanced spectral mammography (CESM with an iodine-based contrast agent were asked to have their risk of CIN assessed by a dedicated POC device (StatSensor CREAT and a risk factor questionnaire based on national guidelines. Prior to contrast injection, a venous blood sample was drawn to compare the results of POC with regular laboratory testing. Results. A total of 351 patients were included; 344 were finally categorized as low risk patients by blood creatinine evaluation. Seven patients had a eGFR below 60 ml/min/1.73 m2, necessitating additional preparation prior to contrast delivery. The POC device failed to categorize six out of seven patients (86%, leading to (at that stage unwanted contrast administration. Two patients subsequently developed CIN after 2–5 days, which was self-limiting after 30 days. Conclusion. The POC device tested was not able to reliably assess impairment of renal function in our patient cohort undergoing CESM. Consequently, we still consider classic clinical laboratory testing preferable in patients at potential risk for developing CIN.

Usefulness of Sodium Bicarbonate for the Prevention of Contrast-Induced Nephropathy in Patients Undergoing Cardiac Resynchronization Therapy.

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Alonso, Pau; Sanz, Jorge; García-Orts, Ana; Reina, Samuel; Jiménez, Sonia; Osca, Joaquín; Cano, Oscar; Andrés, Ana; Sancho-Tello, María José; Martínez, Luis

2017-11-01

The use of contrast media during cardiac resynchronization therapy (CRT) devices implantation is associated with the risk of contrast-induced nephropathy (CIN). The aim of this study was to evaluate the possible beneficial role of periprocedural intravenous volume expansion with isotonic saline and sodium bicarbonate solution in patients who undergo CRT implantation. Eligible patients were randomly assigned in a 1:1 ratio to receive hydration plus one-sixth molar sodium bicarbonate (study group) or not (control group). Primary end point was CIN incidence. Secondary end points were (1) a combined end point of death, heart transplantation, or hospitalization for heart failure at 12 months, (2) incidence of death, and (3) the need for renal replacement therapy at 12 months. Final analysis was performed with 93 patients. In the hydration group CIN incidence was significantly reduced related to control group (0% vs 11%, p = 0.02). There was a trend to reduce the combined end point in hydration group (12.5% vs 22%, p = 0.14). Finally, CIN incidence was related to a higher 12 months mortality (25% vs 7%, p = 0.03). In conclusion, CIN incidence was 11% in a nonselected population of patients receiving a CRT device. CIN appearance could be reduced by using a hydration protocol based on sodium bicarbonate and isotonic saline. Copyright © 2017 Elsevier Inc. All rights reserved.

Sodium Bicarbonate-Ascorbic Acid Combination for Prevention of Contrast-Induced Nephropathy in Chronic Kidney Disease Patients Undergoing Catheterization.

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Komiyama, Kota; Ashikaga, Takashi; Inagaki, Dai; Miyabe, Tomonori; Arai, Marina; Yoshida, Kiyotaka; Miyazawa, Satoshi; Nakada, Akihiro; Kawamura, Iwanari; Masuda, Shinichiro; Nagamine, Sho; Hojo, Rintaro; Aoyama, Yuya; Tsuchiyama, Takaaki; Fukamizu, Seiji; Shibui, Takashi; Sakurada, Harumizu

2017-01-25

Sodium bicarbonate and ascorbic acid have been proposed to prevent contrast-induced nephropathy (CIN). The present study evaluated the effect of their combined use on CIN incidence.Methods and Results:We prospectively enrolled 429 patients with chronic kidney disease (CKD: baseline estimated glomerular filtration rate <60 mL/min/1.73 m 2 ) prior to elective coronary catheterization. CIN was defined as absolute (≥0.5 mg/dL) or relative (≥25%) increase in serum creatinine within 72 h. In the saline hydration (n=218) and combined sodium bicarbonate+ascorbic acid (n=211) groups, a total of 1,500-2,500 mL 0.9% saline was given before and after the procedure. In addition, the combination group received 20 mEq sodium bicarbonate and 3 g ascorbic acid i.v. before the procedure, followed by 2 g ascorbic acid after the procedure and a further 2 g after 12 h. There were no significant differences between the basic characteristics and contrast volume in the 2 groups. CIN occurred in 19 patients (8.7%) in the saline group, and in 6 patients (2.8%) in the combined treatment group (P=0.008). Combined sodium bicarbonate and ascorbic acid could prevent CIN following catheterization in CKD patients.

Impact of minimum contrast media volumes during elective percutaneous coronary intervention for prevention of contrast-induced nephropathy in patients with stable coronary artery disease.

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Ebisawa, Soichiro; Kurita, Tairo; Tanaka, Nobuyoshi; Nasu, Kenya; Kimura, Masashi; Ito, Tatsuya; Kinoshita, Yoshihisa; Tsuchikane, Etsuo; Terashima, Mitsuyasu; Suzuki, Takahiko

2016-01-01

Contrast-induced nephropathy (CIN) is an important complication following percutaneous coronary intervention (PCI). The clinical importance of a minimum contrast media volume (CMV) for PCI to prevent CIN has not been well evaluated. The purpose of this study was to evaluate the impact of minimum CMV to prevent CIN after PCI. In this study, 2052 consecutive patients who underwent elective PCI in our institute were analyzed. We divided patients into two groups according to CMV: a minimum CMV PCI group [CMV ≤50 ml (n = 94)] and a non-minimum CMV PCI group [CMV >50 ml (n = 1958)]. CIN occurred in 160 (7.8 %) patients. The incidence of CIN was significantly lower in the minimum CMV PCI group than in the non-minimum CMV PCI group (2.1 vs. 8.1 %; P = 0.03). According to multivariate analysis, elderly patients and diabetes mellitus patients were at high risk of developing CIN in this study population. When analyzing only high-risk patients, the incidence of CIN was also significantly lower in the minimum CMV group than in the non-minimum CMV group (2.6 vs. 10.3 %; P = 0.03). Minimum CMV PCI could reduce the incidence of CIN, particularly in high-risk patients; as such, defining the minimum CMV clinical cut-off values may be useful for the prevention of CIN.

Acute ciprofloxacin-induced crystal nephropathy with granulomatous interstitial nephritis

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R Goli

2017-01-01

Full Text Available Crystal-induced acute kidney injury (AKI is caused by the intratubular precipitation of crystals, which results in obstruction and kidney injury. Ciprofloxacin, a commonly used antibiotic, causes AKI secondary to immune-mediated interstitial injury. Rare mechanisms of ciprofloxacin-induced renal injury include crystalluria, rhabdomyolysis, and granulomatous interstitial nephritis. Clinical and experimental studies have suggested that crystalluria and crystal nephropathy due to ciprofloxacin occur in alkaline urine. Preexisting kidney function impairment, high dose of the medication, and advanced age predispose to this complication. We report a case of ciprofloxacin-induced crystal nephropathy and granulomatous interstitial nephritis in a young patient with no other predisposing factors. The patient responded to conservative treatment without the need for glucocorticoids.

Contrast-induced acute kidney injury in children with cardiovascular defects – results of a pilot study

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Daria Tomczyk

2016-12-01

Full Text Available Introduction: Contrast-induced nephropathy – acute kidney injury is an acquired kidney injury that is an important factor in short- and long-term cardiovascular complications. Contrast-induced nephropathy – acute kidney injury continues to be diagnosed based on serum creatinine level. Serum creatinine, however, is a delayed indicator of contrast-induced nephropathy, as its levels typically peak between 1 and 3 days following contrast exposure. Currently, more sensitive biomarkers of kidney injury are sought, with human neutrophil lipocalin (also known as neutrophil gelatinase-associated lipocalin highlighted in literature as a troponin-like biomarker of early nephropathy. Aim of the study: Changes in serum and urine neutrophil gelatinase-associated lipocalin levels were assessed in children with congenital heart diseases, following a scheduled cardiac catheterization procedure. Material and methods: The group studied comprised 16 patients. The neutrophil gelatinaseassociated lipocalin and creatinine levels, along with urine and serum neutrophil gelatinase-associated lipocalin/creatinine ratio were evaluated five times at different time intervals from the procedure. The group did not vary in respect of kidney function, preprocedure management, and volume expansion (hydration therapy prior to the procedure. Results: In the assessed material, median neutrophil gelatinase-associated lipocalin rose as early as 2 hours after exposure to contrast as compared with baseline [median = 28.2 ng/mL (Quartile 1 = 22.8 – Quartile 3 = 33.77 vs. median = 25.87 ng/mL (Quartile 1 = 19.4 – Quartile 3 = 29.6]. Serum neutrophil gelatinase-associated lipocalin level peaked in hour 6 of our study: median – 30.6 ng/mL (Quartile 1 = 22.32 – Quartile 3 = 42.17, then reverting to normal. Urine neutrophil gelatinaseassociated lipocalin peaked in hour 24 of the study, subsequently dropping below baseline in hour 48

Hidratação com bicarbonato de sódio não previne a nefropatia de contraste: ensaio clínico multicêntrico Hydration with sodium bicarbonate does not prevent contrast nephropathy: a multicenter clinical trial

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Vitor O. Gomes

2012-12-01

Full Text Available FUNDAMENTO: A exposição ao meio de contraste radiográfico pode causar comprometimento agudo da função renal. Há evidências limitadas e conflitantes de que a hidratação com bicarbonato de sódio previne a Nefropatia Induzida por Contraste (NIC em pacientes submetidos a cateterismo cardíaco. OBJETIVO: O presente estudo teve como objetivo determinar se o bicarbonato de sódio é superior à hidratação com soro fisiológico para evitar a nefropatia em pacientes de risco submetidos a cateterismo cardíaco. MÉTODOS: Trezentos e um pacientes submetidos a intervenção coronariana percutânea ou angiografia coronariana com creatinina sérica > 1,2 mg/dL ou Taxa de Filtração Glomerular (TFG BACKGROUND: Radiographic contrast media exposition can cause acute renal function impairment. There is limited and conflicting evidence that hydration with sodium bicarbonate prevents contrast-induced nephropathy (CIN in patients undergoing cardiac catheterization. OBJECTIVE: The present study was aimed at determining whether sodium bicarbonate is superior to hydration with saline to prevent nephropathy in patients at risk undergoing cardiac catheterization. METHODS: Three hundred and one patients undergoing coronary angiography or percutaneous coronary intervention with serum creatinine > 1.2mg/dL or glomerular filtration rate (GFR < 50ml/min were randomized to receive hydration with sodium bicarbonate starting 1 hour before the procedure and 6 hours after the procedure, or hydration with 0.9% saline. CIN was defined as an increase of 0.5mg/dL in creatinine in 48h RESULTS: Eighteen patients (5.9% developed contrast induced nephropathy: 9 patients in the bicarbonate group (6.1% and 9 patients in the saline group (6.0%, p = 0.97. The change in serum creatinine was similar in both groups, 0.01 ± 0.26 mg/dL in the bicarbonate group and 0.01 ± 0.35 mg/dL in the saline group, p = 0.9. No statistical difference was observed between the change in glomerular

Hidratação com bicarbonato de sódio não previne a nefropatia de contraste: ensaio clínico multicêntrico Hydration with sodium bicarbonate does not prevent contrast nephropathy: a multicenter clinical trial

Directory of Open Access Journals (Sweden)

Vitor O. Gomes

2012-01-01

Full Text Available FUNDAMENTO: A exposição ao meio de contraste radiográfico pode causar comprometimento agudo da função renal. Há evidências limitadas e conflitantes de que a hidratação com bicarbonato de sódio previne a Nefropatia Induzida por Contraste (NIC em pacientes submetidos a cateterismo cardíaco. OBJETIVO: O presente estudo teve como objetivo determinar se o bicarbonato de sódio é superior à hidratação com soro fisiológico para evitar a nefropatia em pacientes de risco submetidos a cateterismo cardíaco. MÉTODOS: Trezentos e um pacientes submetidos a intervenção coronariana percutânea ou angiografia coronariana com creatinina sérica > 1,2 mg/dL ou Taxa de Filtração Glomerular (TFG BACKGROUND: Radiographic contrast media exposition can cause acute renal function impairment. There is limited and conflicting evidence that hydration with sodium bicarbonate prevents contrast-induced nephropathy (CIN in patients undergoing cardiac catheterization. OBJECTIVE: The present study was aimed at determining whether sodium bicarbonate is superior to hydration with saline to prevent nephropathy in patients at risk undergoing cardiac catheterization. METHODS: Three hundred and one patients undergoing coronary angiography or percutaneous coronary intervention with serum creatinine > 1.2mg/dL or glomerular filtration rate (GFR < 50ml/min were randomized to receive hydration with sodium bicarbonate starting 1 hour before the procedure and 6 hours after the procedure, or hydration with 0.9% saline. CIN was defined as an increase of 0.5mg/dL in creatinine in 48h RESULTS: Eighteen patients (5.9% developed contrast induced nephropathy: 9 patients in the bicarbonate group (6.1% and 9 patients in the saline group (6.0%, p = 0.97. The change in serum creatinine was similar in both groups, 0.01 ± 0.26 mg/dL in the bicarbonate group and 0.01 ± 0.35 mg/dL in the saline group, p = 0.9. No statistical difference was observed between the change in glomerular

Oral contrast medium in PET/CT: should you or shouldn't you?

International Nuclear Information System (INIS)

Groves, Ashley M.; Kayani, Irfan; Dickson, John C.; Townsend, Caroline; Croasdale, Ian; Syed, Rizwan; Nagabushan, Nagesh; Hain, Sharon F.; Ell, Peter J.; Bomanji, Jamshed B.

2005-01-01

It has been suggested that the use of computed tomography (CT) positive contrast agents has led to attenuation-induced artefacts on 18 F-fluorodeoxyglucose positron emission tomography ( 18 F-FDG PET/CT) systems. Consequently, centres may withhold the use of such agents. Whilst there is theoretical evidence to support the aforementioned claim, the clinical relevance of the induced artefacts has not been widely established. Moreover, the potential benefits of bowel enhancement on PET/CT have yet to be formally evaluated. We therefore prospectively examined PET/CT studies to assess whether the use of oral contrast medium induces clinically relevant artefacts and whether the use of these agents is diagnostically helpful. Over a 2-month period, 18 F-FDG PET/CT images were prospectively reviewed from 200 patients following Gastrografin administration 2 h prior to examination. Both a radiologist and a nuclear medicine physician reviewed the images for contrast medium-mediated clinically relevant artefacts. Artefacts were sought on the CT attenuation-corrected images and were compared with the appearance on non-attenuated-corrected images. The number of examinations in which the oral contrast aided image interpretation was also noted. There were no oral contrast medium-induced clinically significant artefacts. In 38 of the 200 patients, oral contrast aided image interpretation (owing to differentiation of mass/node from bowel, discrimination of intestinal wall from lumen or definition of the anatomy of a relevant site). In 33 of these 38 patients, the anatomical site of interest was the abdomen/pelvis. The use of oral contrast medium in 18 F-FDG PET studies should not be withheld as it improves image interpretation and does not produce clinically significant artefacts. (orig.)

In vivo and in vitro assessment of pathways involved in contrast media-induced renal cells apoptosis

Science.gov (United States)

Quintavalle, C; Brenca, M; De Micco, F; Fiore, D; Romano, S; Romano, M F; Apone, F; Bianco, A; Zabatta, M A; Troncone, G; Briguori, C; Condorelli, G

2011-01-01

Contrast-induced nephropathy accounts for >10% of all causes of hospital-acquired renal failure, causes a prolonged in-hospital stay and represents a powerful predictor of poor early and late outcome. Mechanisms of contrast-induced nephropathy are not completely understood. In vitro data suggests that contrast media (CM) induces a direct toxic effect on renal tubular cells through the activation of the intrinsic apoptotic pathway. It is unclear whether this effect has a role in the clinical setting. In this work, we evaluated the effects of CM both in vivo and in vitro. By analyzing urine samples obtained from patients who experienced contrast-induced acute kidney injury (CI-AKI), we verified, by western blot and immunohistochemistry, that CM induces tubular renal cells apoptosis. Furthermore, in cultured cells, CM caused a dose–response increase in reactive oxygen species (ROS) production, which triggered Jun N-terminal kinases (JNK1/2) and p38 stress kinases marked activation and thus apoptosis. Inhibition of JNK1/2 and p38 by different approaches (i.e. pharmacological antagonists and transfection of kinase-death mutants of the upstream p38 and JNK kinases) prevented CM-induced apoptosis. Interestingly, N-acetylcysteine inhibited ROS production, and thus stress kinases and apoptosis activation. Therefore, we conclude that CM-induced tubular renal cells apoptosis represents a key mechanism of CI-AKI. PMID:21562587

Role of (Pro)Renin Receptor in Albumin Overload-Induced Nephropathy in Rats.

Science.gov (United States)

Fang, Hui; Deng, Mokan; Zhang, Linlin; Lu, Aihua; Su, Jiahui; Xu, Chuanming; Zhou, Li; Wang, Lei; Ou, Jing-Song; Wang, Weidong; Yang, Tianxin

2018-05-30

Proteinuria is not only a common feature of chronic kidney diseases (CKD) but also an independent risk factor promoting CKD progression to end-stage renal failure. However, the underlying molecular mechanisms for protein overload-induced renal injury remain elusive. The present study examined the role of (pro)renin receptor (PRR) in pathogenesis of albumin overload (AO)-induced nephropathy and activation of intrarenal renin-angiotensin system (RAS) in rats. Wistar rats underwent unilateral nephrectomy and were treated for 7 weeks with vehicle, bovine serum albumin (5 g/kg/d via a single i.p. injection) alone or in conjunction with a PRR decoy inhibitor PRO20 (500 μg/kg/d via 3 s.c. injections). The AO rat model exhibited severe proteinuria, tubular necrosis, and interstitial fibrosis, oxidative stress, inflammation, accompanied by elevated urinary N-acetyl-beta-D-glucosaminidase activity and urinary β2-microglobulin secretion, all of which were significantly attenuated by PRO20. Urinary and renal levels of renin, angiotensinogen (AGT), and Ang II were elevated by AO and suppressed by PRO20, contrasting to largely unaltered plasma levels of the RAS parameters. The AO model also showed increased renal expression of full-length PRR and soluble PRR (sPRR) and urinary excretion of sPRR. Taken together, we conclude that PRR antagonism with PRO20 alleviates AO-induced nephropathy via inhibition of intrarenal RAS.

Mechanisms of Contrast-Induced Nephropathy Reduction for Saline (NaCl and Sodium Bicarbonate (NaHCO3

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W. Patrick Burgess

2014-01-01

Full Text Available Nephropathy following contrast media (CM exposure is reduced by administration before, during, and after the contrast procedure of either isotonic sodium chloride solution (Saline or isotonic sodium bicarbonate solution (IsoBicarb. The reasons for this reduction are not well established for either sodium salt; probable mechanisms are discussed in this paper. For Saline, the mechanism for the decrease in CIN is likely related primarily to the increased tubular flow rates produced by volume expansion and therefore a decreased concentration of the filtered CM during transit through the kidney tubules. Furthermore, increased tubular flow rates produce a slight increase in tubular pH resulting from a fixed acid excretion in an increased tubular volume. The mechanism for the decreased CIN associated with sodium bicarbonate includes the same mechanisms listed for Saline in addition to a renal pH effect. Increased filtered bicarbonate anion raises both tubular pH and tubular bicarbonate anion levels toward blood physiologic levels, thus providing increased buffer for reactive oxygen species (ROS formed in the tubules as a result of exposure to CM in renal tubular fluid.

Impact of an Early Decrease in Systolic Blood Pressure on The Risk of Contrast-Induced Nephropathy after Percutaneous Coronary Intervention.

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Li, Hualong; Huang, Shuijin; He, Yiting; Liu, Yong; Liu, Yuanhui; Chen, Jiyan; Zhou, Yingling; Tan, Ning; Duan, Chongyang; Chen, Pingyan

2016-02-01

The early postprocedural period was thought to be the rush hour of contrast media excretion, causing rapid and prolonged renal hypoperfusion, which was the critical time window for contrast-induced nephropathy (CIN). 349 consecutive patients were enrolled into the study. The relation between an early postprocedural decrease in systolic blood pressure (SBP) and the risk of CIN was assessed using multivariate logistic regression. A postprocedural decrease in SBP was observed in 63% of patients and CIN developed in 28 (8.0%) patients. The CIN group had a lower postprocedural SBP (114.5±13.5 vs. 123.7±15.6mmHg, P=0.003) and a greater postprocedural decrease in SBP (16.2±19.1 vs. 5.9±18.7mmHg, P=0.005) than the no-CIN group. ROC analysis revealed that the optimum cutoff value for the SBP decrease in detecting CIN was >10mmHg (sensitivity 60.7%, specificity 59.5%, AUC=0.66). Multivariate logistic regression analysis found that a postprocedural decrease in SBP >10mmHg was a significant independent predictor of CIN (OR 2.368, 95%CI: 1.043-5.379, P=0.039), after adjustment for other risk factors. An early moderate postprocedural decrease in SBP may increase the risk of CIN in patients undergoing PCI. Copyright © 2015. Published by Elsevier B.V.

Preventive effect of pretreatment with intravenous nicorandil on contrast-induced nephropathy in patients with renal dysfunction undergoing coronary angiography (PRINCIPLE Study).

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Ko, Young-Guk; Lee, Byoung-Kwon; Kang, Woong Chol; Moon, Jae-Youn; Cho, Yun Hyeong; Choi, Seong Hun; Hong, Myeong-Ki; Jang, Yangsoo; Kim, Jong-Youn; Min, Pil-Ki; Kwon, Hyuck-Moon

2013-07-01

To investigate the effect of pretreatment with intravenous nicorandil on the incidence of contrast-induced nephropathy (CIN) in patients with renal dysfunction undergoing coronary angiography. This randomized controlled multicenter study enrolled a total of 166 patients (nicorandil n=81; control n=85) with an estimated glomerular filtration rate 0.5 mg/dL increase or >25% rise in serum creatinine (SCr) concentration within 48 hours of contrast exposure compared to baseline. The final analysis included 149 patients (nicorandil n=73; control n=76). The baseline characteristics and the total volume of the used contrast (Iodixanol, 125.6±69.1 mL vs. 126.9±74.6 mL, p=0.916) were similar between the two groups. The incidence of CIN also did not differ between the nicorandil and control groups (6.8% vs. 6.6%, p=0.794). There was no difference between the two groups in the relative change in SCr from baseline to peak level within 48 hours after coronary angiography (-1.58±24.07% vs. 0.96±17.49%, p=0.464), although the nicorandil group showed less absolute change in SCr than the control group (-0.01±0.43 mg/mL vs. 0.02±0.31 mg/mL, p=0.005). Prophylactic intravenous infusion of nicorandil did not decrease the incidence of CIN in patients with renal dysfunction undergoing coronary angiography.

Renal Safety of Iodinated Contrast Media Depending on Their Osmolarity – Current Outlooks

International Nuclear Information System (INIS)

Mruk, Bartosz

2016-01-01

Iodinated contrast media (ICM) are commonly administered pharmaceutical agents. Most often they are used intravenously and intraarterially. Although iodinated contrast agents are relatively safe and widely used, adverse events occur and questions remain about their use, safety, and interactions. The most important adverse effects of contrast media include hypersensitivity reactions, thyroid dysfunction, and contrast-induced nephropathy. Radiologists must be aware of the risk factors for reactions to contrast media. Nonionic iodinated contrast agents can be divided into monomeric, low-osmolar, and dimeric, iso-osmolar classes. The osmotic characteristics of contrast media have been a significant focus in many investigations of contrast-induced nephropathy

[Contrast-induced nephropathy in patients at risk of renal failure undergoing computed tomography: systematic review and meta-analysis of randomized controlled trials].

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Arana, Estanislao; Catalá-López, Ferrán

2010-09-11

We evaluated and quantified by meta-analysis techniques the incidence of contrast-induced nephropathy (CIN) in patients at risk undergoing computed tomography (CT). We conducted a systematic review of randomized controlled clinical trials designated to evaluate the nephrotoxicity related to iso-osmolar contrast media (IOCM) compared to low-osmolar contrast media (LOCM). Main electronic databases searched included PubMed/MEDLINE, EMBASE, ISI Web of Knowledge and Virtual Health Library (BVS-BIREME), as well as abstracts presented at related scientific societies meetings. Prior to data extraction, definitions of nephrotoxicity and risk population were established. Besides meta-analysis, the global agreement between CIN definitions was evaluated with Mantel-Haenszel stratified test. Five studies were included with 716 randomized patients. When CIN was defined as increased serum creatinine (SCr)>or=25%, the relative risk (RR) was 0.71 (CI95%: 0.40-1.26)-in favor of IOCM-and when it was defined as SCr>or=0.5mg/dL it showed a RR 1.48 (CI95%: 0.37-5.87)-favoring LOCM-in the four studies used this criterion. Mantel-Haenszel stratified test was chi2=2.51 (p=0.8). In patients with renal failure undergoing CT there is a similar risk of CIN with the administration of any contrast media studied. CIN incidence depends on the chosen criteria and is lower with the definition of SCr>or=0.5mg/dL at 24-72h. No agreement was found between CIN definitions were adopted. Copyright © 2009 Elsevier España, S.L. All rights reserved.

Incompatibility of Contrast Medium and Trisodium Citrate

International Nuclear Information System (INIS)

Delcour, Christian; Bruninx, Guy

2013-01-01

To test the compatibility of trisodium citrate, a catheter lock solution, with iodinated contrast medium. Iohexol, iobitridol, iodixanol, ioxaglate, ioxithalamate, iomeprol, and iopromide were tested. In all tests, 2 ml of contrast medium were mixed with 2 ml of trisodium citrate solution. Iodixanol and ioxaglate provoked a highly viscous gluelike precipitation when mixed with trisodium citrate. A brief transient precipitate was observed with iohexol, iomeprol, and ioxithalamate. Permanent precipitation occurred with iobitridol and iopromide. One must be aware of the potential for precipitation when contrast medium is mixed with trisodium citrate solution. Before trisodium citrate solution is injected, the catheter should be thoroughly flushed with saline if a contrast medium has previously been injected through it.

Acute renal failure following contrast injection for head computerized tomography in two patients with diabetic nephropathy

International Nuclear Information System (INIS)

Matsunaga, Hiroshi; Sando, Hiroyuki; Nunokawa, Tomoo; Murakami, Tooru; Miyakawa, Yuzo

1981-01-01

Two cases of diabetes mellitus with renal and retinal involvement developed acute renal failure after undergoing head computerized tomography. The first case was a 62-year-old male who had been diagnosed as having diabetes 25 years before. He had diabetic retinopathy of Scott IIIb. Before head computerized tomography, the serum BUN was 37 mg/dl, and creatinine was 4.1 mg/dl. Oliguria began immediately after the scanning and confinued for 48 hr. The serum levels of BUN and creatinine rose to 106 and 7.7 mg/dl, respectively. Case 2 was a 49-year-old male who had been diagnosed as having diabetes 15 years before. He showed Scott IIb and IV retinopathy. The BUN and creatinine levels in the serum were 32 and 2.3 mg/dl, respectively. After receiving head computerized tomography, he developed oliguria and remained oliguric for 48 hr. During that period, the serum levels of BUN and creatinin were elevated to 112 and 7.5 mg/dl, respectively. Fortunately, both of these patients recovered from the oliguria without resorting to hemodialysis. The iodine contrast medium routinely used for contrast enhancement in the head computerized tomography was implicated in the acute renal failure of these patients. Only elevn cases have so far been reported in the literature who developed acute renal failure following computerized tomography. In view of the three or four times greater dosis of iodine contrast medium employed in computerized tomography compared to intravenous pyelography, the acute incidence of such complications might be much higher. Among the thirteen cases including the two reported here, as many as eight were diabetic. It is well recongnized that the incidence of acute renal failure after intravenous pyelography is particularly high in cases of diabetic nephropathy. (author)

Nephroprotective Effects of N-Acetylcysteine Amide against Contrast-Induced Nephropathy through Upregulating Thioredoxin-1, Inhibiting ASK1/p38MAPK Pathway, and Suppressing Oxidative Stress and Apoptosis in Rats

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Xuezhong Gong

2016-01-01

Full Text Available Contrast-induced nephropathy (CIN is a leading cause of hospital-acquired acute kidney injury (AKI due to apoptosis induced in renal tubular cells. Our previous study demonstrated the novel N-acetylcysteine amide (NACA; the amide form of N-acetyl cysteine (NAC prevented renal tubular cells from contrast-induced apoptosis through inhibiting p38 MAPK pathway in vitro. In the present study, we aimed to compare the efficacies of NACA and NAC in preventing CIN in a well-established rat model and investigate whether thioredoxin-1 (Trx1 and apoptosis signal-regulating kinase 1 (ASK1 act as the potential activator for p38 MAPK. NACA significantly attenuated elevations of serum creatinine, blood urea nitrogen, and biomarkers of AKI. At equimolar concentration, NACA was more effective than NAC in reducing histological changes of renal tubular injuries. NACA attenuated activation of p38 MAPK signal, reduced oxidative stress, and diminished apoptosis. Furthermore, we demonstrated that contrast exposure resulted in Trx1 downregulation and increased ASK1/p38 MAPK phosphorylation, which could be reversed by NACA and NAC. To our knowledge, this is the first report that Trx1 and ASK1 are involved in CIN. Our study highlights a renal protective role of NACA against CIN through modulating Trx1 and ASK1/p38 MAPK pathway to result in the inhibition of apoptosis among renal cells.

The predictive value of the product of contrast medium volume and urinary albumin/creatinine ratio in contrast-induced acute kidney injury.

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Wang, Chunrui; Ma, Shuai; Deng, Bo; Lu, Jianxin; Shen, Wei; Jin, Bo; Shi, Haiming; Ding, Feng

2017-11-01

Preexisting renal impairment and the amount of contrast media are the most important risk factors for contrast-induced acute kidney injury (CI-AKI). We aimed to investigate whether the product of contrast medium volume and urinary albumin/creatinine ratio (CMV × UACR) would be a better predictor of CI-AKI in patients undergoing nonemergency coronary interventions. This was a prospective single-center observational study, and 912 consecutive patients who were exposed to contrast media during coronary interventions were investigated prospectively. CI-AKI is defined as a 44.2 μmol/L rise in serum creatinine or a 25% increase, assessed within 48 h after administration of contrast media in the absence of other causes. Fifty patients (5.48%) developed CI-AKI. The urinary albumin/creatinine ratio (UACR) (OR = 1.002, 95% CI = 1.000-1.003, p = .012) and contrast medium volume (CMV) (OR = 1.008, 95% CI = 1.001-1.014, p = .017) were independent risk factors for the development of CI-AKI. The area under the ROC curve of CMV, UACR and CMV × UACR were 0.662 (95% CI = 0.584-0.741, p < .001), 0.761 (95% CI = 0.674-0.847, p < .001) and 0.808 (95% CI = 0.747-0.896, p < .001), respectively. The cutoff value of CMV × UACR to predict CI-AKI was 1186.2, with 80.0% sensitivity and 62.2% specificity. The product of CMV and UACR (CMV × UACR) might be a predictor of CI-AKI in patients undergoing nonemergency coronary interventions, which was superior to CMV or UACR alone.

Roentgen contrast medium

International Nuclear Information System (INIS)

Tamborski, C.

1989-01-01

The patent deals with a roentgen contrast medium containing a perfluorinebrominealkylether of the formula C m F 2m+1 OC n F 2n Br dispersed in water, preferentially in the presence of a non-ionic dispersing agent such as a fluorinated amidoaminoxide. 2 tabs

Contrast media induced acute renal failure in diabetics

International Nuclear Information System (INIS)

Rambausek, M.

1985-01-01

Dehydration, preexisting renal insufficiency, multiple myeloma and insulin-dependent diabetes mellitus are known risk factors for a radiocontrast medium induced acute renal failure. In 90% of patients with insulin-dependent diabetes mellitus, renal insufficiency and proteinuria, a further detoriation of renal function can be expected after i.v. administration of radiocontrast medium. Recent concepts on the genesis of acute renal failure after radiocontrast medium in multiple myeloma emphasize the role of tubular blocade (tubular precipitation of myeloma protein with contrast medium). In insulin-dependent diabetic patients we found altered carbohydrate composition of urinary Tamm Horsfall Protein (THP), with increased glucose and diminished N-acetyl-neuraminicacid content. This was paralleled by a difference in an in-vitro system of coprecipitation where THP of diabetes triggered more pronounced calcium dependent coprecipitation of contrast medium and albumin. These in-vitro findings might be important for the explanation of the genesis of radiocontrast medium-induced acute renal failure in insulin-dependent diabetes mellitus. (orig.) [de

Efficacy of atorvastatin on the prevention of contrast-induced acute kidney injury: a meta-analysis

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Liu L

2018-03-01

Full Text Available Ling-Yun Liu,1 Yang Liu,2 Mei-Yan Wu,2 Yan-Yan Sun,3 Fu-Zhe Ma2 1Department of Andrology, 2Department of Nephrology, the First Hospital of Jilin University, 3Department of Nephrology, the Fourth Hospital of Jilin University, Changchun, China Background: Results of studies on the efficacy of atorvastatin pretreatment on reducing the prevalence of contrast-induced acute kidney injury (CIAKI in patients undergoing coronary angiography (CAG or percutaneous coronary intervention (PCI have been controversial.Objective: We undertook a meta-analysis to evaluate the efficacy of atorvastatin on contrast-induced nephropathy (CIN after CAG or PCI.Materials and methods: We undertook a systematic search of electronic databases (PubMed, Embase, and the Cochrane Library up to June 2017. A meta-analysis was carried out including randomized controlled trials (RCTs that compared atorvastatin pretreatment with pretreatment with a low-dose statin or placebo for CIAKI prevention in patients undergoing CAG. The main endpoint was CIN prevalence.Results: Nine RCTs were included in our meta-analysis. Atorvastatin pretreatment reduced the prevalence of CIN significantly (odds ratio [OR] 0.46; 95% confidence interval [95% CI] 0.27–0.79; p=0.004. The benefit of high-dose atorvastatin pretreatment was consistent when compared with the control group (OR 0.45; 95% CI 0.21–0.95; p=0.04.Conclusion: At high doses, atorvastatin pretreatment was associated with a significant reduction in the prevalence of CIAKI in patients undergoing CAG. Pretreatment with high-dose atorvastatin could be employed to prevent CIAKI. Keywords: atorvastatin, contrast-induced acute kidney injury, coronary angiography, percutaneous coronary intervention, contrast-induced nephropathy, meta-analysis

Aspiration of barium contrast medium in an elderly man with disordered swallowing

OpenAIRE

Bağcı Ceyhan, B.; Çelikel, T.; Koç, M.; Ahıskalı, R.; Biren, T.; Ataizi Çelikel, Ç.

1995-01-01

The aspiration of contrast medium during the investigation of gastrointestinal diseases is a well recognized hazard, particularly in patients with swallowing disorders. A case is reported in which accidental aspiration of contrast barium occurred owing to disordered swallowing in an elderly man. The infiltration on chest x-ray persisted 2 years after barium contrast aspiration. Inflammatory reaction and retractile, granular material observed in lung biopsy specimens suggested barium-induced p...

Effect of sodium bicarbonate on the prevention of contrast induced nephropathy in patients undergoing coronary angiography

International Nuclear Information System (INIS)

Isono, Tsuyoshi; Kamihata, Hiroshi; Seno, Takeshi; Manabe, Kenichi; Moriguchi, Akira; Yurugi, Takatomi; Iwasaka, Toshiji; Motohiro, Masayuki

2007-01-01

Contrast induced nephropathy (CIN) remains a common complication of coronary angiography (CAG) and is associated with significant morbidity and mortality. Although a previous study reported pretreatment with sodium bicarbonate is more effective than sodium chloride for prophylaxis of CIN, this has not been a universal finding and the long-term effects of sodium bicarbonate on CIN have not been studied before. We performed a prospective, single-center, randomized trial to investigate whether CIN can be avoided by sodium bicarbonate in patients with chronic renal failure. Eighty patients with chronic renal failure (defined as serum creatinine concentration (SCr), >1.1 mg per deciliter), who were undergoing CAG, were enrolled in this study. We assigned them to either sodium chloride plus sodium bicarbonate (Group B: n=35) or sodium chloride alone (Group C: n=45). In all patients, an infusion of sodium chloride of 1 ml/kg per hour was given between 12 hours before and after the procedure. In Group B, sodium bicarbonate infusion of 1 ml/kg per hour continued from 3 hours before procedure to 6 hours after procedure, changing from sodium chloride at 1 ml/kg per hour. SCr was measured at baseline, day 1, day 2 and 1 month after the procedure. CIN was defined as a 25% increase in SCr from baseline value, or an absolute increase of at least 0.5 mg/dl, which appears within 2 days after CAG. No differences in age, sex and contrast volume were observed between the two groups. SCr at baseline was not significantly different in the two groups (Group B: 1.41±0.32 versus Group C: 1.50±0.38 mg/dl). SCr at day 2 was significantly lower in Group B than Group C (1.44±0.38 versus 1.60±0.5 mg/dl, p<0.05) and 1 month (1.28±0.27 versus 1.49±0.55 mg/dl, p<0.05). CIN occurred in 9 patients (20%) in Group C but in only 2 (6%) in Group B (p=0.03). Sodium chloride plus sodium bicarbonate is more effective than sodium chloride alone for prophylaxis of CIN and can help retain long

Prevention of contrast-induced nephropathy with single bolus erythropoietin in patients with diabetic kidney disease: A randomized controlled trial.

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Shema-Didi, Lilach; Kristal, Batya; Eizenberg, Sarit; Marzuq, Nabil; Sussan, Majdy; Feldman-Idov, Yulie; Ofir, Pnina; Atar, Shaul

2016-04-01

Contrast-induced-nephropathy (CIN) is associated with poor outcomes, thus prevention of CIN may be of clinical value. Erythropoietin (EPO) has been shown to elicit tissue-protective effects in experimental models and in clinical studies of acute kidney injury. We therefore evaluated its effectiveness for prevention of CIN after coronary angiography (CA) ± percutaneous coronary intervention (PCI) in diabetic patients with chronic kidney disease. A prospective, randomized, controlled trial was carried out in 138 diabetic patients with eGFR <60 mL/min who underwent non-urgent CA ± PCI. Patients received normal saline and n-acetyl cysteine before CA, with or without 50,000 U of EPO administered 30 min prior to CA. CIN was defined as an increase in serum creatinine of at least 0.5 mg/dL during the first 2 days after exposure to contrast media. Primary outcome was the incidence of CIN. Secondary outcomes were the sensitivity and positive predictive value (PPV) of Cystatin C (CC) and Neutrophil-gelatinase-associated-lipocalin (NGAL) for diagnosis of CIN. The observed incidence of CIN was 8.7%, significantly lower than the expected for such high-risk population. The administration of EPO prior to CA did not reduce the incidence of CIN (9.7% vs. 7.6%, P = 0.65). CC and NGAL demonstrated a low sensitivity (16.6%) and low PPV (6.7 and 33.3%, respectively) for detecting CIN. The administration of EPO prior to CA did not reduce the incidence of CIN. Additional prospective research with a larger sample size and in other patient categories is essential to further define the potential protective effect of EPO on prevention of CIN. © 2015 Asian Pacific Society of Nephrology.

Ameliorative effect of combination of benfotiamine and fenofibrate in diabetes-induced vascular endothelial dysfunction and nephropathy in the rat.

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Balakumar, Pitchai; Chakkarwar, Vishal Arvind; Singh, Manjeet

2009-01-01

The study has been designed to investigate the effect of benfotiamine and fenofibrate in diabetes-induced experimental vascular endothelial dysfunction (VED) and nephropathy. The single administration of streptozotocin (STZ) (50 mg/kg, i.p.) produced diabetes, which was noted to develop VED and nephropathy in 8 weeks. The diabetes produced VED by attenuating acetylcholine-induced endothelium dependent relaxation, impairing the integrity of vascular endothelium, decreasing serum nitrite/nitrate concentration and increasing serum TBARS and aortic superoxide anion generation. Further, diabetes altered the lipid profile by increasing the serum cholesterol, triglycerides and decreasing the high density lipoprotein. The nephropathy was noted to be developed in the diabetic rat that was assessed in terms of increase in serum creatinine, blood urea, proteinuria, and glomerular damage. The benfotiamine (70 mg/kg, p.o.) and fenofibrate (32 mg/kg, p.o.) or lisinopril (1 mg/kg, p.o., a standard agent) treatments were started in diabetic rats after 1 week of STZ administration and continued for 7 weeks. The treatment with benfotiamine and fenofibrate either alone or in combination attenuated diabetes-induced VED and nephropathy. In addition, the combination of benfotiamine and fenofibrate was noted to be more effective in attenuating the diabetes-induced VED and nephropathy when compared to treatment with either drug alone or lisinopril. Treatment with fenofibrate normalizes the altered lipid profile in diabetic rats, whereas benfotiamine treatment has no effect on lipid alteration in diabetic rats. It may be concluded that diabetes-induced oxidative stress, lipids alteration, and consequent development of VED may be responsible for the induction of nephropathy in diabetic rats. Concurrent administration of benfotiamine and fenofibrate may provide synergistic benefits in preventing the development of diabetes-induced nephropathy by reducing the oxidative stress and lipid

Application of 80-kVp scan and raw data-based iterative reconstruction for reduced iodine load abdominal-pelvic CT in patients at risk of contrast-induced nephropathy referred for oncological assessment: effects on radiation dose, image quality and renal function.

Science.gov (United States)

Nagayama, Yasunori; Tanoue, Shota; Tsuji, Akinori; Urata, Joji; Furusawa, Mitsuhiro; Oda, Seitaro; Nakaura, Takeshi; Utsunomiya, Daisuke; Yoshida, Eri; Yoshida, Morikatsu; Kidoh, Masafumi; Tateishi, Machiko; Yamashita, Yasuyuki

2018-05-01

To evaluate the image quality, radiation dose, and renal safety of contrast medium (CM)-reduced abdominal-pelvic CT combining 80-kVp and sinogram-affirmed iterative reconstruction (SAFIRE) in patients with renal dysfunction for oncological assessment. We included 45 patients with renal dysfunction (estimated glomerular filtration rate  60 ml per lmin per 1.73 m 2 ) who underwent standard oncological abdominal-pelvic CT (600 mgI kg -1 , 120-kVp, filtered-back projection) were included as controls. CT attenuation, image noise, and contrast-to-noise ratio (CNR) were compared. Two observers performed subjective image analysis on a 4-point scale. Size-specific dose estimate and renal function 1-3 months after CT were measured. The size-specific dose estimate and iodine load of 80-kVp protocol were 32 and 41%,, respectively, lower than of 120-kVp protocol (p 0.05). No significant kidney injury associated with CM administration was observed. 80-kVp abdominal-pelvic CT with SAFIRE yields diagnostic image quality in oncology patients with renal dysfunction under substantially reduced iodine and radiation dose without renal safety concerns. Advances in knowledge: Using 80-kVp and SAFIRE allows for 40% iodine load and 32% radiation dose reduction for abdominal-pelvic CT without compromising image quality and renal function in oncology patients at risk of contrast-induced nephropathy.

Vorapaxar treatment reduces mesangial expansion in streptozotocin-induced diabetic nephropathy in mice.

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Waasdorp, Maaike; Duitman, JanWillem; Florquin, Sandrine; Spek, C Arnold

2018-04-24

Twenty years after the onset of diabetes, up to 40% of patients develop diabetic nephropathy. Protease-activated receptor-1 (PAR-1) has recently been shown to aggravate the development of experimental diabetic nephropathy. PAR-1 deficient mice develop less albuminuria and glomerular lesions and PAR-1 stimulation induces proliferation and fibronectin production in mesangial cells in vitro . Vorapaxar is a clinically available PAR-1 inhibitor which is currently used for secondary prevention of ischemic events. The aim of this study was to investigate in a preclinical setting whether vorapaxar treatment may be a novel strategy to reduce diabetes-induced kidney damage. While control treated diabetic mice developed significant albuminuria, mesangial expansion and glomerular fibronectin deposition, diabetic mice on vorapaxar treatment did not show any signs of kidney damage despite having similar levels of hyperglycemia. These data show that PAR-1 inhibition by vorapaxar prevents the development of diabetic nephropathy in this preclinical animal model for type I diabetes and pinpoint PAR-1 as a novel therapeutic target to pursue in the setting of diabetic nephropathy. 22 C57Bl/6 mice were made diabetic using multiple low-dose streptozotocin injections (50 mg/kg) and 22 littermates served as non-diabetic controls. Four weeks after the induction of diabetes, 11 mice of each group were assigned to control or vorapaxar treatment. Mice were sacrificed after 20 weeks of treatment and kidney damage was evaluated.

[Guideline 'Precautionary measures for contrast media containing iodine'

NARCIS (Netherlands)

Dijk Azn, R. van; Wetzels, J.F.M.; Dam, M.A. ten; Aarts, N.J.; Schimmelpenninck-Scheiffers, M.L.; Freericks, M.P.; Said, S.A.M.; Geenen, R.W.; Stuurman, A.; Everdingen, J.J. van

2008-01-01

Annually, 0.5-1 million injections of contrast media containing iodine are administered in the Netherlands. Almost all contrast media nowadays are low-osmolar and nonionic. Nevertheless, the development ofcontrast-induced nephropathy is still a relevant clinical problem. Through an initiative by the

Accuracy of point-of-care serum creatinine devices for detecting patients at risk of contrast-induced nephropathy: a critical overview.

Science.gov (United States)

Martínez Lomakin, Felipe; Tobar, Catalina

2014-12-01

Contrast-induced nephropathy (CIN) is a common event in hospitals, with reported incidences ranging from 1 to 30%. Patients with underlying kidney disease have an increased risk of developing CIN. Point-of-care (POC) creatinine devices are handheld devices capable of providing quantitative data on a patient's kidney function that could be useful in stratifying preventive measures. This overview aims to synthesize the current evidence on diagnostic accuracy and clinical utility of POC creatinine devices in detecting patients at risk of CIN. Five databases were searched for diagnostic accuracy studies or clinical trials that evaluated the usefulness of POC devices in detecting patients at risk of CIN. Selected articles were critically appraised to assess their individual risk of bias by the use of standard criteria; 13 studies were found that addressed the diagnostic accuracy or clinical utility of POC creatinine devices. Most studies incurred a moderate to high risk of bias. Overall concordance between POC devices and reference standards (clinical laboratory procedures) was found to be moderate, with 95% limits of agreement often lying between -35.4 and +35.4 µmol/L (-0.4 and +0.4 mg/dL). Concordance was shown to decrease with worsening kidney function. Data on the clinical utility of these devices were limited, but a significant reduction in time to diagnosis was reported in two studies. Overall, POC creatinine devices showed a moderate concordance with standard clinical laboratory creatinine measurements. Several biases could have induced optimism in these estimations. Results obtained from these devices may be unreliable in cases of severe kidney failure. Randomized trials are needed to address the clinical utility of these devices.

Nephropathy after administration of iso-osmolar and low-osmolar contrast media: evidence from a network meta-analysis.

Science.gov (United States)

Biondi-Zoccai, Giuseppe; Lotrionte, Marzia; Thomsen, Henrik S; Romagnoli, Enrico; D'Ascenzo, Fabrizio; Giordano, Arturo; Frati, Giacomo

2014-03-15

Contrast-induced nephropathy (CIN) may be a severe complication to the administration of iodine-based contrast media for diagnostic or interventional procedure using radiation exposure. Whether there is a difference in nephrotoxic potential between the various agents is uncertain. We aimed to perform a systematic review and network meta-analysis of randomized trials on iodine-based contrast agents. Randomized trials of low-osmolar or iso-osmolar contrast media were searched in CENTRAL, Google Scholar, MEDLINE/PubMed, and Scopus. Risk of CIN was appraised within a hierarchical Bayesian model computing absolute rates (AR) and odds ratios (OR) with 95% credibility intervals, and probability of being best (Pbest) for each agent. A total of 42 trials (10048 patients) were included focusing on 7 different iodine-based contrast media. Risk of CIN was similarly low with iodixanol (AR=5.7% [2.2%-13.9%], Pbest=18.8%), iomeprol (AR=6.0% [2.2%-15.4%], Pbest=24.8%), iopamidol (AR=6.1% [2.2%-15.5%], Pbest=21.5%), and ioversol (AR=6.0% [2.1%-16.4%], Pbest=31.3%). Conversely, CIN was twice as common with iohexol (AR=11.2% [4.1%-29.5%], Pbest=0.1%) and ioxaglate (AR=11.0% [4.0%-26.9%], Pbestcontrast media with a similar renal safety profile. Iohexol and ioxaglate have a poorer renal safety profile, whereas further data may be required on iopromide. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Attenuation of Diabetic Nephropathy by Carvacrol through Anti-oxidative Effects in Alloxan-Induced Diabetic Rats

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Hamid Reza Jamshidi

2018-03-01

Full Text Available Background and Objectives: Diabetes, a common metabolic disorder, is prevalent in many countries. Nephropathy is a main debate’s side effect. Role of oxidative stress is well known in induction of diabetic nephropathy while carvacrol is a potent anti-oxidant that might attenuate oxidative stress. The aim of this study was to explore the effect of carvacrol in decreasing nephropathy-induced oxidative damage in diabetic rats. Methods: Thirty five Wistar rats (200-250 g were divided to 7 groups. The rats received alloxan (i.p., 200 mg/kg for induction of diabetes. After one week, fasting blood sugar (FBS was assessed and the rats with FBS>250 mg/dL were considered as diabetic. Three weeks after alloxan injection, the blood urea (BUN and creatinine (Cr were determined for confirmation of inducing nephropathy. Then, the animals were treated with carvacrol for one week. Finally, they were anesthetized and blood was collected from animal’s heart for calculation of BUN and Cr. Furthermore, the kidneys were for oxidative stress markers such as glutathione capacity, protein carbonyl, lipid peroxidation and catalase activity. Results: Our results showed that glutathione level and catalase activity significantly increased after treatment with carvacrol. Same results were found in rats that received vitamin E. Also, lipid peroxidation, protein carbonyl content, BUN and Cr levels significantly decreased after treatment with carvacrol in comparison with diabetic rats. Conclusion: Our results showed that carvacrol improved nephropathy-induced oxidative damage similar to vitamin E. Therefore, it may be suggested that carvacrol can be suggested as a useful supplement in decreasing diabetic complaints along with anti-diabetic drugs.

Prophylaxis and treatment of side effects due to iodinated contrast media relevant to radiological practice

International Nuclear Information System (INIS)

Becker, C.

2007-01-01

Increased utilization of iodinated contrast media may be associated with increased incidence of adverse events. The most important side effects include contrast-induced nephropathy, anaphylactoid reaction, thyrotoxicosis, and extravasation. In patients with moderate renal dysfunction, saline hydration and reduction of contrast media volume are recommended. No regime to prevent anaphylactoid reactions has yet proven to be efficient. If subclinical hyperthyroidism has been determined, prophylaxis with sodium perchlorate is advised. Contrast-induced nephropathy is commonly transient and needs to be followed over time. Mild general anaphylactoid reactions may be treated with antihistaminic drugs and corticosteroids. Furthermore the choice of the X-ray contrast media might influence the risk of any adverse effects. (orig.) [de

Myths and misconceptions concerning contrast media-induced anaphylaxis: a narrative review.

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Böhm, Ingrid; Morelli, John; Nairz, Knud; Silva Hasembank Keller, Patricia; Heverhagen, Johannes T

2017-03-01

Contrast-enhanced radiological examinations are an increasingly important diagnostic tool in modern medicine. All approved and available contrast media (iodinated and gadolinium-based) are safe compounds that are well-tolerated by most patients. However, a small percentage of patients exhibit contrast medium-induced adverse drug reactions that are dose-dependent and predictable (type A) or an even smaller cohort experience so-called type B (dose-independent, non-predictable). To increase patients' safety, recommendations/guidelines have been put forth in the literature and advice passed down informally by radiologists in practice to ensure contrast media safety. Through these, both reasonable suggestions as well as misinterpretations and myths (such as the misleading terms "allergy-like" reactions, and "iodine-allergy", the wrong assumption that the initial contact to a contrast medium could not induce an allergy, the estimation that an anti-allergy premedication could suppress all possible adverse reactions, and interleukin-2 as a risk/trigger for contrast medium adverse events) have arisen. Since the latter are not only unhelpful but also potentially reduce patients' safety, such myths and misconceptions are the focus of this review.

Radon inhalation suppresses nephropathy in streptozotocin-induced type-1 diabetic mice

International Nuclear Information System (INIS)

Nishiyama, Yuichi; Kataoka, Takahiro; Yamato, Keiko; Etani, Reo; Taguchi, Takehito; Yamaoka, Kiyonori

2016-01-01

In this study, we investigated the suppressive effects of radon inhalation against nephropathy in C57BL/6J mice with type-1 diabetes induced by intraperitoneal injection of streptozotocin (50 mg/kg weight, given five times). Four weeks after diabetes induction, the diabetic mice were continuously treated with inhaled radon-222 of 2000 Bq/m3 or air only (sham) for four weeks. The results showed that radon inhalation did not affect type-1 diabetic symptoms such as body weight loss, hyperglycemia, and hypoinsulinemia. However, diabetic mice treated with radon showed lower urinary albumin excretion and fibrotic change in renal glomeruli compared with diabetic mice not treated with radon. Furthermore, renal superoxide dismutase activity and glutathione content were significantly higher in diabetic mice treated with radon than in diabetic mice not treated with radon. These findings suggested that radon inhalation enhanced renal antioxidants activities, resulting in the suppression of diabetic nephropathy. This study may contribute to the development of a novel approach in the treatment of nephropathy for diabetic patients. (author)

Effects of computed tomography contrast medium factors on contrast enhancement

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Terasawa, Kazuaki; Hatcho, Atsushi; Okuda, Itsuko

2011-01-01

The various nonionic iodinated contrast media used in contrast computed tomography (CT) studies differ in terms of their composition, characteristics, and iodine concentration (mgI/ml), as well as the volume injected (ml). Compared with ionic iodinated contrast media, nonionic iodinated contrast media are low-osmolar agents, with different agents having different osmotic pressures. Using a custom-made phantom incorporating a semipermeable membrane, the osmotic flow rate (hounsfield unit (HU)/s) could easily be measured based on the observed increase in CT numbers, and the relationship between the osmotic pressure and the osmotic flow rate could be obtained (r 2 =0.84). In addition, taking the effects of patient size into consideration, the levels of contrast enhancement in the abdominal aorta (AA) and inferior vena cava (IVC) were compared among four types of CT contrast medium. The results showed differences in contrast enhancement in the IVC during the equilibrium phase depending on the type of contrast medium used. It was found that the factors responsible for the differences observed in enhancement in the IVC were the osmotic flow rate and the volume of the blood flow pathways in the circulatory system. It is therefore considered that the reproducibility of contrast enhancement is likely to be reduced in the examination of parenchymal organs, in which scanning must be performed during the equilibrium phase, even if the amount of iodine injected per unit body weight (mgI/kg) is maintained at a specified level. (author)

The Multi-center Evaluation of the Accuracy of the Contrast MEdium INduced Pd/Pa RaTiO in Predicting FFR (MEMENTO-FFR) Study.

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Leone, Antonio Maria; Martin-Reyes, Roberto; Baptista, Sergio B; Amabile, Nicolas; Raposo, Luis; Franco Pelaez, Juan Antonio; Trani, Carlo; Cialdella, Pio; Basile, Eloisa; Zimbardo, Giuseppe; Burzotta, Francesco; Porto, Italo; Aurigemma, Cristina; Rebuzzi, Antonio G; Faustino, Mariana; Niccoli, Giampaolo; Abreu, Pedro F; Slama, Michel S; Spagnoli, Vincent; Telleria Arrieta, Miren; Amat Santos, Ignacio J; de la Torre Hernandez, Jose M; Lopez Palop, Ramon; Crea, Filippo

2016-08-20

Adenosine administration is needed for the achievement of maximal hyperaemia fractional flow reserve (FFR) assessment. The objective was to test the accuracy of Pd/Pa ratio registered during submaximal hyperaemia induced by non-ionic contrast medium (contrast FFR [cFFR]) in predicting FFR and comparing it to the performance of resting Pd/Pa in a collaborative registry of 926 patients enrolled in 10 hospitals from four European countries (Italy, Spain, France and Portugal). Resting Pd/Pa, cFFR and FFR were measured in 1,026 coronary stenoses functionally evaluated using commercially available pressure wires. cFFR was obtained after intracoronary injection of contrast medium, while FFR was measured after administration of adenosine. Resting Pd/Pa and cFFR were significantly higher than FFR (0.93±0.05 vs. 0.87±0.08 vs. 0.84±0.08, ptime and costs.

Chemical substances as risk factors of nephropathy in diabetes mellitus

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Zofia Marchewka

2009-12-01

Full Text Available Although diabetes mellitus, a metabolic disease, does not fall into the group of diseases induced by toxic substances or environmental pollution, there is much evidence that some chemicals have considerable importance in its development. Exposure to substances with potential renal toxicity is especially dangerous for diabetics because it accelerates and intensifies diabetic nephropathy. This paper discusses the relationship between the xenobiotics and the development of diabetes mellitus and diabetic nephropathy with particular emphasis on those substances that causes the greatest damage to the kidneys. These are cadmium, iron, lead, arsenic, polychlorinated organic compounds, nitrogen compounds, and contrast agents. In addition, the mechanisms of diabetes mellitus induction or kidney damage by these xenobiotics are described.

Clinical experience with a non-ionic contrast medium (ultravist) in left ventriculography

International Nuclear Information System (INIS)

Lee, Ghi Jai; Park, Jae Hyung; Soe, Gwy Suk; Hong, Ju Hee; Han, Man Chung

1988-01-01

Non-ionic contrast medium, iopromide (Ultravist), was compared with ionic contrast medium, ioxitalamate (Telebrix), for efficacy and safety in 63 patients undergoing left ventriculography. In all patients, adverse symptoms and signs including pain, heat sense, nausea, vomiting, etc., were checked during and shortly after the injection. Blood pressure, heart rate, EKG and left ventricular pressure were also monitored during the study, and CBC, UA, BUN and creatinine were checked before and 24 hours after the study. The cineangiographic films were analysed and compared by 2 radiologists for the quality. Serious adverse effect did not occur in any case. Minor effects, especially nausea, were lee frequently caused by non-ionic contrast medium than by ionic contrast medium, and heat sense to non-ionic contrast medium was less severe than to ionic contrast medium. Except slightly elevated LVEDP at 1,5 minutes after the study in patients given ionic contrast medium, there was no significant change of electrophysiologic parameters and laboratory findings in both groups. In regard to image quality, there was no significant difference between ionic and non-ionic contrast medium. Thus non-ionic contrast medium, iopromide, appears to be safer for use in left ventriculography than the conventional ionic contrast medium, particularly in those patients at high risk of adverse effects.

Effects of acetylcysteine and probucol on contrast medium-induced depression of intrinsic renal glutathione peroxidase activity in diabetic rats.

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Yen, Hsueh-Wei; Lee, Hsiang-Chun; Lai, Wen-Te; Sheu, Sheng-Hsiung

2007-04-01

Antioxidants such as N-acetylcysteine and probucol have been used to protect patients from contrast media-induced nephrotoxicity. The mechanisms underlying these protective effects are not well understood. We hypothesized that acetylcysteine and probucol alter the activity of endogenous antioxidant enzyme activity. Four weeks after induction of diabetes with streptozotocin, diabetic and nondiabetic rats were divided into three groups. Group 1 rats did not receive any antioxidant agents. Group 2 rats were treated with acetylcysteine and group 3 rats with probucol for 1 week before injection of the contrast medium diatrizoate (DTZ). We found that diabetic rats had higher renal glutathione peroxidase (GPx) activity than normal rats. DTZ suppressed renal GPx activity significantly in both group 1 diabetic and normal rats. Interestingly, renal GPx activity in both diabetic and normal rats pretreated with acetylcysteine or probucol was not inhibited by DTZ. Renal superoxide dismutase (SOD) increased significantly in normal rats after DTZ injection, but not in diabetic rats. Finally, acetylcysteine or probucol did not significantly influence renal SOD. These findings suggest that the renal protective effects of acetylcysteine and probucol against contrast-induced oxidative stress and nephrotoxicity may be mediated by altering endogenous GPx activity.

Attenuation of diabetic nephropathy in streptozotocin-induced diabetic rats by Punica granatum Linn. leaves extract

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Snehal Nitin Mestry

2017-07-01

Full Text Available With an objective to develop Complementary and Alternative Medicine for the treatment of diabetic nephropathy, the present study investigated the protective effects of methanolic extract of Punica granatum leaves (MPGL in streptozotocin-induced diabetic nephropathy. Diabetic nephropathy has become a leading cause of end stage renal failure worldwide. P. granatum, due to its anti-diabetic, anti-inflammatory and antioxidant activities may retard the progression of diabetic nephropathy. In this study, diabetes was induced by a single injection of streptozotocin (STZ, 45 mg/kg, i.p. in rats. STZ-diabetic rats were treated with oral doses of MPGL (100, 200 and 400 mg/kg for 8 weeks. At the end of the experimental period, body and kidney weight and blood glucose levels were determined. Serum and urine parameters were investigated. Antioxidant enzymes and lipid peroxide levels were determined in the kidney along with histopathological examination of the same. MPGL significantly increased body weight, lowered blood glucose levels and ameliorated kidney hypertrophy index in the STZ-diabetic rats. The extract also decreased the levels of creatinine, blood urea nitrogen, total cholesterol, triglycerides, advanced glycation end products and albumin in serum and urine, respectively. MPGL significantly increased the antioxidant parameters in the kidney. Histological evaluation revealed that MPGL treated STZ-diabetic rats demonstrated reduced vacuolar degeneration of tubules; periodic acid Schiff base (PAS positivity staining intensity in glomeruli and basement membrane thickening. Present findings provide experimental evidence that MPGL has potential antioxidant, antihyperglycemic and anti-glycation activities which might be helpful in slowing the progression of diabetic nephropathy.

Attenuation of diabetic nephropathy in streptozotocin-induced diabetic rats by Punica granatum Linn. leaves extract.

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Mestry, Snehal Nitin; Dhodi, Jayesh Bachu; Kumbhar, Sangita Balbhim; Juvekar, Archana Ramesh

2017-07-01

With an objective to develop Complementary and Alternative Medicine for the treatment of diabetic nephropathy, the present study investigated the protective effects of methanolic extract of Punica granatum leaves (MPGL) in streptozotocin-induced diabetic nephropathy. Diabetic nephropathy has become a leading cause of end stage renal failure worldwide. P. granatum , due to its anti-diabetic, anti-inflammatory and antioxidant activities may retard the progression of diabetic nephropathy. In this study, diabetes was induced by a single injection of streptozotocin (STZ, 45 mg/kg, i.p.) in rats. STZ-diabetic rats were treated with oral doses of MPGL (100, 200 and 400 mg/kg) for 8 weeks. At the end of the experimental period, body and kidney weight and blood glucose levels were determined. Serum and urine parameters were investigated. Antioxidant enzymes and lipid peroxide levels were determined in the kidney along with histopathological examination of the same. MPGL significantly increased body weight, lowered blood glucose levels and ameliorated kidney hypertrophy index in the STZ-diabetic rats. The extract also decreased the levels of creatinine, blood urea nitrogen, total cholesterol, triglycerides, advanced glycation end products and albumin in serum and urine, respectively. MPGL significantly increased the antioxidant parameters in the kidney. Histological evaluation revealed that MPGL treated STZ-diabetic rats demonstrated reduced vacuolar degeneration of tubules; periodic acid Schiff base (PAS) positivity staining intensity in glomeruli and basement membrane thickening. Present findings provide experimental evidence that MPGL has potential antioxidant, antihyperglycemic and anti-glycation activities which might be helpful in slowing the progression of diabetic nephropathy.

Association of N-terminal pro-B-type natriuretic peptide with contrast-induced nephropathy and long-term outcomes in patients with chronic kidney disease and relative preserved left ventricular function.

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Liu, Yuan-hui; Liu, Yong; Zhou, Ying-ling; Yu, Dan-qing; He, Peng-cheng; Xie, Nian-jin; Li, Hua-long; Wei-Guo; Chen, Ji-yan; Tan, Ning

2015-04-01

The aim of the present article was to evaluate the association of N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) with contrast-induced nephropathy (CIN) and long-term outcomes in patients with chronic kidney disease (CKD) and relative preserved left ventricular function (LVF) undergoing percutaneous coronary intervention (PCI). We prospectively enrolled 1203 consecutive patients with CKD and preserved LVF undergoing elective PCI. The primary end point was the development of CIN, defined as an absolute increase in serum creatinine (SCr) ≥0.5 mg/dL, from baseline within 48 to 72 hours after contrast medium exposure. CIN incidence varied from 2.2% to 5.2%. Univariate logistic analysis showed that lg-NT-pro-BNP was significantly associated with CIN (odds ratio [OR] = 3.93, 95% confidence interval [CI], 2.22-6.97, P pro-BNP remained a significant predictor of CIN (OR = 3.30, 95% CI, 1.57-6.93, P = 0.002), even after adjusting for potential confounding risk factors. These results were confirmed by using other CIN criteria, which were defined as elevations of the SCr by 25% or 0.5 and 0.3 mg/dL from the baseline. The best cutoff value of lg-NT-pro-BNP for detecting CIN was 2.73 pg/mL (537 pg/mL) with 73.1% sensitivity and 70.0% specificity according to the receiver operating characteristic (ROC) analysis (C statistic = 0.754, 95% CI, 0.67-0.84, P pro-BNP ≥537 pg/mL (2.73 pg/mL, lg-NT-pro-BNP) was associated with an increased risk of all-cause mortality and composite end points during 2.5 years of follow-up. NT-pro-BNP ≥537 pg/mL is independently associated with an increased risk of CIN with different definitions and poor clinical outcomes in patients with CKD and relative preserved LVF undergoing PCI.

Arterial and venous blood pressure and blood flow following femoral angiography with a new non-ionic contrast medium

International Nuclear Information System (INIS)

Nyman, U.; Almen, T.

1978-01-01

At femoral angiography in dogs the effects of a new non-ionic contrast medium (C29) were compared with those of one non-ionic medium (metrizamide) and one ionic medium (meglumine/sodium diatrizoate) in current use. In the leg subjected to angiography the pressure gradient over the peripheral vessels decreased and the femoral blood flow increased. The changes induced by the ionic medium were significantly greater than those induced by metrizamide and C29, whereas no significant difference between the two non-ionic media was recorded. (Auth.)

Total saponin of Dioscoreae hypoglaucae rhizoma ameliorates streptozotocin-induced diabetic nephropathy

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Guo C

2016-02-01

Full Text Available Changrun Guo,1 Gang Ding,2 Wenzhe Huang,2 Zhenzhong Wang,2 Zhaoqing Meng,1,2 Wei Xiao2 1State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, People’s Republic of China; 2Jiangsu Kanion Pharmaceutical Co. Ltd, Lianyungang City, People’s Republic of China Background: Diabetic nephropathy has become the most common cause of morbidity and mortality in diabetic patients. Therefore, there is an urgent need for more effective and safer drugs for use in this condition.Purpose: The aims of this study were to investigate the ameliorative effects of total saponin of Dioscoreae hypoglaucae rhizoma (TSD on diabetic nephropathy and to explore the potential underlying mechanism(s.Methods: Rats with streptozotocin-induced diabetes were orally treated with TSD at 40, 80, and 160 mg/kg/d for 12 weeks. At the end of the treatment, blood, urine, and kidneys were collected for biochemical and histological examination.Results: The results demonstrated that TSD significantly decreased the fasting blood glucose, glycosylated hemoglobin, urinary protein, serum creatinine, and blood urea nitrogen levels in diabetic rats. The results of histological examinations showed that TSD ameliorated glomerular and tubular pathological changes in diabetic rats. Furthermore, TSD significantly prevented oxidative stress and reduced the renal levels of advanced glycation end products, transforming growth factor-β1, connective tissue growth factor, and tumor necrosis factor-α.Conclusion: This study demonstrated the renoprotective effects of TSD in experimental diabetic nephropathy via a number of different mechanisms. Keywords: total saponin of Dioscoreae hypoglaucae rhizoma, diabetic nephropathy, oxidative stress, AGEs, TGF-β1

Efficacy of short-term high-dose statin in preventing contrast-induced nephropathy: a meta-analysis of seven randomized controlled trials.

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Yongchuan Li

Full Text Available A few studies focused on statin therapy as specific prophylactic measures of contrast-induced nephropathy have been published with conflicting results. In this meta-analysis of randomized controlled trials, we aimed to assess the effectiveness of short-term high-dose statin treatment for the prevention of CIN and clinical outcomes and re-evaluate of the potential benefits of statin therapy.We searched PubMed, OVID, EMBASE, Web of science and the Cochrane Central Register of Controlled Trials databases for randomized controlled trials comparing short-term high-dose statin treatment versus low-dose statin treatment or placebo for preventing CIN. Our outcome measures were the risk of CIN within 2-5 days after contrast administration and need for dialysis.Seven randomized controlled trials with a total of 1,399 patients were identified and analyzed. The overall results based on fixed-effect model showed that the use of short-term high-dose statin treatment was associated with a significant reduction in risk of CIN (RR =0.51, 95% CI 0.34-0.76, p =0.001; I(2 = 0%. The incidence of acute renal failure requiring dialysis was not significant different after the use of statin (RR = 0.33, 95% CI 0.05-2.10, p = 0.24; I(2 = 0%. The use of statin was not associated with a significant decrease in the plasma C-reactive protein level (SMD -0.64, 95% CI: -1.57 to 0.29, P = 0.18, I(2 = 97%.Although this meta-analysis supports the use of statin to reduce the incidence of CIN, it must be considered in the context of variable patient demographics. Only a limited recommendation can be made in favour of the use of statin based on current data. Considering the limitations of included studies, a large, well designed trial that incorporates the evaluation of clinically relevant outcomes in participants with different underlying risks of CIN is required to more adequately assess the role for statin in CIN prevention.

Iodinated contrast media and contrast-induced nephropathy: is there a preferred cost-effective agent?

Science.gov (United States)

Sharma, Samin K

2008-05-01

Over 20 years have passed since the introduction of the tri-iodinated low-osmolar nonionic contrast agents such as iopamidol, iohexol, ioversol and iopromide. During this time, most cardiology practices have switched to these nonionic agents to avoid the nuisance side effects and cardiac adverse events associated with the older ionic contrast agents. Although the improved tolerability of the nonionic agents is generally attributed to their decreased osmolality (approximately half that of the older ionic contrast agents), in fact, these contrast agents also differ from the older agents in their ionicity, viscosity and direct chemotoxicity. The impact of these properties on safety, together with cost differences, should be considered when selecting a contrast agent.

Follow Up for Emergency Department Patients After Intravenous Contrast and Risk of Nephropathy

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Getaw Worku Hassen

2014-05-01

Full Text Available Introduction: Contrast-induced nephropathy (CIN, defined as an increase in serum creatinine (SCr greater than 25% or ≥0.5 mg/dL within 3 days of intravenous (IV contrast administration in the absence of an alternative cause, is the third most common cause of new acute renal failure in hospitalized patients. It is known to increase in-hospital mortality up to 27%. The purpose of this study was to investigate the rate of outpatient follow up and the occurrence of CIN in patients who presented to the emergency department (ED and were discharged home after computed tomography (CT of the abdomen and pelvis (AP with IV contrast. Methods: We conducted a single center retrospective review of charts for patients who required CT of AP with IV contrast and who were discharged home. Patients’ clinical data included the presence of diabetes mellitus, hypertension, chronic kidney disease (CKD and congestive heart failure (CHF. Results: Five hundred and thirty six patients underwent CT of AP with IV contrast in 2011 and were discharged home. Diabetes mellitus was documented in 96 patients (18%. Hypertension was present in 141 patients (26.3%, and 82 patients (15.3% were on angiotensin-converting-enzyme inhibitors (ACEI. Five patients (0.9% had documented CHF and all of them were taking furosemide. Seventy patients (13% had a baseline SCr >1.2 mg/dL. One hundred fifty patients (28% followed up in one of the clinics or the ED within one week after discharge, but only 40 patients (7.5% had laboratory workup. Out of 40 patients who followed up within 1 week after discharge, 9 patients (22.5% developed CIN. One hundred ninety patients (35.4% followed up in one of the clinics or the ED after 7 days and within 1 month after discharge, but only 71 patients (13.2% had laboratory workup completed. Out of 71 patients who followed up within 1 month, 11 patients (15% developed CIN. The overall incidence of CIN was 15.3% (17 out of 111 patients. Conclusion: There was a

Novel hydrogen sulfide-releasing compound, S-propargyl-cysteine, prevents STZ-induced diabetic nephropathy

International Nuclear Information System (INIS)

Qian, Xin; Li, Xinghui; Ma, Fenfen; Luo, Shanshan; Ge, Ruowen; Zhu, Yizhun

2016-01-01

In this work, we demonstrated for the first time that S-propargyl-cysteine (SPRC, also named as ZYZ-802), a novel hydrogen sulfide (H_2S)-releasing compound, had renoprotective effects on streptozotocin (STZ)-induced diabetic kidney injury. SPRC treatment significantly reduced the level of creatinine, kidney to body weight ratio and in particular, markedly decreased 24-h urine microalbuminuria excretion. SPRC suppressed the mRNA expression of fibronectin and type IV collagen. In vitro, SPRC inhibited mesangial cells over-proliferation and hypertrophy induced by high glucose. Additionally, SPRC attenuated inflammation in diabetic kidneys. SPRC also reduced transforming growth factor β1 (TGF-β1) signaling and expression of phosphorylated Smad3 (p-Smad3) pathway. Moreover, SPRC inhibited phosphorylation of ERK, p38 protein. Taken together, SPRC was demonstrated to be a potential therapeutic candidate to suppress diabetic nephropathy. - Highlights: • We synthesized a novel hydrogen sulfide-releasing compound, S-propargyl-cysteine (SPRC). • SPRC was preliminarily demonstrated to prevent STZ-induced diabetic nephropathy (DN). • SPRC may exert potential therapeutic candidate to suppress DN.

Novel hydrogen sulfide-releasing compound, S-propargyl-cysteine, prevents STZ-induced diabetic nephropathy

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Qian, Xin [Department of Pharmacology, School of Pharmacy, Fudan University, Shanghai (China); Li, Xinghui [Departments of Physiology and Pathophysiology, Shanghai College of Medicine, Fudan University, Shanghai (China); Ma, Fenfen; Luo, Shanshan [Department of Pharmacology, School of Pharmacy, Fudan University, Shanghai (China); Ge, Ruowen [Departmentof Biological Sciences, National University of Singapore (Singapore); Zhu, Yizhun, E-mail: zhuyz@fudan.edu.cn [Department of Pharmacology, School of Pharmacy, Fudan University, Shanghai (China); Departmentof Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore (Singapore)

2016-05-13

In this work, we demonstrated for the first time that S-propargyl-cysteine (SPRC, also named as ZYZ-802), a novel hydrogen sulfide (H{sub 2}S)-releasing compound, had renoprotective effects on streptozotocin (STZ)-induced diabetic kidney injury. SPRC treatment significantly reduced the level of creatinine, kidney to body weight ratio and in particular, markedly decreased 24-h urine microalbuminuria excretion. SPRC suppressed the mRNA expression of fibronectin and type IV collagen. In vitro, SPRC inhibited mesangial cells over-proliferation and hypertrophy induced by high glucose. Additionally, SPRC attenuated inflammation in diabetic kidneys. SPRC also reduced transforming growth factor β1 (TGF-β1) signaling and expression of phosphorylated Smad3 (p-Smad3) pathway. Moreover, SPRC inhibited phosphorylation of ERK, p38 protein. Taken together, SPRC was demonstrated to be a potential therapeutic candidate to suppress diabetic nephropathy. - Highlights: • We synthesized a novel hydrogen sulfide-releasing compound, S-propargyl-cysteine (SPRC). • SPRC was preliminarily demonstrated to prevent STZ-induced diabetic nephropathy (DN). • SPRC may exert potential therapeutic candidate to suppress DN.

Comparison of neutral oral contrast versus positive oral contrast medium in abdominal multidetector CT

International Nuclear Information System (INIS)

Berther, Ralph; Eckhardt, Boris; Zollikofer, Christoph L.; Patak, Michael A.; Erturk, Sukru M.

2008-01-01

To determine whether neutral contrast agents with water-equivalent intraluminal attenuation can improve delineation of the bowel wall and increase overall image quality for a non-selected patient population, a neutral oral contrast agent (3% mannitol) was administered to 100 patients referred for abdominal multidetector row computed tomography (MDCT). Their results were compared with those of 100 patients given a positive oral contrast agent. Qualitative and quantitative measurements were done on different levels of the gastrointestinal tract by three experienced readers. Patients given the neutral oral contrast agent showed significant better qualitative results for bowel distension (P<0.001), homogeneity of the luminal content (P<0.001), delineation of the bowel-wall to the lumen (P<0.001) and to the mesentery (P<0.001) and artifacts (P<0.001), leading to a significant better overall image quality (P<0.001) than patients receiving positive oral contrast medium. The quantitative measurements revealed significant better distension (P<0.001) and wall to lumen delineation (P<0.001) for the patients receiving neutral oral contrast medium. The present results show that the neutral oral contrast agent (mannitol) produced better distension, better homogeneity and better delineation of the bowel wall leading to a higher overall image quality than the positive oral contrast medium in a non-selected patient population. (orig.)

The evidence-based evaluation of the safety of contrast media in patients with diabetes mellitus

International Nuclear Information System (INIS)

Li Jixia; Huang Baosheng

2009-01-01

Contrast-induced nephropathy (CIN) has now been the third most common cause of acquired renal failure. Diabetes mellitus (DM), the type of contrast agent used and the intra-arterial route of administration are three important risk factors inducing CIN. The incidence rate of CIN is very high in patients with DM or renal insufficiency after iodinated contrast was administered. Unfortunately, it has not yet attracted physicians'and radiologists'sufficient attention. This paper aims to make an evidence-based evaluation of the safety and rephrotoxicity of various contrast agents when they are used in patients with DM. Usually, intravenous administration of contrast media will not cause permanent damage to the kidney in highrisk patients. Low-osmolarity contrast media is relatively safe for patients with DM only, while it takes much risk of CIN when low-osmolarity contrast media is used in patients with diabetic nephropathy or in patients of DM accompanied with renal insufficiency, for such patients, the iso-osmolarity contrast media, iodixanol, can be used. (authors)

Radiculography with water-soluble contraste medium

International Nuclear Information System (INIS)

Araujo Pinheiro, R.S. de

1987-01-01

The etiologic diagnosis of the lumbar pain is discussed. The radiculography with water-soluble contrast medium is used and 250 cases are studied. Some practical criteria of indication executation and interpretation of the examination are reported. (M.A.C.) [pt

GE-145, a new low-osmolar dimeric radiographic contrast medium

International Nuclear Information System (INIS)

Wistrand, Lars-G.; Rogstad, Astri; Hagelin, Gunnar

2010-01-01

Background: Contrast-induced nephrotoxicity is a significant risk when using radiographic contrast media clinically, especially in high risk patients. Consequently, there is a need for a new contrast agent with improved clinical safety with regards to nephrotoxicity. Purpose: To evaluate the physicochemical properties as well as the preclinical safety and biodistribution parameters of the newly developed radiographic contrast medium GE-145. Material and Methods: Standard methods for radiographic contrast media were used for evaluation of physicochemical properties. The acute toxicity in rats was studied at 8, 10, and 12.5 gI/kg, the clinical chemistry parameters were determined, and histology of the kidneys was performed. Biodistribution was studied in rats using 123 I-labeled GE-145. Results: GE-145 is more hydrophilic than iodixanol and has a considerably lower osmolality. The viscosity is similar to that of iodixanol and the protein binding is low. The acute toxicity is similar to that of iodixanol and the biodistribution is similar to that of other radiographic contrast media, showing mainly renal excretion. Kidney histology showed a moderate reversible vacuolization, similar to that of iodixanol. Conclusion: GE-145 exhibits similar preclinical properties to other dimeric radiographic contrast media. In addition, the low osmolality enables an iso-osmolar formulation containing a significantly higher concentration of electrolytes than Visipaque

Efficacy of high iodine concentration contrast medium with saline pushing in hepatic CT in patients with chronic liver disease. Comparison of high doses-standard contrast medium concentration

International Nuclear Information System (INIS)

Matoba, Munetaka; Kondo, Tamaki; Nishikawa, Takahiro; Kuginuki, Yasuaki; Yokota, Hajime; Higashi, Kotaro; Tonami, Hisao

2006-01-01

The aim of this study was to compare the enhancement of liver parenchyama with high iodine concentration contrast medium with saline pushing to that with high doses standard iodine concentration in hepatic CT in patients with chronic liver disease. There was no statistically significant difference regarding to the enhancement of liver parenchyama between the 370 mgI/ml of contrast medium with saline pushing and high doses standard iodine concentration contrast medium. (author)

Nefropatia induzida por contraste: avaliação da proteção pela n-acetilcisteína e alopurinol em ratos uninefrectomizados Contrast-induced nephropathy: evaluation of n-acetylcysteine and allopunirol protective effect in uninephrectomized rats

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José Carlos Carraro Eduardo

2008-06-01

Full Text Available OBJETIVO: A nefropatia por contraste é a terceira causa de insuficiência renal aguda em pacientes hospitalizados. O objetivo deste estudo foi avaliar a ação da n-acetilcisteína e do alopurinol na proteção renal em ratos de ambos os sexos que receberam diatrizoato. MATERIAIS E MÉTODOS: Ratos Wistar adultos jovens, uninefrectomizados e submetidos a restrição hídrica, receberam solução salina (grupo 1: machos; grupo 2: fêmeas, diatrizoato (grupo 3: machos; grupo 4: fêmeas, diatrizoato e n-acetilcisteína (grupo 5: machos, diatrizoato e alopurinol (grupo 6: machos e diatrizoato e n-acetilcisteína + alopurinol (grupo 7: machos. A filtração glomerular foi avaliada pela creatinina. O teste t de Student e o teste do sinal foram utilizados para análises estatísticas. RESULTADOS: Ratos que receberam diatrizoato apresentaram elevação estatisticamente significante da creatinina sérica, quando comparados aos controles, porém não houve diferença entre os sexos. Os animais que receberam alopurinol não mostraram aumento significante da creatinina, enquanto a administração de n-acetilcisteína não impediu a elevação da creatinina. CONCLUSÃO: O alopurinol mostrou-se mais efetivo que a n-acetilcisteína na proteção funcional renal ao dano induzido pelo diatrizoato de sódio. Não houve diferença entre os sexos na intensidade do dano renal pelo diatrizoato de sódio.OBJECTIVE: Contrast medium-induced nephropathy is the third most frequent cause of iatrogenic acute renal failure involving inpatients. The present study was aimed at evaluating the protective effect of n-acetylcysteine and allopurinol in both male and female rats receiving diatrizoate. MATERIALS AND METHODS: Thirty-five young adult Wistar rats submitted to hydric restriction were divided into groups as follows: groups 1 and 2 (respectively male and female rats receiving saline solution; groups 3 and 4 (respectively male and female rats receiving diatrizoate; group 5

Local blood-brain barrier penetration following systemic contrast medium administration

International Nuclear Information System (INIS)

Utz, R.; Ekholm, S.E.; Isaac, L.; Sands, M.; Fonte, D.

1988-01-01

The present study was initiated by a severe complication in a patient with renal dysfunction who developed cortical blindness and weakness of her left extremities 30 hours following renal and abdominal angiography. To evaluate the impact of prolonged high serum concentrations of contrast medium (CM) this clinical situation was simulated in a laboratory model using sheep with elevated serum levels of contrast medium maintained for 48 hours. The experimental data did not support the theory that the prolonged exposure to high circulating levels of contrast medium (4 ml/kg body weight of meglumine diatrizoate 60%) is sufficient alone to cause penetration of the blood-brain barrier. (orig.)

Atorvastatin attenuates contrast-induced nephropathy by modulating inflammatory responses through the regulation of JNK/p38/Hsp27 expression

Directory of Open Access Journals (Sweden)

Xuyu He

2016-05-01

Our study demonstrates that high-dosage atorvastatin treatment attenuates both the inflammatory processes and apoptosis in contrast-induced acute kidney injury, and that the JNK/p38 MAPK pathway participates in the contrast-induced apoptosis of renal tubular cells. Finally, atorvastatin reduces CIN by suppression of apoptosis, which may be through inhibition of JNK/p38 MAPK pathways.

Predictors for contrast media-induced nephropathy and long-term survival: Prospectively assessed data from the randomized controlled Dialysis-Versus-Diuresis (DVD) trial

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Hölscher, Birgit; Heitmeyer, Christine; Fobker, Manfred; Breithardt, Günter; Schaefer, Roland M; Reinecke, Holger

2008-01-01

BACKGROUND: Among the numerous studies concerning contrast media-induced nephropathy (CIN), there was no prospective trial that provided data on the long-term outcomes. OBJECTIVES: To prospectively assess predictors of CIN and long-term outcomes of affected patients. METHODS: Four hundred twelve consecutive patients with serum creatinine levels of 115 μmol/L to 309 μmol/L (1.3 mg/dL to 3.5 mg/dL) undergoing elective coronary angiography were included. Patients were randomly assigned to periprocedural hydration alone, hydration plus onetime hemodialysis or hydration plus N-acetylcysteine. RESULTS: Multivariate logistic regression identified the following as predictors of CIN within 72 h (equivalent to an increase in creatinine 44.2 μmol/L [0.5 mg/dL] or more) : prophylactic postprocedural hemodialysis (OR 2.86, 95% CI 1.07 to 7.69), use of angiotensin-converting enzyme inhibitors (OR 6.16, 95% CI 2.01 to 18.93), baseline glomerular filtration rate (OR 0.94, 95% CI 0.90 to 0.98) and the amount of contrast media given (OR 1.01, 95% CI 1.00 to 1.01). With regard to long-term outcome (mean follow-up 649 days), multivariate Cox regression models found elevated creatinine levels at 30 days (hazard rate ratio [HRR] 5.48, 95% CI 2.85 to 10.53), but not CIN within 72 h (HRR 1.12, 95% CI 0.63 to 2.02), to be associated with increased mortality. In addition, independent predictors for death during follow-up included left ventricular ejection fraction lower than 35% (HRR 4.01, 95% CI 2.22 to 7.26), serum phosphate (HRR 1.64, 95% CI 1.10 to 2.43) and hemoglobin (HRR 0.80, 95% CI 0.67 to 0.96). CONCLUSION: From the present prospective trial, performance of post-procedural hemodialysis, use of angiotensin-converting enzyme inhibitors, reduced baseline glomerular filtration rate and amount of contrast media were independent predictors of CIN within 72 h after catheterization. Assessing renal function after 30 days, rather than within 72 h, seemed to be more predictive for

Relationship Between the Urine Flow Rate and Risk of Contrast-Induced Nephropathy After Emergent Percutaneous Coronary Intervention.

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Liu, Yong; Lin, Lixia; Li, Yun; Li, Hualong; Wu, Deng-Xuan; Zhao, Jian-bin; Lian, Dan; Zhou, Yingling; Liu, Yuanhui; Ye, Piao; Ran, Peng; Duan, Chongyang; Chen, Shiqun; Chen, Pingyan; Xian, Ying; Chen, Jiyan; Tan, Ning

2015-12-01

A low urine flow rate is a marker of acute kidney injury. However, it is unclear whether a high urine flow rate is associated with a reduced risk of contrast-induced nephropathy (CIN) in high-risk patients. We conducted this study to evaluate the predictive value of the urine flow rate for the risk of CIN following emergent percutaneous coronary intervention (PCI). We prospectively examined 308 patients undergoing emergent PCI who provided consent. The predictive value of the 24-hour postprocedural urine flow rate, adjusted by weight (UR/W, mL/kg/h) and divided into quartiles, for the risk of CIN was assessed using multivariate logistic regression analysis. The cumulative incidence of CIN was 24.4%. In particular, CIN was observed in 29.5%, 19.5%, 16.7%, and 32.0% of cases in the UR/W quartile (Q)-1 (≤0.94  mL/kg/h), Q2 (0.94-1.30  mL/kg/h), Q3 (1.30-1.71  mL/kg/h), and Q4 (≥1.71  mL/kg/h), respectively. Moreover, in-hospital death was noted in 7.7%, 3.9%, 5.1%, and 5.3% of patients in Q1, Q2, Q3, and Q4, respectively. After adjusting for potential confounding predictors, multivariate analysis indicated that compared with the moderate urine flow rate quartiles (Q2 + Q3), a high urine flow rate (Q4) (odds ratio [OR], 2.69; 95% confidence interval [CI], 1.27-5.68; P = 0.010) and low urine flow rate (Q1) (OR, 2.23; 95% CI, 1.03-4.82; P = 0.041) were significantly associated with an increased risk of CIN. Moreover, a moderate urine flow rate (0.94-1.71  mL/kg/h) was significantly associated with a decreased risk of mortality. Our data suggest that higher and lower urine flow rates were significantly associated with an increased risk of CIN after emergent PCI, and a moderate urine flow rate (0.94-1.71  mL/kg/h) may be associated with a decreased risk of CIN with a good long-term prognosis after emergent PCI.

Radiculography with reduced amounts of contrast medium

International Nuclear Information System (INIS)

Signorini, E.; Caputo, N.; Chiurulla, C.; Ciorba, E.; Pelliccioli, G.P.; Cianciulli, E.

1984-01-01

Because of the frequency and seriousness of side effects observed after radiculography, due to, among the other things, the amount of contrast medium, the authors describe a method that gives diagnostically satisfactory results using a low dose of contrast and a tangent-beam technique. Among 106 patients undergoing radiculography with a tangent-beam technique and Iopamidol, only 4 developed mild side effects, namely headache in three cases and headache with nausea in one. (Author)

Risk factors and outcomes of contrast-induced nephropathy in ...

African Journals Online (AJOL)

Hospitalised patients undergoing computed tomography scan contrast media administration and angiography were consecutively recruited to the study and followed up for development of AKI. CIN was defined as an increase in serum creatinine >25% or an absolute increase of >44 μmol/L from baseline at 48 - 72 hours ...

Targeting cancer chemotherapeutic agents by use of lipiodol contrast medium

International Nuclear Information System (INIS)

Konno, T.

1990-01-01

Arterially administered Lipiodol Ultrafluid contrast medium selectively remained in various malignant solid tumors because of the difference in time required for the removal of Lipiodol contrast medium from normal capillaries and tumor neovasculature. Although blood flow was maintained in the tumor, even immediately after injection Lipiodol contrast medium remained in the neovasculature of the tumor. To target anti-cancer agents to tumors by using Lipiodol contrast medium as a carrier, the characteristics of the agents were examined. Anti-cancer agents had to be soluble in Lipiodol, be stable in it, and separate gradually from it so that the anti-cancer agents would selectively remain in the tumor. These conditions were found to be necessary on the basis of the measurement of radioactivity in VX2 tumors implanted in the liver of 16 rabbits that received arterial injections of 14C-labeled doxorubicin. Antitumor activities and side effects of arterial injections of two types of anti-cancer agents were compared in 76 rabbits with VX2 tumors. Oily anti-cancer agents that had characteristics essential for targeting were compared with simple mixtures of anti-cancer agents with Lipiodol contrast medium that did not have these essential characteristics. Groups of rabbits that received oily anti-cancer agents responded significantly better than groups that received simple mixtures, and side effects were observed more frequently in the groups that received the simple mixtures. These results suggest that targeting of the anti-cancer agent to the tumor is important for treatment of solid malignant tumors

Comparative analysis of diabetic nephropathy and non-diabetic nephropathy disease.

Science.gov (United States)

Chen, Qiuxiang; Zhu, Aimin; Wang, Junsheng; Huan, Xuelai

2017-12-01

Clinical symptoms of diabetic nephropathy patients and non-diabetic nephropathy are compared and analyzed, hemodialysis effect and quality of life of two kinds of nephrotic patients are analyzed. Respectively extract 1300 cases of diabetic nephropathy and non-diabetic nephropathy patients admitted to different hospitals during December 2011-December 2014. Based on whether the patient suffers from diabetes, they were divided into diabetic group and control group. Hemodialysis of two groups of patients were followed up to observe effectiveness of blood treatment, and complications were observed after one year of follow-up. Hematodialysis effectiveness of diabetic nephropathy patients is significantly lower than that of non-diabetic nephropathy group. After 1 year's follow-up, it can be found that survival rate of diabetic nephropathy patients is much lower than that of control group. In statistical comparison of data involved in the two groups of patients, P diabetic nephropathy patients is relatively poor compared to that of non-diabetic patients. In clinics, management and prevention of diabetic patients should be strengthened to avoid complication of nephropathy which brings serious injury to patients.

Predictive Value of CHA2DS2-VASC Score for Contrast-Induced Nephropathy After Percutaneous Coronary Intervention for Acute Coronary Syndrome.

Science.gov (United States)

Kurtul, Alparslan; Yarlioglues, Mikail; Duran, Mustafa

2017-03-15

The CHA2DS2-VASC score, used for embolic risk stratification in atrial fibrillation (AF), has been reported recently to predict adverse clinical outcomes in patients with acute coronary syndrome (ACS), regardless of having AF. We investigated the correlation between the CHA2DS2-VASC score and contrast-induced nephropathy (CIN) in patients with ACS who underwent urgent percutaneous coronary intervention (PCI). A total of 1,408 patients were enrolled in the study. The CHA2DS2-VASC score was calculated for each patient. Based on the receiver operating characteristic analysis, the study population was divided into 2 groups: CHA2DS2-VASC score ≤3 group (n = 944) and CHA2DS2-VASC score ≥4 group (n = 464). Patients were then reallocated to 2 groups according to the presence or absence of CIN. CIN was defined as a rise in serum creatinine >0.5 mg/dl or >25% increase in baseline within 72 hours after PCI. Overall, 159 cases (11.3%) of CIN were diagnosed. Receiver operating characteristic curve analysis revealed good diagnostic value of CHA2DS2-VASC score in predicting CIN (area under the curve 0.769, 95% confidence interval 0.733 to 0.805; p high score had a higher frequency of CIN (23.9% vs 5.1%; p <0.001), and multivariate analysis identified the CHA2DS2-VASC score of ≥4 as an independent predictor of CIN. In conclusion, CHA2DS2-VASC score can be used as a new, simple, and reliable tool to predict CIN in patients with ACS who underwent urgent PCI. Copyright © 2016 Elsevier Inc. All rights reserved.

Contrast enhancement technique in brain 3D-CTA studies. Optimizing the amount of contrast medium according to scan time based on TDC

International Nuclear Information System (INIS)

Terasawa, Kazuaki; Hatcho, Atsushi

2008-01-01

In three-dimensional CT angiography (3D-CTA), good reproducibility can be obtained by maintaining the maximum CT numbers (HU) at a specified level. However, the correlation between the scan time and the injection time showed that the maximum CT numbers increased and varied due to the additional contrast enhancement effect from recirculation of the injected contrast medium for longer injection times when the dose of iodinated contrast medium per unit time (mgI/s) was maintained at a specified level based on the time-density curve (TDC) of the phantom. The amount of contrast medium employed at our hospital has been optimized based on an iodinated contrast medium dose per unit time providing a contrast enhancement effect of 300 HU in the middle cerebral artery. Using this standard, a TDC phantom was employed to obtain an iodinated contrast medium dose per unit time, permitting equivalent maximum CT values (used as standard values) to be obtained by changing the injection time. A contrast-enhancement technique that accounts for the variation in the scan time was evaluated. Strong correlations were observed between the scan time and the injection time (R 2 =0.969) and between the injection time and the dose of iodinated contrast medium per unit body weight (R 2 =0.994). We conclude that adjusting the dose of iodinated contrast medium per unit body weight per unit time according to the scan time permits optimization of the contrast-enhancement technique. (author)

MRI of the liver with the new contrast medium Gd-BOPTA

International Nuclear Information System (INIS)

Vogl, T.J.; Pegios, W.; Balzer, J.; Lissner, J.; Pirovano, G.

1992-01-01

A phase 1 study on 8 normals has been carried out to determine the effectiveness and safety during MRI of a new hepatobiliary contrast medium Gd-BOPTA for causing enhancement of the upper abdominal organs. Gradient echo sequences (flash), T 1 and T 2 -weighted spin echo sequences and turbo-flash sequences were used. The contrast medium was given as a single infusion in various concentrations (0.005, 0.05, 0.1 and 0.2 mmol/kg body weight). Optimal contrast of liver parenchyma was obtained with a dose of 0.05-0.1 mmol/kg body weight, resulting in contrast increase of 149.1% during gradient echo sequences and 107.8% during T 1 spin echo sequences. In general, the increased contrast lasted for about two hours. Because of the biliary and renal excretion there was an enormous increase in signal intensity of the bile ducts and a significant increase in the kidneys and ureters. The results of the first in-vivo-trial of Gd-BOPTA encourages the performance of further clinical studies of this new hepatobiliary contrast medium. (orig.) [de

Computed tomography using contrast medium in disorders of the patello-femoral joint

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Suzuki, Kenji; Chiba, Mitsuho; Morita, Hiromi; Kikuchi, Toshihiko; Shimada, Yoichi; Yamamoto, Masahiro; Tozawa, Kazuma

1985-01-01

The morphology and alignment of the articular cartilage of the patello-femoral joint were examined by computed tomography (CT) using a contrast medium in 15 patients with a chief complaint of patellar pain. CT was undertaken immediately after injecting a contrast medium and air into the knee joint. Retention and irregularity of the contrast medium in the joint estimated the expansion and depth of lesions in patients with osteomalacia of the auricular joint or osteoarthritis of the knee, and the thickness of the auricular cartilage. Considering the individual differences of the patella itself and specificity of the form of the auricular cartilage, the auricular joint should also be examined in terms of alignment of the cartilage surface. CT using a contrast medium is a simple, less invasive method for evaluating disorders of the patello-femoral joint.

Radiologists' knowledge and perceptions of the impact of contrast-induced nephropathy and its risk factors when performing computed tomography examinations: A survey of European radiologists

International Nuclear Information System (INIS)

Reddan, Donal; Fishman, Elliot K.

2008-01-01

Background: The past decade has seen a proliferation in the number of CT procedures. As increasing numbers of elderly patients with multiple comorbidities undergo contrast media (CM)-enhanced procedures, more patients are at risk for contrast-induced nephropathy (CIN). Objectives: To understand whether radiologists are sufficiently aware of the incidence, impact and risk factors of CIN, and whether they are taking sufficient measures to prevent CIN among patients undergoing CT. Materials and methods: A telephone or online survey was conducted in 2005 with 509 radiologists from 10 European countries. Participants had a minimum of 3 years' experience and performed at least 50 CT scans per week. Results: Most (88%) radiologists believed that CIN is an important issue. While 45% identify that a patient is experiencing CIN when the serum creatinine level increases >25% (0.5 mg/dL) from baseline within 48 h, the remainder used criteria that might lead to significant under-diagnosis. Most (72%) radiologists believed that CIN is associated with increased morbidity; 56% did not believe that it is associated with increased mortality. Most respondents agreed that pre-existing renal impairment (97%), dehydration (90%) and diabetes (89%) were risk factors for CIN; however, 26%, 30% and 46%, respectively, did not identify advanced age, CM dose or congestive cardiac failure as risk factors. Only 7% of radiologists thought they were always made aware of CIN associated with their cases and 28% never consulted a nephrologist to discuss patients at risk of CIN or who had developed CIN. Conclusion: There is highly variable awareness of the definition, impact and risk factors for CIN among European radiologists. Data regarding the importance of CIN in CT are limited. Improved efforts are required to better educate radiologists and referring physicians and to institute appropriate protocols to identify at-risk patients and prevent CIN

The role of oxidative stress in streptozotocin-induced diabetic nephropathy in rats.

Science.gov (United States)

Fernandes, Sheila Marques; Cordeiro, Priscilla Mendes; Watanabe, Mirian; Fonseca, Cassiane Dezoti da; Vattimo, Maria de Fatima Fernandes

2016-10-01

The objective of this study was to evaluate the role of oxidative stress in an experimental model of streptozotocin-induced diabetic nephropathy in rats. Wistar, adult, male rats were used in the study. Animals were divided in the following groups: Citrate (control, citrate buffer 0.01M, pH 4.2 was administrated intravenously - i.v - in the caudal vein), Uninephrectomy+Citrate (left uninephrectomy-20 days before the study), DM (streptozotocin, 65 mg/kg, i.v, on the 20th day of the study), Uninephrectomy+DM. Physiological parameters (water and food intake, body weight, blood glucose, kidney weight, and relative kidney weight); renal function (creatinine clearance), urine albumin (immunodiffusion method); oxidative metabolites (urinary peroxides, thiobarbituric acid reactive substances, and thiols in renal tissue), and kidney histology were evaluated. Polyphagia, polydipsia, hyperglycemia, and reduced body weight were observed in diabetic rats. Renal function was reduced in diabetic groups (creatinine clearance, p < 0.05). Uninephrectomy potentiated urine albumin and increased kidney weight and relative kidney weight in diabetic animals (p < 0.05). Urinary peroxides and thiobarbituric acid reactive substances were increased, and the reduction in thiol levels demonstrated endogenous substrate consumption in diabetic groups (p < 0.05). The histological analysis revealed moderate lesions of diabetic nephropathy. This study confirms lipid peroxidation and intense consumption of the antioxidant defense system in diabetic rats. The association of hyperglycemia and uninephrectomy resulted in additional renal injury, demonstrating that the model is adequate for the study of diabetic nephropathy.

Reversal of diabetic nephropathy by a ketogenic diet.

Directory of Open Access Journals (Sweden)

Michal M Poplawski

Full Text Available Intensive insulin therapy and protein restriction delay the development of nephropathy in a variety of conditions, but few interventions are known to reverse nephropathy. Having recently observed that the ketone 3-beta-hydroxybutyric acid (3-OHB reduces molecular responses to glucose, we hypothesized that a ketogenic diet, which produces prolonged elevation of 3-OHB, may reverse pathological processes caused by diabetes. To address this hypothesis, we assessed if prolonged maintenance on a ketogenic diet would reverse nephropathy produced by diabetes. In mouse models for both Type 1 (Akita and Type 2 (db/db diabetes, diabetic nephropathy (as indicated by albuminuria was allowed to develop, then half the mice were switched to a ketogenic diet. After 8 weeks on the diet, mice were sacrificed to assess gene expression and histology. Diabetic nephropathy, as indicated by albumin/creatinine ratios as well as expression of stress-induced genes, was completely reversed by 2 months maintenance on a ketogenic diet. However, histological evidence of nephropathy was only partly reversed. These studies demonstrate that diabetic nephropathy can be reversed by a relatively simple dietary intervention. Whether reduced glucose metabolism mediates the protective effects of the ketogenic diet remains to be determined.

Reversal of Diabetic Nephropathy by a Ketogenic Diet

Science.gov (United States)

Poplawski, Michal M.; Mastaitis, Jason W.; Isoda, Fumiko; Grosjean, Fabrizio; Zheng, Feng; Mobbs, Charles V.

2011-01-01

Intensive insulin therapy and protein restriction delay the development of nephropathy in a variety of conditions, but few interventions are known to reverse nephropathy. Having recently observed that the ketone 3-beta-hydroxybutyric acid (3-OHB) reduces molecular responses to glucose, we hypothesized that a ketogenic diet, which produces prolonged elevation of 3-OHB, may reverse pathological processes caused by diabetes. To address this hypothesis, we assessed if prolonged maintenance on a ketogenic diet would reverse nephropathy produced by diabetes. In mouse models for both Type 1 (Akita) and Type 2 (db/db) diabetes, diabetic nephropathy (as indicated by albuminuria) was allowed to develop, then half the mice were switched to a ketogenic diet. After 8 weeks on the diet, mice were sacrificed to assess gene expression and histology. Diabetic nephropathy, as indicated by albumin/creatinine ratios as well as expression of stress-induced genes, was completely reversed by 2 months maintenance on a ketogenic diet. However, histological evidence of nephropathy was only partly reversed. These studies demonstrate that diabetic nephropathy can be reversed by a relatively simple dietary intervention. Whether reduced glucose metabolism mediates the protective effects of the ketogenic diet remains to be determined. PMID:21533091

Effects of use of the lodine contrast medium on gamma camera imaging

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Pyo, Sung Jae; Cho, Yun Ho [Dept. of Nuclear Medicine, Inha University hospital, Incheon (Korea, Republic of); Choi, Jae Ho [Dept. of Radiological Technology, Ansan College, Ansan (Korea, Republic of)

2016-12-15

Effects of Gamma camera imaging on gamma ray counting rates as a function of use and density of the iodine contrast medium currently in primary use for clinics, and changes in gamma ray counting rates as a function of the contrast medium status upon attenuation correction using a CT absorption coefficientin an SPECT/CT attenuation correction will be considered herein. For experimental materials used 99mTcO4 370 MBq and Pamiray 370 mg, Iomeron 350 mg, Visipaque 320 mg, Bonorex 300 mg of iodine contrast medium. For image acquisition, planar imaging was consecutively filmed for 1, 2, 3, 4, 5 min, respectively, 30 min after administration of 99mTcO4. while 60 views were filmed per frame for 20 min at 55 min for the SPECT/CT imaging. In planar imaging, the gamma ray counting rates as a function of filming time were reduced showing a statistically significant difference when mixed according to the type of contrast medium density rather than when the radioactive isotope 99mTcO4 and the saline solution were mixed. In the tomography for mixing of the radioactive isotope 99mTcO4 and saline solution, the mean counting rate without correction by the CT absorption coefficient is 182±26 counts, while the counting rate with correction by the CT absorption coefficient is 531.3±34 counts. In the tomography for mixing of the radioactive isotope 99mTcO4 and the saline solution with the contrast medium, the mean values before attenuation correction by CT absorption coefficient were 166±29, 158.3±17, 154±36, and 150±33 counts depending on the densities of the contrast medium, while the mean values after attenuation correction were 515±03, 503±10, 496±31, and 488.7±33 counts, showing significant differences in both cases when comparatively evaluated with the imaging for no mixing of the contrast medium. Iodine contrast medium affects the rate of gamma ray. Therefore, You should always be preceded before another test on the day of diagnosis.

Contrast-induced encephalopathy following cardiac catheterization.

Science.gov (United States)

Spina, Roberto; Simon, Neil; Markus, Romesh; Muller, David Wm; Kathir, Krishna

2017-08-01

To describe the epidemiology, pathophysiology, clinical presentation, and management of contrast-induced encephalopathy (CIE) following cardiac catheterization. CIE is an acute, reversible neurological disturbance directly attributable to the intra-arterial administration of iodinated contrast medium. The PubMed database was searched and all cases in the literature were retrieved and reviewed. 52 reports of CIE following cardiac catheterization were found. Encephalopathy, motor and sensory disturbances, vision disturbance, opthalmoplegia, aphasia, and seizures have been reported. Transient cortical blindness is the most commonly reported neurological syndrome, occurring in approximately 50% of cases. The putative mechanism involves disruption of the blood brain barrier and direct neuronal injury. Contrast-induced transient vasoconstriction has also been implicated. Symptoms typically appear within minutes to hours of contrast administration and resolve entirely within 24-48 hr. Risk factors may include hypertension, diabetes mellitus, renal impairment, the administration of large volumes of iodinated contrast, percutaneous coronary intervention or selective angiography of internal mammary grafts, and previous adverse reaction to iodinated contrast. Characteristic findings on cerebral imaging include cortical and sub-cortical contrast enhancement on computed tomography (CT). Imaging findings in CIE may mimic subarachnoid hemorrhage or cerebral ischemia; the Hounsfield scale on CT and the apparent diffusion coefficient on magnetic resonance imaging (MRI) are useful imaging tools in distinguishing these entities. In some cases, brain imaging is normal. Prognosis is excellent with supportive management alone. CIE tends to recur, although re-challenge with iodinated contrast without adverse effects has been documented. CIE is an important clinical entity to consider in the differential diagnosis of stroke following cardiac catheterization. Given that prognosis is

Experimentally induced acute uric acid nephropathy in rabbits: Findings of high resolution gray scale and doppler ultrasonographies

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Yang, Ik; Chung, Soo Young; Lee, Kyung Won; Kim, Hong Dae; Ko, Eun Young; Won, Mi Sook; Noh, Jung Woo [Hallym University College of Medicine, Seoul (Korea, Republic of); Park, Moon Hyang [Hanyang University College of Medicine, Seoul (Korea, Republic of)

2001-12-15

To evaluate changes of the high-resolution (HR) gray scale and doppler ultrasonographic (US) characteristics of experimentally induced acute uric acid (UA) nephropathy in rabbits. Acute UA nephropathy was induced in ten rabbits using supersaturated lithium carbonate solution. The rabbits were divided in two groups. Group I consisted of five rabbits, and they were injected with a single dose of 150 ml of saturated UA over one hour. During tis period, serial US studies of the kidneys of these rabbits were performed every ten minutes. Group II consisted of the remaining five rabbits, and three injections of 50 ml of saturated UA solution were given on the first, fifth and eight day and follow-up was done upto twenty fifth day. Sequential HR and Doppler US, renal biopsy and blood sampling were performed on day 1, 5, 8, 21, and 25 in the group II rabbits. In group I, HR and Doppler US examination revealed the normal resistive index without significant abnormality. On the other hand, US studies of group II showed poor renal corticomedullary differentiation, decreased renal blood flow and elevated resistive index. There was statistically significant correlation among US findings, histologic characteristics and chemical index (BUN, creatinine) of renal function. In addition, sequentially increased size and volume of the kidney were noted in both groups. HR gray scale and doppler US characteristics of experimentally induced acute UA nephropathy in rabbits were similar to those of acute renal failure caused by other well-known causes.

Experimentally induced acute uric acid nephropathy in rabbits: Findings of high resolution gray scale and doppler ultrasonographies

International Nuclear Information System (INIS)

Yang, Ik; Chung, Soo Young; Lee, Kyung Won; Kim, Hong Dae; Ko, Eun Young; Won, Mi Sook; Noh, Jung Woo; Park, Moon Hyang

2001-01-01

To evaluate changes of the high-resolution (HR) gray scale and doppler ultrasonographic (US) characteristics of experimentally induced acute uric acid (UA) nephropathy in rabbits. Acute UA nephropathy was induced in ten rabbits using supersaturated lithium carbonate solution. The rabbits were divided in two groups. Group I consisted of five rabbits, and they were injected with a single dose of 150 ml of saturated UA over one hour. During tis period, serial US studies of the kidneys of these rabbits were performed every ten minutes. Group II consisted of the remaining five rabbits, and three injections of 50 ml of saturated UA solution were given on the first, fifth and eight day and follow-up was done upto twenty fifth day. Sequential HR and Doppler US, renal biopsy and blood sampling were performed on day 1, 5, 8, 21, and 25 in the group II rabbits. In group I, HR and Doppler US examination revealed the normal resistive index without significant abnormality. On the other hand, US studies of group II showed poor renal corticomedullary differentiation, decreased renal blood flow and elevated resistive index. There was statistically significant correlation among US findings, histologic characteristics and chemical index (BUN, creatinine) of renal function. In addition, sequentially increased size and volume of the kidney were noted in both groups. HR gray scale and doppler US characteristics of experimentally induced acute UA nephropathy in rabbits were similar to those of acute renal failure caused by other well-known causes.

Extracellular gadolinium-based contrast media: An overview

International Nuclear Information System (INIS)

Bellin, Marie-France; Van Der Molen, Aart J.

2008-01-01

Increasing use is made of extracellular MRI contrast agents that alter the image contrast following intravenous administration; they predominantly shorten the T1 relaxation time of tissues. The degree and location of these changes provide substantial diagnostic information. However gadolinium-based contrast agents (Gd-CA) are not inert drugs. They may cause acute non-renal adverse reactions (e.g. anaphylactoid reactions), acute renal adverse reactions (e.g. contrast induced nephropathy), delayed adverse reactions (nephrogenic systemic fibrosis) and problems at the site of injection (e.g. local necrosis). This review describes the current status of Gd-CA, their mechanism of action, chemical structure, pharmacokinetics, dosage, elimination, nephrotoxicity and adverse events

Extracellular gadolinium-based contrast media: An overview

Energy Technology Data Exchange (ETDEWEB)

Bellin, Marie-France [University Paris-Sud 11, Department of Radiology, University Hospital Paul-Brousse, AP-HP, 12, Avenue Paul Vaillant-Couturier, 94804 Villejuif Cedex (France)], E-mail: marie-france.bellin@pbr.aphp.fr; Van Der Molen, Aart J. [University Paris-Sud 11, Department of Radiology, University Hospital Paul-Brousse, AP-HP, 12, Avenue Paul Vaillant-Couturier, 94804 Villejuif Cedex (France)

2008-05-15

Increasing use is made of extracellular MRI contrast agents that alter the image contrast following intravenous administration; they predominantly shorten the T1 relaxation time of tissues. The degree and location of these changes provide substantial diagnostic information. However gadolinium-based contrast agents (Gd-CA) are not inert drugs. They may cause acute non-renal adverse reactions (e.g. anaphylactoid reactions), acute renal adverse reactions (e.g. contrast induced nephropathy), delayed adverse reactions (nephrogenic systemic fibrosis) and problems at the site of injection (e.g. local necrosis). This review describes the current status of Gd-CA, their mechanism of action, chemical structure, pharmacokinetics, dosage, elimination, nephrotoxicity and adverse events.

Renal clearance of an ionic high-osmolar and a nonionic low-osmolar contrast medium

International Nuclear Information System (INIS)

Thomsen, H.S.; Vestergaard, A.; Nielsen, S.L.; Fogh-Andersen, N.; Golman, K.; Dorph, S.

1991-01-01

One hundred patients with normal serum creatinine concentration underwent intravenous urography with either an ionic high-osmolar (diatrizoate) or a nonionic low-osmolar (iopamidol) contrast medium after randomization. Before injection of the contrast medium, a blood sample was drawn for determinating serum creatinine concentration, and a urine sample for measurement of urine osmolality. Using x-ray fluorescence, the plasma concentration of iodine (contrast medium) was determined on blood samples drawn approximately 3 and 4 hours after injection of the contrast medium. The glomerular filtration rate was calculated by two different formulas: one requiring only a single sample and one requiring at least two samples (standard). There were poor correlations between the standard contrast medium clearance and the serum creatinine concentration, the estimated creatinine clearance (calculated from a nomogram), as well as the urine osmolality. The 3-hour and the 4-hour single-sample values correlated well with the two-sample values for both contrast media. In patients with normal serum creatinine, the glomerular filtration rate determined by measuring the contrast medium concentration in a single plasma sample obtained at 3 hours, is almost identical to the value determined from two samples. Consequently, two samples are unnecessary

Renoprotective effect of lansoprazole in streptozotocin-induced diabetic nephropathy in wistar rats.

Science.gov (United States)

Kaur, Rupinder; Sodhi, Rupinder Kaur; Aggarwal, Neha; Kaur, Jaspreet; Jain, Upendra K

2016-01-01

Proton pump inhibitors (PPIs) have exhibited glucose lowering action in animal models of diabetes; however, their potential in diabetes-related complications has not yet been evaluated. Hence, the present study has been undertaken to investigate the renoprotective potential of lansoprazole in streptozotocin-induced diabetic nephropathy in wistar rats. Diabetic nephropathy was induced with a single injection of streptozotocin (STZ, 45 mg/kg, i.p.). Lansoprazole (40 mg/kg; 80 mg/kg, p.o.; 4 weeks) was administered to diabetic rats after 4 weeks of STZ treatment. A battery of biochemical tests such as serum glucose, glycated hemoglobin, blood urea nitrogen (BUN), serum creatinine, albumin, and kidney weight/body weight (%) ratio were performed to evaluate the renal functions. Oxidative stress was determined by estimating renal thiobarbituric acid reactive species (TBARS) and reduced glutathione (GSH) levels. Lipid profile was assessed by determining serum cholesterol (TC), triglyceride (TG), and high-density lipoprotein (HDL). The STZ-treated rats demonstrated deleterious alterations in kidney functions, enhanced oxidative stress, and disturbed lipid profile. Administration of lansoprazole to diabetic rats significantly reduced serum glucose, glycated hemoglobin, BUN, creatinine, albumin levels, and oxidative stress. Serum lipids like TC and TG were decreased, and HDL was enhanced in lansoprazole-treated STZ rats. The findings of our study indicate that renoprotective effects of lansoprazole may be attributed to its glucose-lowering, lipid-lowering, and antioxidative potential.

Improve identification of details in double-contrast examination of the stomach by means of a new contrast medium mixture

International Nuclear Information System (INIS)

Tenner, R.

1984-01-01

In a contrast medium study, 100 patients were employed for a comparison between the contrast medium Mikropaque liquid and a mixture of Mikropaque HD and Mikropaque liquid in double-contrast examination of the stomach. The special feature of this method was that one and the same stomach was examined in each case with both contrast media. The new contrast media mixture with Mikropaque HD represents a step forward; the contrast could be enhanced in 80% of the cases, and the finely contoured relief became visible in two-thirds of the cases, compared with one-third of the examined patients before this method was introduced. (orig.) [de

Effects of theophyline on contrast

OpenAIRE

A.R. Fatahiyan; B. Baqerii; A. Mohseni; A. Makhlouq

2006-01-01

Background and purpose: Contrast-induced nephropathy (CN) is one of the most common causes of iatrogenic acute renal failure. In fact CN is the third leading cause of new ARF in hospitalized patients. Radiocontrast-associated ARF is a significant problem in patients with cardiovascular disease. The risk factors for cardiovascular disease also predispose these patients to an increased risk of renal failure. Various strategies have been suggested for preventing CN. Since adenosine may play a ro...

Radiologists' knowledge and perceptions of the impact of contrast-induced nephropathy and its risk factors when performing computed tomography examinations: A survey of European radiologists

Energy Technology Data Exchange (ETDEWEB)

Reddan, Donal [University College Galway Hospitals, Unit 7, Merlin Park Hospital, Galway (Ireland)], E-mail: donal.reddan@mailn.hse.ie; Fishman, Elliot K. [Johns Hopkins Hospital, Baltimore, MD (United States)

2008-05-15

Background: The past decade has seen a proliferation in the number of CT procedures. As increasing numbers of elderly patients with multiple comorbidities undergo contrast media (CM)-enhanced procedures, more patients are at risk for contrast-induced nephropathy (CIN). Objectives: To understand whether radiologists are sufficiently aware of the incidence, impact and risk factors of CIN, and whether they are taking sufficient measures to prevent CIN among patients undergoing CT. Materials and methods: A telephone or online survey was conducted in 2005 with 509 radiologists from 10 European countries. Participants had a minimum of 3 years' experience and performed at least 50 CT scans per week. Results: Most (88%) radiologists believed that CIN is an important issue. While 45% identify that a patient is experiencing CIN when the serum creatinine level increases >25% (0.5 mg/dL) from baseline within 48 h, the remainder used criteria that might lead to significant under-diagnosis. Most (72%) radiologists believed that CIN is associated with increased morbidity; 56% did not believe that it is associated with increased mortality. Most respondents agreed that pre-existing renal impairment (97%), dehydration (90%) and diabetes (89%) were risk factors for CIN; however, 26%, 30% and 46%, respectively, did not identify advanced age, CM dose or congestive cardiac failure as risk factors. Only 7% of radiologists thought they were always made aware of CIN associated with their cases and 28% never consulted a nephrologist to discuss patients at risk of CIN or who had developed CIN. Conclusion: There is highly variable awareness of the definition, impact and risk factors for CIN among European radiologists. Data regarding the importance of CIN in CT are limited. Improved efforts are required to better educate radiologists and referring physicians and to institute appropriate protocols to identify at-risk patients and prevent CIN.

Hypoglycemic action of vitamin K1 protects against early-onset diabetic nephropathy in streptozotocin-induced rats.

Science.gov (United States)

Sai Varsha, M K N; Raman, Thiagarajan; Manikandan, R; Dhanasekaran, G

2015-10-01

Vitamin K is a potent regulator of vascular dynamics and prevents vascular calcification. Vitamin K is increasingly being recognized for its antioxidant and antiinflammatory properties. Recently we demonstrated that vitamin K1 (5 mg/kg) protects against streptozotocin-induced type 1 diabetes and diabetic cataract. The aim of this study was to determine whether the hypoglycemic action of vitamin K1 could inhibit early-onset diabetic nephropathy in a streptozotocin-induced rat kidney. Male Wistar rats were administered with 35 mg/kg STZ and after 3 days were treated with vitamin K1 (5 mg/kg, twice a week) for 3 months. Blood glucose was monitored once a month. At the end of the study, animals were sacrificed and kidney was dissected out and analysed for free radicals, antioxidants, aldose reductase, membrane ATPases, histopathology evaluation and expression of pro- and anti-inflammatory cytokines. Urea, uric acid, creatinine, albumin and insulin levels were also estimated. Treatment of diabetic rats with vitamin K1 resulted in a decrease in blood glucose and prevented microalbuminuria. Vitamin K1 also reduced oxidative stress and protected renal physiology by modulating Ca(2+) and Na(+)/K(+)-ATPases. Vitamin K1 inhibited renal inflammation by reducing nuclear factor-κB and inducible nitric oxide synthase. Interleukin-10 levels were increased in renal tissues, suggesting the ability of vitamin K1 to trigger antiinflammatory state. The hypoglycemic action of vitamin K1 could have an indirect effect by inhibiting early-onset diabetic nephropathy triggered by high blood glucose. Vitamin K1 could be an important nutrient based interventional strategy for early onset diabetic nephropathy. Copyright © 2015 Elsevier Inc. All rights reserved.

The influence of contrast media on kidney function in patients with stable coronary artery disease

DEFF Research Database (Denmark)

Reuter, Simon Bertram; Harutyunyan, Marina; Mygind, Naja Dam

2014-01-01

AIMS: To investigate the incidence of contrast media-induced nephropathy (CIN) in patients with stable coronary artery disease (CAD) referred for elective coronary intervention following hydration routines. The reversibility of CIN was followed in a 6 month-period. METHODS AND RESULTS: A total...... coronary interventions. Kidney function and the amount of contrast media used was not a predictor of CIN development. The induced CIN was not completely normalized in a 6-month follow-up period....

Adverse effects in coronary angiography: a comparative study of different temperature contrast medium

International Nuclear Information System (INIS)

Zhou Peng; Wang Qiulin; Cai Guocai; Li Lu; Jiang Licheng; Yang Zhen; Huang Xiuping

2011-01-01

Objective: To investigate the correlation between different temperature contrast medium and the occurrence of adverse effects, including the chest discomfort, the changes of heart rate, ST segment and T wave, the operating time and the used dosage of contrast medium, in performing coronary angiography. Methods: According to the contrast medium temperature used in coronary angiography, the patients were randomly divided into two groups: room temperature group (n=521) and warm temperature group (n=522). The contrast medium used in warm temperature group was bathed in 37 ℃ water for 60 minutes when the coronary angiography was carried out. The T Wave amplitude changes ≥ 0.01 mv, ST segment depression ≥ 0.05 mv, changes in heart rate ≥ 10 times/min were brought into the positive accounting. The occurrence of adverse effects, such as palpitation, chest distress and pectoralgia, the operative time and the used dosage of contrast medium were recorded. The results were analyzed and compared between the two groups. Results: Statistically significant differences in the changes of heart rate, ST segment deviation, T wave change and operating time existed between the two groups (P<0.05). And the difference in the occurrence of adverse effects between the two groups was also statistically significant (P<0.05). Conclusion: When performing coronary angiography, warming of the contrast medium with water bath is greatly conducive to the prevention of cardiac adverse effects. (authors)

Nephroprotective effect of Bauhinia variegata (Linn.) whole stem extract against cisplatin-induced nephropathy in rats

Science.gov (United States)

Pani, Saumya R.; Mishra, Satyaranjan; Sahoo, Sabuj; Panda, Prasana K.

2011-01-01

The nephroprotective activity of the ethanolic extract of Bauhinia variegata (Linn.) whole stem against cisplatin-induced nephropathy was investigated by an in vivo method in rats. Acute nephrotoxicity was induced by i.p. injection of cisplatin (7 mg/kg of body weight (b.w.)). Administration of ethanol extract at dose levels of 400 and 200 mg/kg (b.w.) to cisplatin-intoxicated rats for 14 days attenuated the biochemical and histological signs of nephrotoxicity of cisplatin in a dose-dependent fashion. Ethanol extract at 400 mg/kg decreased the serum level of creatinine (0.65 ± 0.09; P<0.001) and urea (32.86 ± 5.88; P<0.001) associated with a significant increase in body weight (7.16 ± 1.10; P<0.001) and urine volume output (11.95 ± 0.79; P<0.05) as compared to the toxic control group. The ethanol extract of B. variegata at 400 mg/kg (b.w.) exhibited significant and comparable nephroprotective potential to that of the standard polyherbal drug cystone. The statistically (one-way-ANOVA followed by Tukey-Kramer multiple comparison) processed results suggested the protective action of B. variegate whole stem against cisplatin-induced nephropathy. PMID:21572659

Assessment of renal perfusion with contrast-enhanced ultrasound: Preliminary results in early diabetic nephropathies.

Science.gov (United States)

Dong, Yi; Wang, Wen-Ping; Lin, Pan; Fan, Peili; Mao, Feng

2016-01-01

We performed a prospective study to evaluate the value of contrast-enhanced ultrasound (CEUS) in quantitative evaluation of renal cortex perfusion in patients suspected of early diabetic nephropathies (DN), with the estimated GFR (MDRD equation) as the gold standard. The study protocol was approved by the hospital review board; each patient gave written informed consent. Our study included 46 cases (21 males and 25 females, mean age 55.6 ± 4.14 years) of clinical confirmed early DN patients. After intravenous bolus injection of 1 ml sulfur hexafluoride microbubbles of ultrasound contrast agent, real time CEUS of renal cortex was performed successively using a 2-5 MHz convex probe. Time-intensity curves (TICs) and quantitative indexes were created with Qlab software. Receiver operating characteristic (ROC) curves were used to predict the diagnostic criteria of CEUS quantitative indexes, and their diagnostic efficiencies were compared with resistance index (RI) and peak systolic velocity (PSV) of renal segmental arteries by chi square test. Our control group included forty-five healthy volunteers. Difference was considered statistically significant with P  0.05). CEUS might be helpful to improve early diagnosis of DN by quantitative analyses. AUC and DPI might be valuable quantitative indexes.

Prophylaxis and treatment of side effects due to iodinated contrast media relevant to radiological practice; Radiologisch praxisrelevante Prophylaxe und Therapie von Nebenwirkungen jodhaltiger Kontrastmittel

Energy Technology Data Exchange (ETDEWEB)

Becker, C. [Klinikum Grosshadern der Ludwig-Maximilians-Universitaet Muenchen, Institut fuer Klinische Radiologie, Muenchen (Germany)

2007-09-15

Increased utilization of iodinated contrast media may be associated with increased incidence of adverse events. The most important side effects include contrast-induced nephropathy, anaphylactoid reaction, thyrotoxicosis, and extravasation. In patients with moderate renal dysfunction, saline hydration and reduction of contrast media volume are recommended. No regime to prevent anaphylactoid reactions has yet proven to be efficient. If subclinical hyperthyroidism has been determined, prophylaxis with sodium perchlorate is advised. Contrast-induced nephropathy is commonly transient and needs to be followed over time. Mild general anaphylactoid reactions may be treated with antihistaminic drugs and corticosteroids. Furthermore the choice of the X-ray contrast media might influence the risk of any adverse effects. (orig.) [German] Durch den zunehmenden Einsatz jodhaltiger Kontrastmittel in der Radiologie steigt auch die Rate der Nebenwirkungen; zu den wichtigsten gehoeren die kontrastmittelinduzierte Nephropathie, anaphylaktoide Reaktion, thyreotoxische Krise und Extravasation. Bei Patienten mit mittelgradig eingeschraenkter Nierenfunktion wird eine Prophylaxe durch Hydrierung und Reduktion der KM-Menge empfohlen. Bei hochgradig eingeschraenkter Nierenfunktion sollte die Kontrastmittelgabe nur noch kontrolliert im interdisziplinaeren Konsens erfolgen. Eine nachgewiesen wirkungsvolle Prophylaxe anaphylaktoider Reaktionen ist bisher nicht bekannt. Bei Nachweis einer sublatenten Hyperthyreose ist die Gabe von Natriumperchlorat eine sinnvolle Gegenmassnahme. Eine kontrastmittelinduzierte Nephropathie ist meistens transient und sollte mehrfach im Verlauf kontrolliert werden. Leichte allgemeine anaphylaktoide Reaktionen koennen mit Antihistaminika und Kortikosteroiden behandelt werden. Auch die Wahl des Roentgenkontrastmittels koennte Einfluss auf das Risiko von Nebenwirkungen haben. (orig.)

Valuation of using saline flush technique of contrast medium on abdominal multidetector row CT scanning

International Nuclear Information System (INIS)

Zhao Hong; Wang Ying; He Yanli; Liu Xiaobing; Bao Shiliang; Han Mingjun

2006-01-01

Objective: The purpose of this study was to compare the enhancement degree of abdomen organs and vessels after different amount of contrast medium using saline flush in abdomen MDCT scanning, which aimed to not affect contrast enhancement, decreased the amount of contrast medium, and reduced the side-effect. Methods: This study group consisted of 75 patients who were referred for contrast enhanced abdominal MDCT for various reasons. Patients were allocated into three groups: injection of 100ml of contrast medium only (A group), injection of 80ml pushed with 20ml of saline solution (B group), and injection of 70ml pushed with 30ml of saline solution (C group). Attenuation values were measured from the liver, spleen, pancreas, kidney, aorta, portal vein, and inferior vena cava in 33 second and 80 second of imaging after injection contrast medium. Results: The portal venous phases of the spleen, pancreas, kidney, aorta, portal vein had statistically significant difference among groups A, B and C. Post hoc test showed statistically significant difference between A group and C group, But no statistically significant difference during the portal venous phases of the pancreas and the kidney between A group and B group. Conclusion: Using a saline flush technique after the injection contrast medium in abdominal MDCT reduced waste of contrast medium and decrease in nephrotoxicity, at the same time, it would not lose important diagnostic information and saved patients cost for the contrast medium. (authors)

Relationship between changes of plasma endothelin (ET) level, ATPase activity of erythrocyte membrane and development of nephropathy in patients with pregnancy induced hypertension

International Nuclear Information System (INIS)

Qin Lin; Lu Beiyi

2008-01-01

Objective: To investigate the possible role played by alteration of plasma ET levels and activities of Na + - K + -APT ase and Ca 2+ -Mg 2+ -ATPase of erythrocyte membrane in patients with nephropathy pregnancy induced hypertension. Methods: The concentrations of plasma ET was detected with RIA and erythrocyte membrane ATPase activities were determined with Reilni method in 32 pregnant women with PIH complicated with nephropathy and 70 women with PIH but no nephropathy and 35 normal pregnant women as controls. Results: The plasma ET levels in patients with PHI (both with and without nephropathy) were significantly higher than those in normal preganat women (P + -K + -ATPase and Ca 2+ -Mg 2+ -ATPase levels were significantly de- creased (P + -K + -ATPase and Ca 2+ -Mg 2+ -ATPase activity of erythrocyte membrane. (authors)

Involvement of caspase-12-dependent apoptotic pathway in ionic radiocontrast urografin-induced renal tubular cell injury

Energy Technology Data Exchange (ETDEWEB)

Wu, Cheng Tien [Institute of Toxicology, College of Medicine, National Taiwan University, Taipei, Taiwan (China); Weng, Te I. [Department of Forensic Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan (China); Chen, Li Ping [Department of Dentistry, Chang Gang Memorial Hospital, Chang Gang University, Taoyuan, Taiwan (China); Chiang, Chih Kang [Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (China); Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (China); Liu, Shing Hwa, E-mail: shinghwaliu@ntu.edu.tw [Institute of Toxicology, College of Medicine, National Taiwan University, Taipei, Taiwan (China); Department of Urology, National Taiwan University Hospital, Taipei, Taiwan (China)

2013-01-01

Contrast medium (CM) induces a direct toxic effect on renal tubular cells. This toxic effect subjects in the disorder of CM-induced nephropathy. Our previous work has demonstrated that CM shows to activate the endoplasmic reticulum (ER)-related adaptive unfolding protein response (UPR) activators. Glucose-regulated protein 78 (GRP78)/eukaryotic initiation factor 2α (eIF2α)-related pathways play a protective role during the urografin (an ionic CM)-induced renal tubular injury. However, the involvement of ER stress-related apoptotic signals in the urografin-induced renal tubular cell injury remains unclear. Here, we examined by the in vivo and in vitro experiments to explore whether ER stress-regulated pro-apoptotic activators participate in urografin-induced renal injury. Urografin induced renal tubular dilation, tubular cells detachment, and necrosis in the kidneys of rats. The tubular apoptosis, ER stress-related pro-apoptotic transcriptional factors, and kidney injury marker-1 (kim-1) were also conspicuously up-regulated in urografin-treated rats. Furthermore, treatment of normal rat kidney (NRK)-52E tubular cells with urografin augmented the expressions of activating transcription factor-6 (ATF-6), C/EBP homologous protein (CHOP), Bax, caspase-12, JNK, and inositol-requiring enzyme (IRE) 1 signals. Urografin-induced renal tubular cell apoptosis was not reversed by the inhibitors of ATF-6, JNK signals or CHOP siRNA transfection, but it could be partially reversed by the inhibitor of caspase-12. Taken together, the present results and our previous findings suggest that exposure of CM/urografin activates the ER stress-regulated survival- and apoptosis-related signaling pathways in renal tubular cells. Caspase-12-dependent apoptotic pathway may be partially involved in the urografin-induced nephropathy. -- Highlights: ► Ionic contrast medium-urografin induces renal tubular cell apoptosis. ► Urografin induces the ER stress-regulated survival and apoptosis

Extravasation of contrast medium during CT examination: An ...

African Journals Online (AJOL)

2013-03-31

Extravasation of contrast medium during CT examination: An observational casecontrol study. ... Methods: every incident of extravasation which occurred between March 2012 and March 31, 2013 was recorded in an extravasation form. Ethics Committee approval was obtained and the patients gave their consent to ...

Quantitative contrast-enhanced mammography for contrast medium kinetics studies

Science.gov (United States)

Arvanitis, C. D.; Speller, R.

2009-10-01

Quantitative contrast-enhanced mammography, based on a dual-energy approach, aims to extract quantitative and temporal information of the tumour enhancement after administration of iodinated vascular contrast media. Simulations using analytical expressions and optimization of critical parameters essential for the development of quantitative contrast-enhanced mammography are presented. The procedure has been experimentally evaluated using a tissue-equivalent phantom and an amorphous silicon active matrix flat panel imager. The x-ray beams were produced by a tungsten target tube and spectrally shaped using readily available materials. Measurement of iodine projected thickness in mg cm-2 has been performed. The effect of beam hardening does not introduce nonlinearities in the measurement of iodine projected thickness for values of thicknesses found in clinical investigations. However, scattered radiation introduces significant deviations from slope equal to unity when compared with the actual iodine projected thickness. Scatter correction before the analysis of the dual-energy images provides accurate iodine projected thickness measurements. At 10% of the exposure used in clinical mammography, signal-to-noise ratios in excess of 5 were achieved for iodine projected thicknesses less than 3 mg cm-2 within a 4 cm thick phantom. For the extraction of temporal information, a limited number of low-dose images were used with the phantom incorporating a flow of iodinated contrast medium. The results suggest that spatial and temporal information of iodinated contrast media can be used to indirectly measure the tumour microvessel density and determine its uptake and washout from breast tumours. The proposed method can significantly improve tumour detection in dense breasts. Its application to perform in situ x-ray biopsy and assessment of the oncolytic effect of anticancer agents is foreseeable.

Deletion of pro-angiogenic factor vasohibin-2 ameliorates glomerular alterations in a mouse diabetic nephropathy model

Science.gov (United States)

Masuda, Kana; Ujike, Haruyo; Hinamoto, Norikazu; Miyake, Hiromasa; Tanimura, Satoshi; Sugiyama, Hitoshi; Sato, Yasufumi; Maeshima, Yohei; Wada, Jun

2018-01-01

Angiogenesis has been implicated in glomerular alterations in the early stage of diabetic nephropathy. We previously reported the renoprotective effects of vasohibin-1 (VASH1), which is a novel angiogenesis inhibitor derived from endothelial cells, on diabetic nephropathy progression. Vasohibin-2 (VASH2) was originally identified as a VASH1 homolog and possesses pro-angiogenic activity in contrast to VASH1. In addition, VASH2 was recently shown to promote epithelial-to-mesenchymal transition via enhanced transforming growth factor (TGF)-β signaling in cancer cells. Herein, we investigated the pathogenic roles of VASH2 in diabetic nephropathy using VAHS2-deficient mice. The type 1 diabetes model was induced by intraperitoneal injections of streptozotocin in VASH2 homozygous knockout (VASH2LacZ/LacZ) or wild-type mice. These mice were euthanized 16 weeks after inducing hyperglycemia. Increased urine albumin excretion and creatinine clearance observed in diabetic wild-type mice were significantly prevented in diabetic VASH2-deficient mice. Accordingly, diabetes-induced increase in glomerular volume and reduction in glomerular slit-diaphragm density were significantly improved in VASH2 knockout mice. Increased glomerular endothelial area was also suppressed in VASH2-deficient mice, in association with inhibition of enhanced vascular endothelial growth factor (VEGF) receptor 2 (VEGFR2), but not VEGF level. Furthermore, glomerular accumulation of mesangial matrix, including type IV collagen, and increased expression of TGF-β were improved in diabetic VASH2 knockout mice compared with diabetic wild-type mice. Based on the immunofluorescence findings, endogenous VASH2 localization in glomeruli was consistent with mesangial cells. Human mesangial cells (HMCs) were cultured under high glucose condition in in vitro experiments. Transfection of VASH2 small interfering RNA (siRNA) into the HMCs resulted in the suppression of type IV collagen production induced by high glucose

Contrast-enhanced angiographic cone-beam computed tomography without pre-diluted contrast medium

Energy Technology Data Exchange (ETDEWEB)

Jo, K.I.; Kim, S.R.; Choi, J.H.; Kim, K.H.; Jeon, P. [Sungkyunkwan University School of Medicine, Department of Radiology, Samsung Medical Center, Gangnam-gu, Seoul (Korea, Republic of)

2015-11-15

Contrast-enhanced cone-beam computed tomography (CBCT) has been introduced and accepted as a useful technique to evaluate delicate vascular anatomy and neurovascular stents. Current protocol for CBCT requires quantitative dilution of contrast medium to obtain adequate quality images. Here, we introduce simple methods to obtain contrast-enhanced CBCT without quantitative contrast dilution. A simple experiment was performed to estimate the change in flow rate in the internal carotid artery during the procedure. Transcranial doppler (TCD) was used to evaluate the velocity change before and after catheterization and fluid infusion. In addition, 0.3 cm{sup 3}/s (n = 3) and 0.2 cm{sup 3}/s (n = 7) contrast infusions were injected and followed by saline flushes using a 300 mmHg pressure bag to evaluate neurovascular stent and host arteries. Flow velocities changed -15 ± 6.8 % and +17 ± 5.5 % from baseline during catheterization and guiding catheter flushing with a 300 mmHg pressure bag, respectively. Evaluation of the stents and vascular structure was feasible using this technique in all patients. Quality assessment showed that the 0.2 cm{sup 3}/s contrast infusion protocol was better for evaluating the stent and host artery. Contrast-enhanced CBCT can be performed without quantitative contrast dilution. Adequate contrast dilution can be achieved with a small saline flush and normal blood flow. (orig.)

Power port contrast medium flushing and trapping: impact of temperature, an in vitro experimental study.

Science.gov (United States)

Guiffant, Gérard; Durussel, Jean Jacques; Flaud, Patrice; Royon, Laurent; Marcy, Pierre Yves; Merckx, Jacques

2013-01-01

The use of totally implantable venous access devices (TIVADs) certified as "high pressure resistant" or "power port" has begun to spread worldwide as a safe procedure for power contrast injection. Owing to the thermo-rheological properties of the contrast media, the primary aim of this work is to present an in vitro experimental impact study concerning the impact of the temperature level on flushing efficiency after contrast medium injection. Moreover, we report experimental data that confirms the role of needle bevel orientation. The secondary aim is to answer the following questions: Is there significant device contrast medium trapping after contrast medium injection? Is saline flushing efficient? And, finally, is it safe to inject contrast medium through an indwelled port catheter? The experimental results show that in addition to hydrodynamics, temperature is a key parameter for the efficiency of device flushing after contrast medium injection. It appears that this is the case when the cavity is incompletely rinsed after three calibrated flushing volumes of 10 mL saline solution, even by using the Huber needle bevel opposite to the port exit. This leads to a potentially important trapped volume of contrast medium in the port, and consequently to the possibility of subsequent salt precipitates and long term trisubstituted benzene nuclei delivery that might impair the solute properties, which may be further injected via the power port later on. We thus suggest, in TIVADS patients, the use of a temporary supplementary intravenous line rather than the port to perform contrast medium injections in daily radiology routine practice.

[Complications due to contrast agent administration: what has been confirmed in prevention?].

Science.gov (United States)

Schönenberger, E; Mühler, M; Dewey, M

2010-12-01

Computed tomography (CT) and magnetic resonance imaging (MRI) have been evaluated by internists to be the most important medical innovations. Often, intravenous contrast agent administration is required for answering the clinical questions to CT and MRI. In this review we present an overview of the most common and most important aspects that need to be considered prior to intravenous contrast agent administration. We discuss aspects of renal impairment (contrast-induced nephropathy, nephrogenic systemic fibrosis), allergy-like reactions, hyperthyroidism, and pregnancy and breast-feeding.

Heat Stress Nephropathy From Exercise-Induced Uric Acid Crystalluria: A Perspective on Mesoamerican Nephropathy.

Science.gov (United States)

Roncal-Jimenez, Carlos; García-Trabanino, Ramón; Barregard, Lars; Lanaspa, Miguel A; Wesseling, Catharina; Harra, Tamara; Aragón, Aurora; Grases, Felix; Jarquin, Emmanuel R; González, Marvin A; Weiss, Ilana; Glaser, Jason; Sánchez-Lozada, Laura G; Johnson, Richard J

2016-01-01

Mesoamerican nephropathy (MeN), an epidemic in Central America, is a chronic kidney disease of unknown cause. In this article, we argue that MeN may be a uric acid disorder. Individuals at risk for developing the disease are primarily male workers exposed to heat stress and physical exertion that predisposes to recurrent water and volume depletion, often accompanied by urinary concentration and acidification. Uric acid is generated during heat stress, in part consequent to nucleotide release from muscles. We hypothesize that working in the sugarcane fields may result in cyclic uricosuria in which uric acid concentrations exceed solubility, leading to the formation of dihydrate urate crystals and local injury. Consistent with this hypothesis, we present pilot data documenting the common presence of urate crystals in the urine of sugarcane workers from El Salvador. High end-of-workday urinary uric acid concentrations were common in a pilot study, particularly if urine pH was corrected to 7. Hyperuricemia may induce glomerular hypertension, whereas the increased urinary uric acid may directly injure renal tubules. Thus, MeN may result from exercise and heat stress associated with dehydration-induced hyperuricemia and uricosuria. Increased hydration with water and salt, urinary alkalinization, reduction in sugary beverage intake, and inhibitors of uric acid synthesis should be tested for disease prevention. Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Mesenchymal stem cells attenuate adriamycin-induced nephropathy by diminishing oxidative stress and inflammation via downregulation of the NF-kB.

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Song, In-Hwan; Jung, Kyong-Jin; Lee, Tae-Jin; Kim, Joo-Young; Sung, Eon-Gi; Bae, Young Chul; Park, Yong Hoon

2018-05-01

This study aimed to evaluate the molecular mechanism mitigating progress of chronic nephropathy by mesenchymal stem cells (MSCs). Rats were divided into normal control (Normal), adriamycin (ADR)+vehicle (CON), and ADR+MSC (MSC) groups. Nephropathy was induced by ADR (4 mg/kg) and MSCs (2 × 10 6 ) were injected. Rats were euthanized 1 or 6 weeks after ADR injection. NF-kB, MAPKs, inflammation, oxidative stress, profibrotic molecules, and nephrin expression were evaluated. Electron and light microscopy were used for structural analysis. MSCs were co-cultured with renal tubular epithelial cells or splenocytes to evaluate relation with oxidative stress and inflammatory molecules RESULTS: Adriamycin treatment upregulated inflammation, oxidative stress, and profibrotic molecules; this was mitigated by MSCs. Glomerulosclerosis and interstitial fibrosis were observed in ADR-treated groups, and were more prominent in the CON group than in the MSC group. Fusion of foot processes and loss of slit diaphragms were also more prominent in the CON group than in the MSC group. In vitro, MSCs reduced oxidative stress related molecules, inflammatory cytokines, and NF-kB transcription. MSC- or ADR-induced regulation of NF-kB transcriptional activity was confirmed by a luciferase reporter assay. Mesenchymal stem cells attenuate ADR-induced nephropathy by diminishing oxidative stress and inflammation via downregulation of NF-kB. © 2017 Asian Pacific Society of Nephrology.

Cobrotoxin from Naja naja atra Venom Ameliorates Adriamycin Nephropathy in Rats

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Shu-Zhi Wang

2015-01-01

Full Text Available Chronic kidney disease (CKD becomes a global health problem with high morbidity and mortality. Adriamycin- (ADR- induced rodent chronic nephropathy is a classic experimental model of human minimal lesion nephrotic syndrome. The present study investigated the effect of cobrotoxin (CTX on ADR-induced nephropathy. Rats were given 6 mg/kg ADR once through the tail vein to replicate ADR nephropathy model. CTX was administered to rats daily by placing a fast dissolving CTX membrane strip under the tongue starting from 5 days prior to ADR administration until the end of experiment. The results showed that CTX ameliorated the symptoms of ADR nephropathy syndrome with reduced body weight loss, proteinuria, hypoalbuminemia, dyslipidemia, serum electrolyte imbalance, oxidative stress, renal function abnormities, and kidney pathological lesions. Anti-inflammatory cytokine IL-10 expression was elevated after CTX administration in ADR nephropathy model. CTX inhibited the phosphorylation of IκB-α and NF-κB p65 nuclear translocation. Meanwhile, CTX upregulated the protein level of podocyte-specific nephrin and downregulated the level of fibrosis-related TGF-β. These findings suggest that CTX may be a potential drug for chronic kidney diseases.

Physicochemical properties of radiographic contrast media, potential nephrotoxicity and prophylaxis.

Science.gov (United States)

Hogstrom, Barry; Ikei, Nobuhiro

2015-12-01

Contrast induced nephropathy (CIN) remains a controversial topic. The clinical relevance of changes in laboratory parameters has been challenged; some authors have even suggested that CIN simply reflects natural fluctuations. Other areas of controversy include the pathophysiology of CIN, effectiveness of prophylactic approaches and differences in nephrotoxicity between individual contrast media (CM). The aim of this review is to summarize the current understanding of laboratory findings and explore its relationship to CM toxicity. © 2015 Wiley Publishing Asia Pty Ltd.

Power port contrast medium flushing and trapping: impact of temperature, an in vitro experimental study

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Guiffant G

2013-09-01

Full Text Available Gérard Guiffant,1 Jean Jacques Durussel,1 Patrice Flaud,1 Laurent Royon,1 Pierre Yves Marcy,2 Jacques Merckx1,31University Paris Diderot, Paris, France; 2Radiodiagnosis and Interventional Radiology Department, Caen, France; 3University Teaching Hospital Necker-Enfants Malades, Paris, FrancePurpose: The use of totally implantable venous access devices (TIVADs certified as "high pressure resistant" or "power port" has begun to spread worldwide as a safe procedure for power contrast injection. Owing to the thermo-rheological properties of the contrast media, the primary aim of this work is to present an in vitro experimental impact study concerning the impact of the temperature level on flushing efficiency after contrast medium injection. Moreover, we report experimental data that confirms the role of needle bevel orientation. The secondary aim is to answer the following questions: Is there significant device contrast medium trapping after contrast medium injection? Is saline flushing efficient? And, finally, is it safe to inject contrast medium through an indwelled port catheter?Results: The experimental results show that in addition to hydrodynamics, temperature is a key parameter for the efficiency of device flushing after contrast medium injection. It appears that this is the case when the cavity is incompletely rinsed after three calibrated flushing volumes of 10 mL saline solution, even by using the Huber needle bevel opposite to the port exit. This leads to a potentially important trapped volume of contrast medium in the port, and consequently to the possibility of subsequent salt precipitates and long term trisubstituted benzene nuclei delivery that might impair the solute properties, which may be further injected via the power port later on.Conclusion: We thus suggest, in TIVADS patients, the use of a temporary supplementary intravenous line rather than the port to perform contrast medium injections in daily radiology routine practice

Na+/Ca2+ exchange inhibitor, KB-R7943, attenuates contrast-induced acute 
kidney injury.

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Yang, Dingwei; Yang, Dingping; Jia, Ruhan; Tan, Jin

2013-01-01

Intracellular Ca2+ overload is considered to be a key factor in contrast-induced acute kidney injury (CI-AKI). The Na+/Ca2+ exchanger (NCX) system is one of the main pathways of intracellular Ca2+ overload. We investigated the effects of KB-R7943, an inhibitor of the reverse mode of NCX, on CI-AKI in a rat model. Rats were divided into control group, CI-AKI group and pretreatment groups (with KB-R7943 dose of 5 or 10 mg/kg). CI-AKI was induced by diatrizoate administration in rats with cholesterol-supplemented diet for 8 weeks. Renal function and renal hemodynamics were determined 1 day following contrast medium administration. Renal histopathology was observed by light microscope. Renal tubular apoptosis was examined by TUNEL. Renal endothelin-1 (ET-1) was measured by radioimmunoassay. Renal malondialdehyde (MDA) and catalase (CAT) were measured as oxidative markers. Levels of serum creatinine (Scr), renal ET-1, MDA and CAT, and resistance index (RI) of renal blood vessels increased significantly in CI-AKI rats. The 
increases in Scr and RI of renal blood vessels induced by diatrizoate were suppressed significantly and 
dose-dependently by pretreatment with KB-R7943. Histopathological and TUNEL results showed that 
the contrast medium-induced severe renal tubular 
necrosis and apoptosis were significantly and dose-dependently attenuated by KB-R7943. KB-R7943 significantly suppressed the increment of renal ET-1 content and MDA and CAT level induced by contrast medium administration. Activation of the reverse mode of NCX, followed by ET-1 overproduction and increased oxidative stress, seems to play an important role in the pathogenesis of CI-AKI. The inhibitor of the reverse mode of NCX, KB-R7943, has renoprotective effects on CI-AKI.

Protective effects of tocotrienols against lipid-induced nephropathy in experimental type-2 diabetic rats by modulation in TGF-β expression

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Siddiqui, Shabeena [Department of Biochemistry, Lipid Metabolism Laboratory, Jamia Hamdard (Hamdard University), New Delhi 110062 (India); Ahsan, Haseeb [Department of Biochemistry, Faculty of Dentistry, Jamia Millia Islamia, New Delhi 110025 (India); Khan, Mohammad Rashid [Department of Biochemistry, Lipid Metabolism Laboratory, Jamia Hamdard (Hamdard University), New Delhi 110062 (India); Siddiqui, Waseem A., E-mail: wasiddiqui01@gmail.com [Department of Biochemistry, Lipid Metabolism Laboratory, Jamia Hamdard (Hamdard University), New Delhi 110062 (India)

2013-12-01

Dyslipidemia is common in patients with diabetes mellitus (DM) and is considered a risk factor for the progression of diabetic nephropathy (DN). Hyperlipidemia and hyperglycemia act synergistically to induce renal injury. The present study was designed to investigate the protective effects of tocotrienols as tocotrienol-rich fraction (TRF) extracted from palm (PO) and rice bran oils (RBO) against lipid induced nephropathy in type-2 diabetic rats and its probable molecular mechanism. Male Wistar rats (175–200 g) were divided into four groups. The first group served as diabetic control, while the second and third groups received PO-TRF and RBO-TRF, respectively by gavage over a period of sixteen weeks post-induction of diabetes. The fourth group comprised of age-matched rats that served as normal control. The effects of TRF on serum lipid profile, oxidative stress markers, expression of TGF-β, fibronectin and collagen type IV were analyzed in the kidney of diabetic rats. Treatment with PO-TRF and RBO-TRF significantly improved glycemic status, serum lipid profile and renal function in type-2 diabetic rats. In addition, TRF supplementation down-regulated the expression of TGF-β, fibronectin and collagen type IV in the kidney of diabetic rats. Transforming growth factor-β (TGF-β) plays a critical role in progression of DN, but its modulation by tocotrienols in DN remains unexplored. TRF ameliorated lipid induced nephropathy in type-2 diabetes by its hypoglycemic, hypolipidemic and antioxidant activities as well as by modulation of TGF-β to prevent increased expression of collagen type IV and fibrinogen. We finally propose a mechanism for the expression of molecular markers that are significant in the events leading to diabetic nephropathy and its modulation by tocotrienols/TRF. - Highlights: • The nephroprotective effect of TRF in type-2 diabetic rats was investigated. • Treatment with TRF improved glycemic status, lipid profile and renal functions in rats

Protective effects of tocotrienols against lipid-induced nephropathy in experimental type-2 diabetic rats by modulation in TGF-β expression

International Nuclear Information System (INIS)

Siddiqui, Shabeena; Ahsan, Haseeb; Khan, Mohammad Rashid; Siddiqui, Waseem A.

2013-01-01

Dyslipidemia is common in patients with diabetes mellitus (DM) and is considered a risk factor for the progression of diabetic nephropathy (DN). Hyperlipidemia and hyperglycemia act synergistically to induce renal injury. The present study was designed to investigate the protective effects of tocotrienols as tocotrienol-rich fraction (TRF) extracted from palm (PO) and rice bran oils (RBO) against lipid induced nephropathy in type-2 diabetic rats and its probable molecular mechanism. Male Wistar rats (175–200 g) were divided into four groups. The first group served as diabetic control, while the second and third groups received PO-TRF and RBO-TRF, respectively by gavage over a period of sixteen weeks post-induction of diabetes. The fourth group comprised of age-matched rats that served as normal control. The effects of TRF on serum lipid profile, oxidative stress markers, expression of TGF-β, fibronectin and collagen type IV were analyzed in the kidney of diabetic rats. Treatment with PO-TRF and RBO-TRF significantly improved glycemic status, serum lipid profile and renal function in type-2 diabetic rats. In addition, TRF supplementation down-regulated the expression of TGF-β, fibronectin and collagen type IV in the kidney of diabetic rats. Transforming growth factor-β (TGF-β) plays a critical role in progression of DN, but its modulation by tocotrienols in DN remains unexplored. TRF ameliorated lipid induced nephropathy in type-2 diabetes by its hypoglycemic, hypolipidemic and antioxidant activities as well as by modulation of TGF-β to prevent increased expression of collagen type IV and fibrinogen. We finally propose a mechanism for the expression of molecular markers that are significant in the events leading to diabetic nephropathy and its modulation by tocotrienols/TRF. - Highlights: • The nephroprotective effect of TRF in type-2 diabetic rats was investigated. • Treatment with TRF improved glycemic status, lipid profile and renal functions in rats

Protective effects of tocotrienols against lipid-induced nephropathy in experimental type-2 diabetic rats by modulation in TGF-β expression

Energy Technology Data Exchange (ETDEWEB)

Siddiqui, Shabeena [Department of Biochemistry, Lipid Metabolism Laboratory, Jamia Hamdard (Hamdard University), New Delhi 110062 (India); Ahsan, Haseeb [Department of Biochemistry, Faculty of Dentistry, Jamia Millia Islamia, New Delhi 110025 (India); Khan, Mohammad Rashid [Department of Biochemistry, Lipid Metabolism Laboratory, Jamia Hamdard (Hamdard University), New Delhi 110062 (India); Siddiqui, Waseem A., E-mail: wasiddiqui01@gmail.com [Department of Biochemistry, Lipid Metabolism Laboratory, Jamia Hamdard (Hamdard University), New Delhi 110062 (India)

2013-12-01

Dyslipidemia is common in patients with diabetes mellitus (DM) and is considered a risk factor for the progression of diabetic nephropathy (DN). Hyperlipidemia and hyperglycemia act synergistically to induce renal injury. The present study was designed to investigate the protective effects of tocotrienols as tocotrienol-rich fraction (TRF) extracted from palm (PO) and rice bran oils (RBO) against lipid induced nephropathy in type-2 diabetic rats and its probable molecular mechanism. Male Wistar rats (175–200 g) were divided into four groups. The first group served as diabetic control, while the second and third groups received PO-TRF and RBO-TRF, respectively by gavage over a period of sixteen weeks post-induction of diabetes. The fourth group comprised of age-matched rats that served as normal control. The effects of TRF on serum lipid profile, oxidative stress markers, expression of TGF-β, fibronectin and collagen type IV were analyzed in the kidney of diabetic rats. Treatment with PO-TRF and RBO-TRF significantly improved glycemic status, serum lipid profile and renal function in type-2 diabetic rats. In addition, TRF supplementation down-regulated the expression of TGF-β, fibronectin and collagen type IV in the kidney of diabetic rats. Transforming growth factor-β (TGF-β) plays a critical role in progression of DN, but its modulation by tocotrienols in DN remains unexplored. TRF ameliorated lipid induced nephropathy in type-2 diabetes by its hypoglycemic, hypolipidemic and antioxidant activities as well as by modulation of TGF-β to prevent increased expression of collagen type IV and fibrinogen. We finally propose a mechanism for the expression of molecular markers that are significant in the events leading to diabetic nephropathy and its modulation by tocotrienols/TRF. - Highlights: • The nephroprotective effect of TRF in type-2 diabetic rats was investigated. • Treatment with TRF improved glycemic status, lipid profile and renal functions in rats

Potentials and limitations of low-concentration contrast medium (150 mg iodine/ml) in CT pulmonary angiography

International Nuclear Information System (INIS)

Radon, M.R.; Kaduthodil, M.J.; Jagdish, J.; Matthews, S.; Hill, C.; Bull, M.J.; Morcos, S.K.

2011-01-01

Aim: To assess the feasibility of producing diagnostic multidetector computed tomography (MDCT) pulmonary angiography with low iodine concentration contrast media (150 mg iodine/ml) in patients with suspected acute pulmonary embolism. Materials and methods: Ninety-five randomized patients underwent MDCT (64 row) pulmonary angiography with 100 ml iopromide either at low concentration (LC) of 150 mg iodine/ml (n = 45) or high concentration (HC) of 300 mg iodine/ml (n = 50), delivered at the rate of 5 ml/s via a power injector. Two experienced radiologists, blinded to the concentration used, subjectively assessed the diagnostic quality and confidence using a four-point scale [1 = poor (not diagnostic), 2 = satisfactory, 3 = good, 4 = excellent]. Attenuation values (in HU) were measured in the main proximal branches of the pulmonary arteries. Results: The median diagnostic quality score for both observers was 3.5 (interquartile range 3-4) in the HC group and 2.5 (interquartile range 1.5-3) in the LC group (p < 0.01). The median diagnostic confidence score for both observers was 4 (interquartile range 3-4) in the HC group and 3 (interquartile range 1.5-4) in the LC group (p < 0.01). Both observers rated examinations as diagnostic in 69% of cases in the LC group, compared with 96% of cases in the HC group. Good interobserver agreement was found in both groups (K value 0.72 in the LC group and 0.73 in the HC). Obesity, poor scan timing, and dilution by venous return of non-opacified blood were the main reasons for a reduction in diagnostic quality of examinations in the LC group. Conclusion: Despite a 50% reduction of contrast medium dose in comparison to the standard technique, 150 mg iodine/ml can produce diagnostic MDCT pulmonary angiogram studies in the absence of obesity or high cardiac output and hyper-dynamic pulmonary circulation. Reducing the dose of contrast media would minimize the risk of contrast nephropathy in patients at risk of this complication

Decreased Expression of Na+/K+-ATPase, NHE3, NBC1, AQP1 and OAT in Gentamicin-induced Nephropathy

Science.gov (United States)

Bae, Woo Kyun; Lee, JongUn; Park, Jeong Woo; Bae, Eun Hui; Ma, Seong Kwon; Kim, Suhn Hee

2008-01-01

The present study was aimed to determine whether there is an altered regulation of tubular transporters in gentamicin-induced nephropathy. Sprague-Dawley male rats (200~250 g) were subcutaneously injected with gentamicin (100 mg/kg per day) for 7 days, and the expression of tubular transporters was determined by immunoblotting and immunohistochemistry. The mRNA and protein expression of OAT was also determined. Gentamicin-treated rats exhibited significantly decreased creatinine clearance along with increased plasma creatinine levels. Accordingly, the fractional excretion of sodium increased. Urine volume was increased, while urine osmolality and free water reabsorption were decreased. Immunoblotting and immunohistochemistry revealed decreased expression of Na+/K+-ATPase, NHE3, NBC1, and AQP1 in the kidney of gentamicin-treated rats. The expression of OAT1 and OAT3 was also decreased. Gentamicin-induced nephropathy may at least in part be causally related with a decreased expression of Na+/K+-ATPase, NHE3, NBC1, AQP1 and OAT. PMID:19967075

Softened food reduces weight loss in the streptozotocin-induced male mouse model of diabetic nephropathy.

Science.gov (United States)

Nørgaard, Sisse A; Sand, Fredrik W; Sørensen, Dorte B; Abelson, Klas Sp; Søndergaard, Henrik

2018-01-01

The streptozotocin (STZ)-induced diabetic mouse is a widely used model of diabetes and diabetic nephropathy (DN). However, it is a well-known issue that this model is challenged by high weight loss, which despite supportive measures often results in high euthanization rates. To overcome these issues, we hypothesized that supplementing STZ-induced diabetic mice with water-softened chow in addition to normal chow would reduce weight loss, lower the need for supportive treatment, and reduce the number of mice reaching the humane endpoint of 20% weight loss. In a 15 week STZ-induced DN study we demonstrated that diabetic male mice receiving softened chow had reduced acute weight loss following STZ treatment ( p = 0.045) and additionally fewer mice were euthanized due to weight loss. By supplementing the diabetic mice with softened chow, no mice reached 20% weight loss whereas 37.5% of the mice without this supplement reached this humane endpoint ( p = 0.0027). Excretion of corticosterone metabolites in faeces was reduced in diabetic mice on softened chow ( p = 0.0007), suggesting lower levels of general stress. Finally, it was demonstrated that the water-softened chow supplement did not significantly affect the induction of key disease parameters, i.e. %HbA1C and albuminuria nor result in abnormal teeth wear. In conclusion, supplementation of softened food is refining the STZ-induced diabetic mouse model significantly by reducing stress, weight loss and the number of animals sacrificed due to humane endpoints, while maintaining the key phenotypes of diabetes and nephropathy.

Changes in Renal Function in Elderly Patients Following Intravenous Iodinated Contrast Administration: A Retrospective Study

International Nuclear Information System (INIS)

Alsafi, A.; Alsafi, Z.; Lakhani, A.; Strickland, N.H.

2014-01-01

Contrast-induced nephropathy (CIN) is a recognised complication of intravascular administration of iodinated contrast media (ICM). Previous studies suggest a higher incidence in the elderly, but no large study has assessed this to date. We set out to assess changes in creatinine in elderly inpatients following computed tomography (CT) examination and compare those who received intravenous contrast to those who did not. Methods. Using the Radiology Information System in two teaching hospitals, inpatients over the age of seventy who had a CT examination and a baseline creatinine were identified and their follow-up creatinine levels were analysed. Elderly inpatients who underwent a non contrast CT over the same period were used as controls. Results. 677 elderly inpatients who received ICM were compared with 487 controls. 9.2% of patients who received ICM developed acute kidney injury (AKI) compared to 3.5% of inpatient controls (Ρ<0.0001). Patients with higher baseline eGFR had a higher incidence of post-CT AKI. Conclusions. The incidence of post-CT AKI is higher in patients who received IV ICM compared to those who did not; the difference may be partly attributable to contrast-induced nephropathy. This suggests that the incidence of CIN in the elderly may not be as high as previously thought.

Protective Effect of Edaravone Against Cyclosporine-Induced Chronic Nephropathy Through Antioxidant and Nitric Oxide Modulating Pathways in Rats

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Elahe Sattarinezhad

2017-03-01

Full Text Available Background: Cyclosporine A (CsA is an immunosuppressant with therapeutic indications in various immunological diseases; however, its use is associated with chronic nephropathy. Oxidative stress has a crucial role in CsA-induced nephrotoxicity. The present study evaluates the protective effect of edaravone on CsA-induced chronic nephropathy and investigates its antioxidant and nitric oxide modulating property. Methods: Male Sprague-Dawley rats (n=66 were distributed into nine groups, including a control (group 1 (n=7. Eight groups received CsA (15 mg/kg for 28 days while being treated. The groups were categorized as: •\tGroup 2: Vehicle (n=10 •\tGroups 3, 4, and 5: Edaravone (1, 5, and 10 mg/kg (n=7 each •\tGroup 6: Diphenyliodonium chloride, a specific endothelial nitric oxide synthase (eNOS inhibitor (n=7 •\tGroup 7: Aminoguanidine, a specific inducible nitric oxide synthase (iNOS inhibitor (n=7 •\tGroup 8: Edaravone (10 mg/kg plus diphenyliodonium chloride (n=7 •\tGroup 9: Edaravone (10 mg/kg plus aminoguanidine (n=7 Blood urea nitrogen and serum creatinine levels, malondialdehyde, superoxide dismutase, and glutathione reductase enzyme activities were measured using standard kits. Renal histopathological evaluations and measurements of eNOS and iNOS gene expressions by RT-PCR were also performed. Data were analyzed using one-way analysis of variance (ANOVA followed by Tukey’s test (SPSS software version 18.0. Results: Edaravone (10 mg/kg significantly attenuated CsA-induced oxidative stress, renal dysfunction, and kidney tissue injury. Aminoguanidine improved the renoprotective effect of edaravone. Edaravone reduced the elevated mRNA level of iNOS, but could not alter the level of eNOS mRNA significantly. Conclusion: Edaravone protects against CsA-induced chronic nephropathy using antioxidant property and probably through inhibiting iNOS gene expression.

Use of iohexol as a gastrointestinal contrast medium in the dog

International Nuclear Information System (INIS)

Agut, A.; Sanchez-Valverde, M.A.; Lasaosa, J.M.; Murciano, J.; Molina, F.

1993-01-01

Iohexol was administered orally in five dogs. The dose, gastrointestinal (GI) transit time, appearance of mucosal patterns and side effects were studied. Three different doses (525, 700, 875 mgI/kg) were used in each dog at 1-week intervals. GI transit time was rapid. In each dose, gastric emptying commenced immediately after administration of the contrast medium, and was completed within 30–60 min with doses of 525–700 mgI/kg and 90–120 min with 875 mgI/kg. Large intestinal filling was observed within 60-90 min. In the majority of studies, the mucosal border appeared as a thin homogeneous halo of lucency surrounding the more opaque bowel lumen contents. The contrast intensity was not adequate with the lowest dose. The image quality did not deteriorate along the GI tract. No adverse reactions were found. Iohexol is an alternative GI contrast medium in the dog when contrast media are contraindicated

Reduced iodinated contrast media for abdominal imaging by dual-layer spectral detector computed tomography for patients with kidney disease

Directory of Open Access Journals (Sweden)

Hirokazu Saito, MD

2018-04-01

Full Text Available Contrast-enhanced computed tomography using iodinated contrast media is useful for diagnosis of gastrointestinal diseases. However, contrast-induced nephropathy remains problematic for kidney diseases patients. Although current guidelines recommended the use of a minimal dose of contrast media necessary to obtain adequate images for diagnosis, obtaining adequate images with sufficient contrast enhancement is difficult with conventional computed tomography using reduced contrast media. Dual-layer spectral detector computed tomography enables the simultaneous acquisition of low- and high-energy data and the reconstruction of virtual monochromatic images ranging from 40 to 200 keV, retrospectively. Low-energy virtual monochromatic images can enhance the contrast of images, thereby facilitating reduced contrast media. In case 1, abdominal computed tomography angiography at 50 keV using 40% of the conventional dose of contrast media revealed the artery that was the source of diverticular bleeding in the ascending colon. In case 2, ischemia of the transverse colon was diagnosed by contrast-enhanced computed tomography and iodine-selective imaging using 40% of the conventional dose of contrast media. In case 3, advanced esophagogastric junctional cancer was staged and preoperative abdominal computed tomography angiography could be obtained with 30% of the conventional dose of contrast media. However, the texture of virtual monochromatic images may be a limitation at low energy. Keywords: Virtual monochromatic images, Contrast-induced nephropathy

Protective effects of losartan in renal dysfunction during coronary angiography and intervention caused by low osmolar non-ionic contrast media

International Nuclear Information System (INIS)

Chen Yueguang; Zhang Dadong; Gu Jun; Song Zhiping; Yu Qiang; Feng Xiaodi; Xiao Hongbing; Yin Guizhi; Guan Ping; Chen Chengjun; Yang Hui; Jin Xian; Dong Jian; Fan Xiaomin

2007-01-01

Objective: To observe the changes of renal function during simple coronary angiography (CAG)and pereutaneous coronary intervention (PCI)caused by low osmolar non-ionic contrast media and to evaluate the preventive effect of losartan on renal function(serum creatinine)in PCI. Methods: All 171 cases were divided into 3 groups, CAG negative group(N=73), PCI group (N=52)and treatment group (PCI + Losartan, N=46)according to the results given by coronary arteriography. The investigation was performed on the influences produced by the low osmolar non-ionic contrast medium(Ioversol)on renal function and minimal albumin proteinuria in the 3 groups. The minimal albumin proteinuria and renal function (serum creatinine) were tested before and 1 d, 3 d, 7 d after the procedure and followed by the comparison and evaluation of the outcoming data. Results: There were no significant changes of serum creatinine among 3 groups, but amount of minimal albumin proteinuria was increased in PCI group (P<0.05), and decreased obviously after Losartan medication (P<0.05). Conclusion: Low ormolar non-ionic contrast media produce no significant influence on renal function (serum creatinine)during CAG and/or PCI but with different degrees of increase for minimal albumin proteinuria, especially in PCI group. Losartan can decrease minimal albumin proteinuria after PCI procedure, possibly providing the prevention for contrast medium induced nephropathy. (authors)

Study of the safety of a new non-ionic contrast medium, iopromide 370 in patients with chronic renal failure

International Nuclear Information System (INIS)

Meyrier, A.; Fernet, M.; Rainfray, M.

1989-01-01

Intravenous injection of iodinated contrast media usually induces modifications of renal function. Adverse effects of contrast media on renal function may affect diuresis, blood flow or glomerular filtration rate. These modifications are mainly related to osmolality but also chemotoxicity. This open study showed that after i.v. injection of a bolus of iopromide 370, a new non-ionic contrast medium, there was no untoward effect on renal function in patients with renal insufficiency. This justifies comparative studies in patients with renal impairment including elderly subjects, to confirm the tolerance of this product in high risk groups [fr

Angiotensin-converting enzyme inhibition in diabetic nephropathy

DEFF Research Database (Denmark)

Parving, H H; Rossing, P; Hommel, E

1995-01-01

The aim of our prospective study was to evaluate putative progression promoters, kidney function, and prognosis during long-term treatment with angiotensin-converting enzyme inhibition in insulin-dependent diabetes mellitus patients suffering from diabetic nephropathy. Eighteen consecutive......, albuminuria (geometric mean +/- antilog SE) 982 +/- 1.2 micrograms/min, and GFR 98 +/- 5 mL/min/1.73 m2. Angiotensin-converting enzyme inhibition induced a significant reduction during the whole treatment period of blood pressure (137/85 +/- 3/1 mm Hg; P ....01), and the rate of decline in GFR was 4.4 +/- 0.7 mL/min/yr, in contrast to previous reports of 10 to 14 mL/min/yr (natural history). Univariate analysis revealed a significant correlation between the rate of decline in GFR and mean arterial blood pressure (r = 0.58, P = 0.01), albuminuria (r = 0.67, P

Gadolinium-DTPA and gadodiamide as an alternative contrast medium for CT

International Nuclear Information System (INIS)

Engelbrecht, V.; Koch, J.A.; Rassek, M.; Moedder, U.

1996-01-01

To evaluate the effect of intravenously applied gadolinium-based contrast medium in computed tomographic (CT) studies. Serial dilutions of iohexol 300, Gd-DTPA and gadodiamide were scanned with CT in a phantom study using water filled tubes. For quantification of X-ray attenuation, the mean Hounsfield units (HU) were calculated from the CT scans. Five patients with contraindications against iodine contrast agents were examined with abdominal or thoracic CT before and after application of 0.2 mmol/kg body weight of a gadolinium-based contrast agent. In these patients attenuation values were obtained in ROI from unenhanced and enhanced CT scans. The phantom study revealed a 38,4% enhancement for Gd-DTPA and a 35.7% enhancement for gadodiamide scaled on the reference measurements with iohexol 300. Thus, 130.2 ml Gd-DTPA or 140.1 ml gadodiamide are needed to achieve the same attenuation as an i.v. injection of 50 ml iohexol 300. Consequently the corresponding dose of 1 mmol/kg body weight would exceed the manufacturer's recommended dose. In four patients with complete thoracic or abdominal CT, i.v. applied gadolinium-based contrast medium (0.2 mmol/kg) yielded no visible advantage. In these patients parenchymal enhancement did not exceed 25%. Dynamic CT of a patient with focal liver lesion revealed an arterial enhancement peak of 75%. Sufficient parenchymal enhancement in CT studies cannot be achieved with the available gadolinium-based contrast mediums. They might be helpful if only short time vascular enhancement is required. (orig.) [de

CT contrasting theory. Effects of the concentration, volume and infusion rate of iodine contrast medium on TDC

International Nuclear Information System (INIS)

Yamachi, Jun

2007-01-01

This study was performed to evaluate the effects in the title on TDC (time-density curve) using a phantom. CT machine used was Toshiba Aquilion Multi 64, TDC phantom was the product of Nemoto-Kyorindo Co., and the contrast medium was Eisai iomeprol, in syringe-sealed formulations of 300 and 350 mg I/mL. The medium was infused at 1-5 mL/sec in the phantom equivalent to body weight of 78 kg (total water volume=1 min circulation=6,000 mL, 800 mL/heart) to obtain 30 TDCs. Evaluated were the relationships of the infusion rate (mL/sec), volume (mL) or time (sec) with TDC parameters of the detection time of the medium, slope, time to reach the maximum CT value, the maximum CT value, time to keep the CT concentration and its actual concentration. Results revealed that, regardless to the difference of formulations of the contrast medium, TDC with high reproducibility can be obtainable by making the infusion rate of I per unit time and body weight (mgI/sec/kg) constant when the infusion time is made identical for CT of the same diagnostic purpose. (R.T.)

Craniopharyngiomas - the utility of contrast medium enhancement for MR imaging at 1.5 T

International Nuclear Information System (INIS)

Hald, J.K.; Eldevik, O.P.; Brunberg, J.A.; Chandler, W.F.

1994-01-01

To evaluate the efficacy of i.v. contrast medium administration in MR imaging at 1.5 T in patients with craniopharyngiomas, MR studies of 10 men and 6 women with pathologically proven craniopharyngiomas were made. The MR images were obtained as 3- to 5-mm-thick coronal (n=13) or axial (n=3) T1-weighted images (T1WI) prior to an following i.v. Gd-DTPA administration. Proton density-(PD) and T2-weighted images (T2WI) were also obtained. Conspicuity of tumor margins, cystic versus solid components, size, location and effect upon adjacent structures were separately characterized in all imaging sequences. In 6 patients contrast medium-enhanced T1WI, PD and T2WI demonstrated cystic tumor components not seen on unenhanced T1WI. There were significant differences (p<0.004) on 2-tailed Student's t-test comparing tumor conspicuity on contrast medium-enhanced T1WI with unenhanced T1WI, PD and T2WI. Optimal tumor delineation on MR imaging of patients with craniopharyngiomas justifies the use of i.v. contrast medium. (orig.)

Does the MRI or MRI contrast medium gadopentetate dimeglumine change the oxidant and antioxidant status in humans?

International Nuclear Information System (INIS)

Olmaz, Refik; Oguz, Ebru Gok; Kiykim, Ahmet; Turgutalp, Kenan; Horoz, M.; Ozhan, Onur; Muslu, Necati; Sungur, Mehmet

2013-01-01

Background: It has become evident that gadolinium-based contrast agents (GBCA) may have nephrotoxic potential. Oxidative stress is one of the most important pathways in the pathogenesis of iodinated contrast-induced nephropathy. Purpose: To investigate the effects of static magnetic fields and gadopentetate dimeglumine (Magnevist) on oxidant/antioxidant status via measurement of total antioxidant capacity (TAC), total oxidant status (TOS), and serum malondialdehide (MDA). Material and Methods: Two age- and sex-matched groups of patients not under oxidative stress conditions that underwent magnetic resonance imaging (MRI) were recruited to this study. While contrast-enhanced (Magnevist, 0.2 mmol/kg) MRI was performed in group 1, MRI without GBCA was performed in group 2. Fasting blood glucose, C-reactive protein, serum creatinine, liver enzymes, uric acid, and lipid parameters were examined in all patients. Peripheral venous blood samples in order to determine TAC, TOS, and MDA were collected before and 6, 24, and 72 h after the MRI procedures. The TOS:TAC ratio was used as the oxidative stress index (OSI). Patients were followed up to 72 h. Results: There were no significant changes in serum TAC, TOS, and MDA levels (Δ s erum T AC, Δ s erum T OS, and Δ M DA) in either group 6, 24, or 72 h after the procedures (P > 0.05). Furthermore, OSI did not change after the procedures in either group (P > 0.05). Conclusion: Magnetic field and gadopentetate dimeglumine (Magnevist) do not change the oxidant or antioxidant status at a dose of 0.2 mmol/kg

Does the MRI or MRI contrast medium gadopentetate dimeglumine change the oxidant and antioxidant status in humans?

Energy Technology Data Exchange (ETDEWEB)

Olmaz, Refik; Oguz, Ebru Gok; Kiykim, Ahmet; Turgutalp, Kenan [Dept. of Internal Medicine, Div. of Nephrology, School of Medicine, Mersin Univ., Mersin (Turkey)], e-mail: k.turgutalp@hotmail.com; Horoz, M. [Dept. of Internal Medicine, Div. of Nephrology, School of Medicine, Harran Univ., Sanliurfa (Turkey); Ozhan, Onur [Dept. of Internal Medicine, Div. of Endocrinology and Metabolism, School of Medicine, Mersin Univ., Mersin (Turkey); Muslu, Necati [Dept. of Biochemistry, School of Medicine, Mersin Univ., Mersin (Turkey); Sungur, Mehmet [Dept. of Biostatistics, School of Medicine, Mersin Univ., Mersin (Turkey)

2013-02-15

Background: It has become evident that gadolinium-based contrast agents (GBCA) may have nephrotoxic potential. Oxidative stress is one of the most important pathways in the pathogenesis of iodinated contrast-induced nephropathy. Purpose: To investigate the effects of static magnetic fields and gadopentetate dimeglumine (Magnevist) on oxidant/antioxidant status via measurement of total antioxidant capacity (TAC), total oxidant status (TOS), and serum malondialdehide (MDA). Material and Methods: Two age- and sex-matched groups of patients not under oxidative stress conditions that underwent magnetic resonance imaging (MRI) were recruited to this study. While contrast-enhanced (Magnevist, 0.2 mmol/kg) MRI was performed in group 1, MRI without GBCA was performed in group 2. Fasting blood glucose, C-reactive protein, serum creatinine, liver enzymes, uric acid, and lipid parameters were examined in all patients. Peripheral venous blood samples in order to determine TAC, TOS, and MDA were collected before and 6, 24, and 72 h after the MRI procedures. The TOS:TAC ratio was used as the oxidative stress index (OSI). Patients were followed up to 72 h. Results: There were no significant changes in serum TAC, TOS, and MDA levels ({Delta}{sub s}erum{sub T}AC, {Delta}{sub s}erum{sub T}OS, and {Delta}{sub M}DA) in either group 6, 24, or 72 h after the procedures (P > 0.05). Furthermore, OSI did not change after the procedures in either group (P > 0.05). Conclusion: Magnetic field and gadopentetate dimeglumine (Magnevist) do not change the oxidant or antioxidant status at a dose of 0.2 mmol/kg.

Prospective evaluation of the development of contrast-induced nephropathy in patients with acute coronary syndrome undergoing rotational coronary angiography vs. conventional coronary angiography: CINERAMA study

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Diego Fernández-Rodríguez

2018-03-01

Full Text Available Introduction and objectives: Rotational coronary angiography (RCA requires less contrast to be administered and can prevent the onset of contrast-induced nephropathy (CIN during invasive coronary procedures. The aim of the study is to evaluate the impact of RCA on CIN (increase in serum creatinine ≥0.5 mg/dL or ≥25% after an acute coronary syndrome. Methods: From April to September 2016, patients suffering acute coronary syndromes who underwent diagnostic coronary angiography, with the possibility of ad hoc coronary angioplasty, were prospectively enrolled. At the operator's discretion, patients underwent RCA or conventional coronary angiography (CCA. CIN (primary endpoint, as well as analytical, angiographic and clinical endpoints, were compared between groups. Results: Of the 235 patients enrolled, 116 patients received RCA and 119 patients received CCA. The RCA group was composed of older patients (64.0 ± 11.8 years vs. 59.7 ± 12.1 years; p = 0.006, a higher proportion of women (44.8 vs. 17.6%; p < 0.001, patients with a lower estimated glomerular filtration rate (76 ± 25 vs. 86 ± 27 ml/min/1.73 m2; p = 0.001, and patients who underwent fewer coronary angioplasties (p < 0.001 compared with the CCA group. Furthermore, the RCA group, received less contrast (113 ± 92 vs. 169 ± 103 ml; p < 0.001, including in diagnostic procedures (54 ± 24 vs. 85 ± 56 ml; p < 0.001 and diagnostic-therapeutic procedures (174 ± 64 vs. 205 ± 98 ml; p = 0.049 compared with the CCA group. The RCA group presented less CIN (4.3 vs. 22.7%; p < 0.001 compared to the CCA group, and this finding was maintained in the regression analysis (Adjusted relative risk: 0.868; 95% CI: 0.794–0.949; p = 0.002. There were no differences in clinical endpoints between the groups. Conclusions: RCA was associated

A method to evaluate the dose increase in CT with iodinated contrast medium

International Nuclear Information System (INIS)

Amato, Ernesto; Lizio, Domenico; Settineri, Nicola; Di Pasquale, Andrea; Salamone, Ignazio; Pandolfo, Ignazio

2010-01-01

Purpose: The objective of this study is to develop a method to calculate the relative dose increase when a computerized tomography scan (CT) is carried out after administration of iodinated contrast medium, with respect to the same CT scan in absence of contrast medium. Methods: A Monte Carlo simulation in GEANT4 of anthropomorphic neck and abdomen phantoms exposed to a simplified model of CT scanner was set up in order to calculate the increase of dose to thyroid, liver, spleen, kidneys, and pancreas as a function of the quantity of iodine accumulated; a series of experimental measurements of Hounsfield unit (HU) increment for known concentrations of iodinated contrast medium was carried out on a Siemens Sensation 16 CT scanner in order to obtain a relationship between the increment in HU and the relative dose increase in the organs studied. The authors applied such a method to calculate the average dose increase in three patients who underwent standard CT protocols consisting of one native scan in absence of contrast, followed by a contrast-enhanced scan in venous phase. Results: The authors validated their GEANT4 Monte Carlo simulation by comparing the resulting dose increases for iodine solutions in water with the ones presented in literature and with their experimental data obtained through a Roentgen therapy unit. The relative dose increases as a function of the iodine mass fraction accumulated and as a function of the Hounsfield unit increment between the contrast-enhanced scan and the native scan are presented. The data shown for the three patients exhibit an average relative dose increase between 22% for liver and 74% for kidneys; also, spleen (34%), pancreas (28%), and thyroid (48%) show a remarkable average increase. Conclusions: The method developed allows a simple evaluation of the dose increase when iodinated contrast medium is used in CT scans, basing on the increment in Hounsfield units observed on the patients' organs. Since many clinical protocols

A method to evaluate the dose increase in CT with iodinated contrast medium

Energy Technology Data Exchange (ETDEWEB)

Amato, Ernesto; Lizio, Domenico; Settineri, Nicola; Di Pasquale, Andrea; Salamone, Ignazio; Pandolfo, Ignazio [Department of Radiological Sciences, University of Messina, Messina 98125 (Italy); Department of Physics, University of Messina, Messina 98166 (Italy); University Hospital ' ' G. Martino' ' , Messina 98125 (Italy); Department of Radiological Sciences, University of Messina, Messina 98125 (Italy) and University Hospital ' ' G. Martino' ' , Messina 98125 (Italy)

2010-08-15

Purpose: The objective of this study is to develop a method to calculate the relative dose increase when a computerized tomography scan (CT) is carried out after administration of iodinated contrast medium, with respect to the same CT scan in absence of contrast medium. Methods: A Monte Carlo simulation in GEANT4 of anthropomorphic neck and abdomen phantoms exposed to a simplified model of CT scanner was set up in order to calculate the increase of dose to thyroid, liver, spleen, kidneys, and pancreas as a function of the quantity of iodine accumulated; a series of experimental measurements of Hounsfield unit (HU) increment for known concentrations of iodinated contrast medium was carried out on a Siemens Sensation 16 CT scanner in order to obtain a relationship between the increment in HU and the relative dose increase in the organs studied. The authors applied such a method to calculate the average dose increase in three patients who underwent standard CT protocols consisting of one native scan in absence of contrast, followed by a contrast-enhanced scan in venous phase. Results: The authors validated their GEANT4 Monte Carlo simulation by comparing the resulting dose increases for iodine solutions in water with the ones presented in literature and with their experimental data obtained through a Roentgen therapy unit. The relative dose increases as a function of the iodine mass fraction accumulated and as a function of the Hounsfield unit increment between the contrast-enhanced scan and the native scan are presented. The data shown for the three patients exhibit an average relative dose increase between 22% for liver and 74% for kidneys; also, spleen (34%), pancreas (28%), and thyroid (48%) show a remarkable average increase. Conclusions: The method developed allows a simple evaluation of the dose increase when iodinated contrast medium is used in CT scans, basing on the increment in Hounsfield units observed on the patients' organs. Since many clinical

Renal Protective Effects of Low Molecular Weight of Inonotus obliquus Polysaccharide (LIOP on HFD/STZ-Induced Nephropathy in Mice

Directory of Open Access Journals (Sweden)

Yen-Jung Chou

2016-09-01

Full Text Available Diabetic nephropathy (DN is the leading cause of end-stage renal disease in diabetes mellitus. Oxidative stress, insulin resistance and pro-inflammatory cytokines have been shown to play an important role in pathogeneses of renal damage on type 2 diabetes mellitus (DM. Inonotus obliquus (IO is a white rot fungus that belongs to the family Hymenochaetaceae; it has been used as an edible mushroom and exhibits many biological activities including anti-tumor, anti-oxidant, anti-inflammatory and anti-hyperglycemic properties. Especially the water-soluble Inonotus obliquus polysaccharides (IOPs have been previously reported to significantly inhibit LPS-induced inflammatory cytokines in mice and protect from streptozotocin (STZ-induced diabetic rats. In order to identify the nephroprotective effects of low molecular weight of IOP fraction (LIOP, from the fruiting bodies of Inonotus obliquus, high-fat diet (HFD plus STZ-induced type 2-like diabetic nephropathy C57BL/6 mice were investigated in this study. Our data showed that eight weeks of administration of 10–100 kDa, LIOP (300 mg/kg had progressively increased their sensitivity to glucose (less insulin tolerance, reduced triglyceride levels, elevated the HDL/LDL ratio and decreased urinary albumin/creatinine ratio(ACR compared to the control group. By pathological and immunohistochemical examinations, it was indicated that LIOP can restore the integrity of the glomerular capsules and increase the numbers of glomerular mesangial cells, associated with decreased expression of TGF-β on renal cortex in mice. Consistently, three days of LIOP (100 μg/mL incubation also provided protection against STZ + AGEs-induced glucotoxicity in renal tubular cells (LLC-PK1, while the levels of NF-κB and TGF-β expression significantly decreased in a dose-dependent manner. Our findings demonstrate that LIOP treatment could ameliorate glucolipotoxicity-induced renal fibrosis, possibly partly via the inhibition of NF

Synergism effects of pioglitazone and Urtica dioica extract in streptozotocin-induced nephropathy via attenuation of oxidative stress

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Mohammad Shokrzadeh

2017-05-01

Full Text Available Objective(s: Hyperglycemia promotes oxidative stress that plays a crucial role in the pathogenesis of Diabetic nephropathy (DN. In this study, we investigated the synergism effects of hydroalcoholic extract of Urtica dioica and pioglitazone (PIO on the prevention of DN in streptozotocin induced-diabetic mice. Materials and Methods: Forty-two mice were divided into six groups as follows: non-diabetic control group, DMSO group (as solvent, diabetic group and four treatment groups which received U. dioica, pioglitazone, U. dioica plus pioglitazone and vitE. Diabetes was induced by a single dose of streptozotocin (STZ (200 mg/kg body wt, IP diluted in citrate buffer (pH= 4.6. After 4 weeks treatment, all animals were anaesthetized and blood was collected for serum urea and creatinine levels assessment in plasma and kidney tissue were excised for evaluation of oxidative stress markers. Results: Treatment with U. dioica significantly inhibited increase in serum urea and creatinine in plasma that were observed in diabetic mice. Furthermore, the elevated level of oxidative stress markers (glutathione oxidation, lipid peroxidation (LPO, protein carbonyl in renal supernatant of diabetic mice was inhibited by U. dioica treatment.  Interestingly, U. dioica promoted beneficial effects of PIO in reducing STZ-induced hyperglycemia, renal damage and oxidative stress markers. Conclusion: Our findings showed that PIO plus U. dioica have synergism protective effects against STZ-induced nephropathy that can be a candidate as a therapeutic approach in order to treatment of DN.

Synergism effects of pioglitazone and Urtica dioica extract in streptozotocin-induced nephropathy via attenuation of oxidative stress.

Science.gov (United States)

Shokrzadeh, Mohammad; Sadat-Hosseini, Sara; Fallah, Marjan; Shaki, Fatemeh

2017-05-01

Hyperglycemia promotes oxidative stress that plays a crucial role in the pathogenesis of Diabetic nephropathy (DN). In this study, we investigated the synergism effects of hydroalcoholic extract of Urtica dioica and pioglitazone (PIO) on the prevention of DN in streptozotocin induced-diabetic mice. Forty-two mice were divided into six groups as follows: non-diabetic control group, DMSO group (as solvent), diabetic group and four treatment groups which received U. dioica , pioglitazone, U. dioica plus pioglitazone and vitE. Diabetes was induced by a single dose of streptozotocin (STZ) (200 mg/kg body wt, IP) diluted in citrate buffer (pH= 4.6). After 4 weeks treatment, all animals were anaesthetized and blood was collected for serum urea and creatinine levels assessment in plasma and kidney tissue were excised for evaluation of oxidative stress markers. Treatment with U. dioica significantly inhibited increase in serum urea and creatinine in plasma that were observed in diabetic mice. Furthermore, the elevated level of oxidative stress markers (glutathione oxidation, lipid peroxidation (LPO), protein carbonyl) in renal supernatant of diabetic mice was inhibited by U. dioica treatment. Interestingly, U. dioica promoted beneficial effects of PIO in reducing STZ-induced hyperglycemia, renal damage and oxidative stress markers. Our findings showed that PIO plus U. dioica have synergism protective effects against STZ-induced nephropathy that can be a candidate as a therapeutic approach in order to treatment of DN.

Elevated vascular endothelial growth factor in type 1 diabetic patients with diabetic nephropathy

DEFF Research Database (Denmark)

Hovind, P; Tarnow, L; Oestergaard, P B

2000-01-01

patients with and without proliferative retinopathy were detected. CONCLUSIONS: Our data suggest that VEGF is elevated early in the course of diabetic nephropathy in men with type 1 diabetes mellitus. Baseline albuminuria, arterial blood pressure and male gender was predictors of diabetic nephropathy......BACKGROUND: Growth factors have been suggested to play a role in the development and progression of diabetic nephropathy. Vascular endothelial growth factor (VEGF) is a potent cytokine family that induces angiogenesis and markedly increases endothelial permeability. The aim of the present study...... was to investigate plasma levels of VEGF in a large cohort of type 1 diabetic patients with diabetic nephropathy and in long-standing type 1 diabetic patients with persistent normoalbuminuria, and to evaluate VEGF as a predictor of nephropathy progression. METHODS: We measured VEGF with an enzyme...

Comparative analysis of diabetic nephropathy and non-diabetic nephropathy disease

Directory of Open Access Journals (Sweden)

Qiuxiang Chen

2017-12-01

Conclusion: Treatment effect of diabetic nephropathy patients is relatively poor compared to that of non-diabetic patients. In clinics, management and prevention of diabetic patients should be strengthened to avoid complication of nephropathy which brings serious injury to patients.

Intravenous contrast medium application in elderly patients - evaluation of Iopentol (Imagopaque trademark 300)

International Nuclear Information System (INIS)

Rathsmann, P.; Jacobs, G.F.; Mueller, R.D.

2004-01-01

Purpose: We examined the subjective compatibility of elderly patients who received the intravenous contrast medium Iopentol (Imagopaque trademark 300). In addition, objective data were acquired to show possible interactions between contrast media and organ systems in old patients. Methods and materials: A CT scan with intravenous application of contrast media was performed on 132 patients ranging in age from 75 to 96 years. The patients were questioned about their individual sensations. In addition, blood pressure, creatinine and CT-densitometry were acquired as objective date. Results: The patients' individual sensations and clinical data show a very low rate of complications. Mild allergic reactions were noticed in two patients. No severe anaphylactic reactions were encountered. Statistically significant changes in blood pressure before and after administration of the contrast medium were not observed. The serum creatinine concentration was unchanged after application of contrast media. For CT-densitometry, the patients were divided into two groups, one group with patients 75-84 years and the other group with patients 85-96 years of age. CT-densitometry showed no age-related differences. The protocol of contrast administration resulted in excellent opacification of the examined regions, only the liver did not enhance in some cases before the opacification of the portal vein. Conclusion: It is shown that old age alone is no reason to withhold contrast media containing iodine when performing CT. For the evaluation of the liver, however, the peculiarities of old age have to be taken into account and the interval between injection of the contrast medium and beginning of the spiral-CT has to be extended. (orig.)

Soft-tissue tumor differentiation using 3D power Doppler ultrasonography with echo-contrast medium injection.

Science.gov (United States)

Chiou, Hong-Jen; Chou, Yi-Hong; Chen, Wei-Ming; Chen, Winby; Wang, Hsin-Kai; Chang, Cheng-Yen

2010-12-01

We aimed to evaluate the ability of 3-dimensional power Doppler ultrasonography to differentiate soft-tissue masses from blood flow and vascularization with contrast medium. Twenty-five patients (mean age, 44.1 years; range, 12-77 years) with a palpable mass were enrolled in this study. Volume data were acquired using linear and convex 3-dimensional probes and contrast medium injected manually by bolus. Data were stored and traced slice by slice for 12 slices. All patients were scanned by the same senior sonologist. The vascular index (VI), flow index (FI), and vascular-flow index (VFI) were automatically calculated after the tumor was completely traced. All tumors were later confirmed by pathology. The study included 8 benign (mean, 36.5 mL; range, 2.4-124 mL) and 17 malignant (mean, 319.4 mL; range, 9.9-1,179.6 mL) tumors. Before contrast medium injection, mean VI, FI and VFI were, respectively, 3.22, 32.26 and 1.07 in benign tumors, and 1.97, 29.33 and 0.67 in malignant tumors. After contrast medium injection, they were, respectively, 20.85, 37.33 and 8.52 in benign tumors, and 40.12, 41.21 and 17.77 in malignant tumors. The mean differences between with and without contrast injection for VI, FI and VFI were, respectively, 17.63, 5.07 and 7.45 in benign tumors, and 38.15, 11.88 and 16.55 in malignant tumors. Tumor volume, VI, FI and VFI were not significantly different between benign and malignant tumors before and after echo-contrast medium injection. However, VI, FI and VFI under self-differentiation (differences between with and without contrast injection) were significantly different between malignant and benign tumors. Three-dimensional power Doppler ultrasound is a valuable tool for differential diagnosis of soft-tissue tumors, especially with the injection of an echo-contrast medium. Copyright © 2010 Elsevier. Published by Elsevier B.V. All rights reserved.

Optical tracking of contrast medium bolus to optimize bolus shape and timing in dynamic computed tomography

International Nuclear Information System (INIS)

Eisa, Fabian; Brauweiler, Robert; Peetz, Alexander; Hupfer, Martin; Nowak, Tristan; Kalender, Willi A

2012-01-01

One of the biggest challenges in dynamic contrast-enhanced CT is the optimal synchronization of scan start and duration with contrast medium administration in order to optimize image contrast and to reduce the amount of contrast medium. We present a new optically based approach, which was developed to investigate and optimize bolus timing and shape. The time-concentration curve of an intravenously injected test bolus of a dye is measured in peripheral vessels with an optical sensor prior to the diagnostic CT scan. The curves can be used to assess bolus shapes as a function of injection protocols and to determine contrast medium arrival times. Preliminary results for phantom and animal experiments showed the expected linear behavior between dye concentration and absorption. The kinetics of the dye was compared to iodinated contrast medium and was found to be in good agreement. The contrast enhancement curves were reliably detected in three mice with individual bolus shapes and delay times of 2.1, 3.5 and 6.1 s, respectively. The optical sensor appears to be a promising approach to optimize injection protocols and contrast enhancement timing and is applicable to all modalities without implying any additional radiation dose. Clinical tests are still necessary. (note)

Utility of gadolinium as a contrast medium in endovascular therapeutic procedures; Utilidad del gadolinio como medio de contraste en procedimientos terapeuticos endovasculares

Energy Technology Data Exchange (ETDEWEB)

Reyes, R.; Pardo, M. D.; Gorriz, E.; Gallardo, L. (Hospital de Gran Canaria Dr. Negrin); Carreira, J. M. (Universidad de Santiago de Compostela)

2001-07-01

To assess the utility of gadolinium associated with CO{sub 2}, as a contrast medium in angiographic studies related to endovascular therapeutic procedures in patients with suboptimal renal function. Between January 2000 and June 2001, endovascular treatments using CO{sub 2} and gadolinium as contrast medium were performed in 10 patients presenting renal function deterioration (creatinine>1.5 mg/ml). A mean dose of 42 ml of gadolinium was administered. The images acquired in diagnostic and therapeutic studied were satisfactory in every case. There was no evidence of significant increases in the previous urea and creatine levels when measured 24, 48 and 72 hours after the procedure. In combination with CO{sub 2} gadolinium is a useful contrast medium for endovascular therapeutic procedures in patients with suboptimal renal function. (Author) 21 refs.

Jet-induced medium excitation in heavy-ion collisions

Energy Technology Data Exchange (ETDEWEB)

Chen, Wei [Key Laboratory of Quark and Lepton Physics (MOE) and Institute of Particle Physics, Central China Normal University, Wuhan 430079 (China); Pang, Long-Gang [Frankfurt Institute for Advanced Studies, Ruth-Moufang-Strasse 1, 60438 Frankfurt am Main (Germany); Stoecker, Horst [Frankfurt Institute for Advanced Studies, Ruth-Moufang-Strasse 1, 60438 Frankfurt am Main (Germany); Gesellschaft für Schwehrionenforschung, Planckstr. 1, Darmstadt (Germany); Luo, Tan; Wang, Enke [Key Laboratory of Quark and Lepton Physics (MOE) and Institute of Particle Physics, Central China Normal University, Wuhan 430079 (China); Wang, Xin-Nian [Key Laboratory of Quark and Lepton Physics (MOE) and Institute of Particle Physics, Central China Normal University, Wuhan 430079 (China); Nuclear Science Division Mailstop 70R0319, Lawrence Berkeley National Laboratory, Berkeley, CA 94740 (United States)

2016-12-15

We use a Linear Boltzmann Transport (LBT) model coupled to the (3+1)D ideal hydrodynamic evolution in real time with fluctuating initial conditions to simulate both the transport of jet shower partons and jet-induced medium excitation. In this coupled approach, propagation of energetic shower partons are treated in the LBT model with the 3+1D hydrodynamic model providing the evolving bulk medium. Soft partons from both elastic and inelastic processes in the LBT are fed back into the medium as a source term in the 3+1D hydrodynamics leading to induced medium excitation. We study the effect of jet-induced medium excitation via γ-hadron correlation within this coupled LBT-hydro (CoLBT-hydro) approach.

Reduction of proteinuria in adriamycin-induced nephropathy is associated with reduction of renal kidney injury molecule (Kim-1) over time

NARCIS (Netherlands)

Kramer, Andrea B.; van Timmeren, Mirjan M.; Schuurs, Theo A.; Vaidya, Vishal S.; Bonventre, Joseph V.; van Goor, Harry; Navis, Gerjan

Kramer AB, van Timmeren MM, Schuurs TA, Vaidya VS, Bonventre JV, van Goor H, Navis G. Reduction of proteinuria in adriamycin-induced nephropathy is associated with reduction of renal kidney injury molecule (Kim-1) over time. Am J Physiol Renal Physiol 296: F1136-F1145, 2009. First published February

Safe use of iodinated and gadolinium-based contrast media in current practice in Japan: a questionnaire survey.

Science.gov (United States)

Tsushima, Yoshito; Ishiguchi, Tsuneo; Murakami, Takamichi; Hayashi, Hiromitsu; Hayakawa, Katsumi; Fukuda, Kunihiko; Korogi, Yukunori; Sugimoto, Hideharu; Takehara, Yasuo; Narumi, Yoshifumi; Arai, Yasuaki; Kuwatsuru, Ryohei; Yoshimitsu, Kengo; Awai, Kazuo; Kanematsu, Masayuki; Takagi, Ryo

2016-02-01

To help establish consensus on the safe use of contrast media in Japan. Questionnaires were sent to accredited teaching hospitals with radiology residency programs. The reply rate was 45.4% (329/724). For contrast-induced nephropathy (CIN), chronic and acute kidney diseases were considered a risk factor in 96.7 and 93.6%, respectively, and dehydration in 73.9%. As preventive actions, intravenous hydration (89.1%) and reduction of iodinated contrast media dose (86.9%) were commonly performed. For nephrogenic systemic fibrosis (NSF), chronic and acute kidney diseases were considered risk factors in 98.5 and 90.6%, respectively, but use of unstable gadolinium-based contrast media was considered a risk factor in only 55.6%. A renal function test was always (63.5% in iodinated; 65.7% in gadolinium) or almost always (23.1; 19.8%) performed, and estimated glomerular filtration rate (eGFR) was the parameter most frequently used (80.8; 82.6%). For the patients with risk factors for acute adverse reaction (AAR), steroid premedication or/and change of contrast medium were frequent preventive actions, but intravenous steroid administration immediately before contrast media use was still performed. Our questionnaire survey revealed that preventive actions against CIN were properly performed based on patients' eGFR. Preventive actions against NSF and AAR still lacked consensus.

Extravasation of contrast medium into the gastrointestinal tract following lymphangiography

International Nuclear Information System (INIS)

Mihara, K.; Koga, K.; Tsurudome, H.; Nakano, T.; Hoshi, H.; Yamada, H.; Kawahira, K.; Inakura, M.; Watanabe, K.; Haraguchi, Y.

1981-01-01

Two cases with roentgenologic findings of extravasation of contrast medium into the stomach and colon following lymphangiography are presented. One is clinically diagnosed as primary intestinal lymphangiectasia; the other as retroperitoneal spread from uterine cancer. The significance of lymphangiography in gastrointestinal or retroperitoneal disorders is discussed. (orig.)

Extravasation of contrast medium into the gastrointestinal tract following lymphangiography

Energy Technology Data Exchange (ETDEWEB)

Mihara, K.; Koga, K.; Tsurudome, H.; Nakano, T.; Hoshi, H.; Yamada, H.; Kawahira, K.; Inakura, M.; Watanabe, K.; Haraguchi, Y.

1981-07-15

Two cases with roentgenologic findings of extravasation of contrast medium into the stomach and colon following lymphangiography are presented. One is clinically diagnosed as primary intestinal lymphangiectasia; the other as retroperitoneal spread from uterine cancer. The significance of lymphangiography in gastrointestinal or retroperitoneal disorders is discussed.

Dialysis and contrast media

International Nuclear Information System (INIS)

Morcos, Sameh K.; Thomsen, Henrik S.; Webb, Judith A.W.

2002-01-01

In a previous survey we revealed uncertainty among responders about (a) whether or not to perform hemodialysis in patients with severely reduced renal function who had received contrast medium; and (b) when to perform hemodialysis in patients on regular treatment with hemodialysis or continuous ambulatory dialysis who received contrast medium. Therefore, the Contrast Media Safety Committee of The European Society of Urogenital Radiology decided to review the literature and to issue guidelines. The committee performed a Medline search. Based on this, a report and guidelines were prepared. The report was discussed at the Ninth European Symposium on Urogenital Radiology in Genoa, Italy. Hemodialysis and peritoneal dialysis safely remove both iodinated and gadolinium-based contrast media. The effectiveness of hemodialysis depends on many factors including blood and dialysate flow rate, permeability of dialysis membrane, duration of hemodialysis and molecular size, protein binding, hydrophilicity, and electrical charge of the contrast medium. Generally, several hemodialysis sessions are needed to removal all contrast medium, whereas it takes 3 weeks for continuous ambulatory dialysis to remove the agent completely. There is no need to schedule the dialysis in relation to the injection of iodinated or MR contrast media or the injection of contrast agent in relation to the dialysis program. Hemodialysis does not protect poorly functioning kidneys against contrast-medium-induced nephrotoxicity. Simple guidelines are given. (orig.)

Catheter-Malposition-Induced Cardiac Tamponade via Contrast Media Leakage During Computed Tomography Study

International Nuclear Information System (INIS)

Liang, C.-D.; Ko, S.-F.; Huang, C.-F.; Chien, S.J.; Tiao, M.M.

2005-01-01

We present a rare case of a central venous catheter-malposition-induced life-threatening cardiac tamponade as a result of computed tomography (CT) with contrast enhancement in an infant with a ventricular septal defect and pulmonary atresia after a modified Blalock-Taussig shunt. The diagnosis was confirmed by chest radiographs and CT study with catheter perforation through the right atrial wall and extravasation of the contrast medium into the pericardium, leading to cardiac tamponade and subsequent circulatory collapse. Two hours after successful cardiopulmonary resuscitation, the patient gradually resumed normal hemodynamic status

Magnetic resonance tomography of the orbit: First experiences with the paramagnetic contrast medium gadolinium-DTPA

International Nuclear Information System (INIS)

Markl, A.; Vogl, T.; Scheidhauer, K.; Riedel, K.G.; Oeckler, R.

1986-01-01

In 21 patients with orbital mass lesions MRI was performed before and after administration of paramagnetic contrast medium, gadolinium-DPTA. In comparison to the plain scan the differentiation of the tumorous tissue against the surrounding structures was improved after application of contrast medium despite a partially moderate increase in signal intensity. Especially highly vascular tumors and vessel diseases show a significant contrast enhancement. With increasing experience in larger number of patients a tissue differentiation seems to be possible. (orig.) [de

Impact of iso-osmolar versus low-osmolar contrast agents on contrast-induced nephropathy and tissue reperfusion in unselected patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (from the Contrast Media and Nephrotoxicity Following Primary Angioplasty for Acute Myocardial Infarction [CONTRAST-AMI] Trial).

Science.gov (United States)

Bolognese, Leonardo; Falsini, Giovanni; Schwenke, Carsten; Grotti, Simone; Limbruno, Ugo; Liistro, Francesco; Carrera, Arcangelo; Angioli, Paolo; Picchi, Andrea; Ducci, Kenneth; Pierli, Carlo

2012-01-01

Conflicting data have been reported on the effects of low-osmolar and iso-osmolar contrast media on contrast-induced acute kidney injury (CI-AKI). In particular, no clinical trial has yet focused on the effect of contemporary contrast media on CI-AKI, epicardial flow, and microcirculatory function in patients with ST-segment elevation acute myocardial infarction who undergo primary percutaneous coronary intervention. The Contrast Media and Nephrotoxicity Following Coronary Revascularization by Angioplasty for Acute Myocardial Infarction (CONTRAST-AMI) trial is a prospective, randomized, single-blind, parallel-group, noninferiority study aiming to evaluate the effects of the low-osmolar contrast medium iopromide compared to the iso-osmolar agent iodixanol on CI-AKI and tissue-level perfusion in patients with ST-segment elevation acute myocardial infarction. Four hundred seventy-five consecutive, unselected patients who underwent primary percutaneous coronary intervention were randomized to iopromide (n = 239) or iodixanol (n = 236). All patients received high-dose N-acetylcysteine and hydration. The primary end point was the proportion of patients with serum creatinine (sCr) increases ≥25% from baseline to 72 hours. Secondary end points were Thrombolysis In Myocardial Infarction (TIMI) myocardial perfusion grade, increase in sCr ≥50%, increase in sCr ≥0.5 or ≥1 mg/dl, and 1-month major adverse cardiac events. The primary end point occurred in 10% of the iopromide group and in 13% of the iodixanol group (95% confidence interval -9% to 3%, p for noninferiority = 0.0002). A TIMI myocardial perfusion grade of 0 or 1 was present in 14% of patients in the 2 groups. No differences between the 2 groups were found in any of the secondary analyses of sCr increase. No significant difference in 1-month major adverse cardiac events was found (8% vs 6%, p = 0.37). In conclusion, in a population of unselected patients with ST-segment elevation acute myocardial infarction

Contrast medium enhancement of soft tissues and brain in CT examinations of dogs

International Nuclear Information System (INIS)

Pavlicek, M.

2000-11-01

CT is an x-ray based method which shows less contrast for soft tissue as has been known from radiography. Therefore, it is necessary to use intravenously administered iodine contrast media to detect and localize tumors, fistulas or other pathologic lesions. Usually contrast medium is administered manually which yields random patterns of media distribution due to varying application pressure during varying administration time, therefore enhancement of parenchymous organs could not be used to the optimum extent. The use of an automatic injection pump guarantees the necessary constancy during the examination procedure to undoubtedly detect pathologic enhancement of organs in the CT-image as known from human medicine. The standards which are expected of the injection pump and the contrast media are: a good contrast enhancement, a good accumulation in the examined organs, an accumulation, which lasts long enough during the diagnostic phase, and a rapid excretion without side effects. Because of the short scan time of the modern CT-scanner, the best contrast enhancement can be administered by a short bolus injection, which can be applied by the automatic injection pump with a defined flow and a defined quantity of contrast media. This guarantees a good enhancement in the chosen region for the duration of the scan. The main aim of this study is to find a standardized flow and quantity of contrast media for defined regions and organs considering the speed of the scanner. In a subsequent step, the existing scan-protocols are then updated using the newly found information. This study showed, that CT examination of the head and brain in middle-sized dogs can be administered with a flow of 0.5 ml/s and a dose of 2 ml of contrast medium per kg weight. The contrast enhancement of the brain is caused by the enhancement of the vessels, the parenchym is free of contrast media - brain shows a low increase of density. Only if the blood-brain-barrier is destroyed, it is possible that

Contrast medium enhancement of soft tissues and brain in CT examinations of dogs

International Nuclear Information System (INIS)

Pavlicek, M.

2000-11-01

CT is a x-ray based method which shows less contrast for soft tissue as has been known from radiography. Therefore, it is necessary to use intravenously administered iodine contrast media to detect and localize tumors, fistulas or other pathologic lesions. Usually contrast medium is administered manually which yields random patterns of media distribution due to varying application pressure during varying administration time, therefore enhancement of parenchymous organs could not be used to the optimum extent. The use of an automatic injection pump guarantees the necessary constancy during the examination procedure to undoubtedly detect pathologic enhancement of organs in the CT-image as known from human medicine. The standards which are expected of the injection pump and the contrast media are: a good contrast enhancement, a good accumulation in the examined organs, an accumulation, which lasts long enough during the diagnostic phase, and a rapid excretion without side effects. Because of the short scan time of the modern CT-scanner, the best contrast enhancement can be administered by a short bolus injection, which can be applied by the automatic injection pump with a defined flow and a defined quantity of contrast media. This guarantees a good enhancement in the chosen region for the duration of the scan. The main aim of this study is to find a standardized flow and quantity of contrast media for defined regions and organs considering the speed of the scanner. In a subsequent step, the existing scan-protocols are then updated using the newly found information. This study showed, that CT examination of the head and brain in middle-sized dogs can be administered with a flow of 0.5 ml/s and a dose of 2 ml of contrast medium per kg weight. The contrast enhancement of the brain is caused by the enhancement of the vessels, the parenchym is free of contrast media - brain shows a low increase of density. Only if the blood-brain-barrier is destroyed, it is possible that

Radiologic diagnosis of gastro-oesophageal reflux. Comparison of barium and low-density contrast medium

Energy Technology Data Exchange (ETDEWEB)

Fransson, S.G.; Soekjer, H.; Johansson, K.E.; Tibbling, L.

It has been proposed that the high density of ordinary barium suspension may complicate the radiologic diagnosis of gastro-oesophageal reflux. For this reason P-contrast was developed (Ferring AB); a contrast medium with the same density as water (1 g/cm/sup 3/). A comparison of P-contrast and barium (Mixobar Ventrikel 400 mg/ml) was performed in 82 patients. All patients were examined with both contrast media and the findings were compared with those at reflux test at manometry, endoscopy and 24-hour pH monitoring. Another 40 patients and 15 symptom-free controls were examined with two different amounts of barium, 100 ml and 200 ml, to study if the radiologic diagnosis of reflux varied with the volume of contrast medium administered. P-contrast was found to have no advantages over barium for the diagnosis of gastro-oesophageal reflux. The outcome of the radiologic examination was not influenced by the different volumes of barium used.

Genetics of diabetic nephropathy

DEFF Research Database (Denmark)

Parving, H H; Tarnow, L; Rossing, P

1996-01-01

factor for cardiovascular disease in diabetic patients. However, a meta-analysis does not support the suggestion that this factor plays any role for the initiation of diabetic nephropathy. Similar negative results have been obtained in relation to polymorphisms of the genes encoding for angiotensinogen......Diabetic nephropathy is a clinical syndrome characterized by persistent albuminuria, a relentless decline in GFR, raised arterial blood pressure, and increased relative mortality for cardiovascular diseases. Diabetic nephropathy is a leading cause of end-stage renal failure. The pathogenesis...... of diabetic nephropathy is multifactorial, with contributions from metabolic abnormalities, hemodynamic alterations, and various growth factors and genetic factors. Epidemiologic and family studies have demonstrated that only a subset of the patients develop this complication that family clustering...

The Preinterventional Cystatin-Creatinine-Ratio: A Prognostic Marker for Contrast Medium-Induced Acute Kidney Injury and Long-Term All-Cause Mortality.

Science.gov (United States)

Lüders, Florian; Meyborg, Matthias; Malyar, Nasser; Reinecke, Holger

2015-01-01

Contrast medium-induced acute kidney injury (CI-AKI) is an important iatrogenic complication following the injection of iodinated contrast media. The level of serum creatinine (SCr) is the currently accepted 'gold standard' to diagnose CI-AKI. Cystatin C (CyC) has been detected as a more sensitive marker for renal dysfunction. Both have their limitations. The role of the preinterventional CyC-SCr ratio for evaluating the risk for CI-AKI and long-term all-cause mortality was retrospectively analyzed in the prospective single-center 'Dialysis-versus-Diuresis trial'. CI-AKI was defined and staged according to the Acute Kidney Injury Network classification. Three hundred and seventy-three patients were included (average age 67.4 ± 10.2 years, 16.4% women, 29.2% with diabetes mellitus, mean baseline glomerular filtration rate 56.3 ± 20.2 ml/min/1.73 m(2) [as estimated by Chronic Kidney Disease Epidemiology Collaboration Serum Creatinine Cystatin C equation], 5.1% ejection fraction high significant association between preinterventional CyC-SCr ratio and long-term all-cause mortality (mean follow-up 649 days, hazards ratio 4.096, 95% CI 1.625-10.329, p = 0.003). The preinterventional CyC-SCr ratio is independently associated with CI-AKI and highly significant associated with long-term mortality after heart catheterization. © 2015 S. Karger AG, Basel.

Softened food reduces weight loss in the streptozotocin-induced male mouse model of diabetic nephropathy

DEFF Research Database (Denmark)

Nørgaard, Sisse A; Sand, Fredrik W; Sørensen, Dorte B

2018-01-01

The streptozotocin (STZ)-induced diabetic mouse is a widely used model of diabetes and diabetic nephropathy (DN). However, it is a well-known issue that this model is challenged by high weight loss, which despite supportive measures often results in high euthanization rates. To overcome...... these issues, we hypothesized that supplementing STZ-induced diabetic mice with water-softened chow in addition to normal chow would reduce weight loss, lower the need for supportive treatment, and reduce the number of mice reaching the humane endpoint of 20% weight loss. In a 15 week STZ-induced DN study we...... demonstrated that diabetic male mice receiving softened chow had reduced acute weight loss following STZ treatment ( p = 0.045) and additionally fewer mice were euthanized due to weight loss. By supplementing the diabetic mice with softened chow, no mice reached 20% weight loss whereas 37.5% of the mice...

Mitochondrial Reactive Oxygen Species and Kidney Hypoxia in the Development of Diabetic Nephropathy.

Science.gov (United States)

Schiffer, Tomas A; Friederich-Persson, Malou

2017-01-01

The underlying mechanisms in the development of diabetic nephropathy are currently unclear and likely consist of a series of dynamic events from the early to late stages of the disease. Diabetic nephropathy is currently without curative treatments and it is acknowledged that even the earliest clinical manifestation of nephropathy is preceded by an established morphological renal injury that is in turn preceded by functional and metabolic alterations. An early manifestation of the diabetic kidney is the development of kidney hypoxia that has been acknowledged as a common pathway to nephropathy. There have been reports of altered mitochondrial function in the diabetic kidney such as altered mitophagy, mitochondrial dynamics, uncoupling, and cellular signaling through hypoxia inducible factors and AMP-kinase. These factors are also likely to be intertwined in a complex manner. In this review, we discuss how these pathways are connected to mitochondrial production of reactive oxygen species (ROS) and how they may relate to the development of kidney hypoxia in diabetic nephropathy. From available literature, it is evident that early correction and/or prevention of mitochondrial dysfunction may be pivotal in the prevention and treatment of diabetic nephropathy.

Gadolinium-DTPA (Magnevist) as a contrast medium for arterial DSA

International Nuclear Information System (INIS)

Schild, H.H.; Weber, W.; Boeck, E.; Mildenberger, P.; Strunk, H.; Dueber, C.; Grebe, P.; Schadmand-Fischer, S.; Thelen, M.

1994-01-01

16 DSA investigations using intra-arterial Gd-DTPA were performed on 12 patients. The contrast medium was administered either as a 0.5 molar gadolinium solution (commercially available) or diluted with distilled water to a 0.2 -0.4 molar gadolinium solution. The injection was made either by pressure injector or by hand. The aortic arch, abdominal aorta and pelvic and lower limb arteries were examined. 14 of the 16 procedures were diagnostically adequate, but compared with iodinated contrast materials, contrast was less marked. There were no cardiovascular, neurological or allergic side effects. Three patients suffered a feeling of heat and one patient had mild pain during the injection. Even large volumes rapidly injected (up to 20 ml/s of the commercially available solution) were well tolerated. DSA with intra-arterial Gd-DTPA seems to be a suitable alternative for vascular imaging if iodine-containing contrast materials are contraindicated. (orig.) [de

Contrast Enhanced US in the Abdomen

International Nuclear Information System (INIS)

Chung, Yong Eun; Kim, Ki Whang

2012-01-01

Contrast enhanced ultrasound, which was introduced in 1996, has been widely used in Europe and Eastern Asia. Ultrasound contrast agent can be classified as first generation and second generation, depending on the gas within the microbubble. With the first generation contrast agent, the high MI technique was used, and only intermittent scanning was possible due to destruction of the microbubble during scanning. Use of the second generation contrast agent with the low MI technique makes continuous scanning possible. Contrast enhanced US can be used in detection and differentiation of focal liver lesions. It is also helpful for monitoring of radiofrequency ablation and for targeting of US guided biopsy. Currently, because morphologic criteria alone may not reflect the response of the tumor to treatment, new criteria are needed for treatment evaluation after administration of anti-angiogenic agents. Contrast enhanced US could provide quantitative markers for evaluation of the response to treatment via use of dynamic contrast enhanced US. Due to cost-effectiveness, contrast enhanced US is not yet widely used in Korea; however, considering recent issues regarding contrast agent related adverse reaction, such as contrast induced nephropathy and nephrogenic systemic fibrosis, and radiation exposure, contrast enhanced US might be more widely used in Korea, as an alternative imaging modality in the future.

Evaluation of reflux nephropathy, pyelonephritis and renal dysplasia

Energy Technology Data Exchange (ETDEWEB)

Grattan-Smith, J.D. [Emory University School of Medicine, Children' s Healthcare of Atlanta, Department of Radiology, Atlanta, GA (United States); Children' s Healthcare of Atlanta, Department of Radiology, Atlanta, GA (United States); Little, Stephen B. [Children' s Healthcare of Atlanta, Department of Radiology, Atlanta, GA (United States); Jones, Richard A. [Emory University School of Medicine, Children' s Healthcare of Atlanta, Department of Radiology, Atlanta, GA (United States)

2008-01-15

MR urography has the potential to significantly improve our understanding of the relationship between reflux nephropathy, pyelonephritis, vesicoureteric reflux and renal dysplasia. MR urography utilizes multiple parameters to assess both renal anatomy and function and provides a more complete characterization of acquired and congenital disease. Pyelonephritis and renal scarring can be distinguished by assessing the parenchymal contours and signal intensity. Characteristic imaging features of renal dysplasia include small size, subcortical cysts, disorganized architecture, decreased and patchy contrast enhancement as well as a dysmorphic pelvicalyceal system. Because of its ability to subdivide and categorize this heterogeneous group of disorders, it seems inevitable that MR urography will replace DMSA renal scintigraphy as the gold standard for assessment of pyelonephritis and renal scarring. MR urography will contribute to our understanding of renal dysplasia and its relationship to reflux nephropathy. (orig.)

Evaluation of reflux nephropathy, pyelonephritis and renal dysplasia

International Nuclear Information System (INIS)

Grattan-Smith, J.D.; Little, Stephen B.; Jones, Richard A.

2008-01-01

MR urography has the potential to significantly improve our understanding of the relationship between reflux nephropathy, pyelonephritis, vesicoureteric reflux and renal dysplasia. MR urography utilizes multiple parameters to assess both renal anatomy and function and provides a more complete characterization of acquired and congenital disease. Pyelonephritis and renal scarring can be distinguished by assessing the parenchymal contours and signal intensity. Characteristic imaging features of renal dysplasia include small size, subcortical cysts, disorganized architecture, decreased and patchy contrast enhancement as well as a dysmorphic pelvicalyceal system. Because of its ability to subdivide and categorize this heterogeneous group of disorders, it seems inevitable that MR urography will replace DMSA renal scintigraphy as the gold standard for assessment of pyelonephritis and renal scarring. MR urography will contribute to our understanding of renal dysplasia and its relationship to reflux nephropathy. (orig.)

Human pharmacokinetics of iohexol. A new nonionic contrast medium

International Nuclear Information System (INIS)

Olsson, B.; Aulie, A.; Sveen, K.; Andrew, E.

1983-01-01

The pharmacokinetics of iohexol, a new nonionic, water-soluble contrast medium, have been determined after intravenous injection in 20 healthy volunteers, at four different dose levels (125-500 mg I/kg). The apparent volume of distribution was 0.27 1/kg, indicating distribution in the extracellular water. The biologic half-life was 121 minutes, comparable with that of other intravascular contrast media. Iohexol was excreted completely unmetabolized in the urine, with a 100% recovery 24 hours after injection. A comparison of iohexol and chromium-51 ( 51 Cr)-EDTA clearances indicates that iohexol is mainly excreted by glomerular filtration. The 51 Cr-EDTA clearance was the same when injected separately and concomitantly with iohexol, indicating that glomerular filtration rate is not affected by iohexol. No dose dependency was observed in the investigated parameters t1/2 alpha, t1/2 beta, Vd, ClT or ClR. Iohexol pharmacokinetics are in correspondence with previously reported data on intravascular contrast media

Diabetic nephropathy : pathology, genetics and carnosine metabolism

NARCIS (Netherlands)

Mooyaart, Antien Leonora

2011-01-01

My thesis concerns different aspects of diabetic nephropathy. A pathologic classification of diabetic nephropathy is developed, a meta-analyis of genes in diabetic nephropathy is developed and the other chapters are about the CNDP1 gene in relation to kidney disease, mainly diabetic nephropathy.

Diagnostic capabilities of the contrast medium verografin in liposomes (animal experiments)

International Nuclear Information System (INIS)

Rozenberg, O.A.; Khason, K.P.; Aliyakparov, M.T.; Davidenkova, E.F.; Zherbin, E.A.; Akademiya Meditsinskikh Nauk SSSR, Leningrad. Inst. Ehksperimental'noj Meditsiny)

1985-01-01

Some examples for the diagnosis of various diseases of liver and spleen after intravenous (cats, dogs) or intraportal (rodents) injection of lecithin-cholesterol liposomes containing the water soluble contrast medium verografin are described. Tumors of 1 mm were found in the spleen of mice with lymphogranulomatosis, hepatomas of 3-5 mm in rats and lesions of 10 mm in cats with turpentine abscesses. The application of liposomes containing radiographic contrast media offers good possibilities for the diagnosis of liver and spleen. (author)

Zinc supplementation alleviates the progression of diabetic nephropathy by inhibiting the overexpression of oxidative-stress-mediated molecular markers in streptozotocin-induced experimental rats.

Science.gov (United States)

Barman, Susmita; Pradeep, Seetur R; Srinivasan, Krishnapura

2018-04-01

Zinc deficiency during diabetes projects a role for zinc nutrition in the management of diabetic nephropathy. The current study explored whether zinc supplementation protects against diabetic nephropathy through modulation of kidney oxidative stress and stress-induced expression related to the inflammatory process in streptozotocin-induced diabetic rats. Groups of hyperglycemic rats were exposed to dietary interventions for 6 weeks with zinc supplementation (5 times and 10 times the normal level). Supplemental-zinc-fed diabetic groups showed a significant reversal of increased kidney weight and creatinine clearance. There was a significant reduction in hyperlipidemic condition along with improved PUFA:SFA ratio in the renal tissue. Expression of the lipid oxidative marker and expression of inflammatory markers, cytokines, fibrosis factors and apoptotic regulatory proteins observed in diabetic kidney were beneficially modulated by zinc supplementation, the ameliorative effect being concomitant with elevated antiapoptosis. There was a significant reduction in advanced glycation, expression of the receptor of the glycated products and oxidative stress markers. Zinc supplementation countered the higher activity and expression of polyol pathway enzymes in the kidney. Overexpression of the glucose transporters, as an adaptation to the increased need for glucose transport in diabetic condition, was minimized by zinc treatment. The pathological abnormalities in the renal architecture of diabetic animals were corrected by zinc intervention. Thus, dietary zinc supplementation has a significant beneficial effect in the control of diabetic nephropathy. This was exerted through a protective influence on oxidative-stress-induced cytokines, inflammatory proliferation and consequent renal injury. Copyright © 2017 Elsevier Inc. All rights reserved.

Computed tomography of the cervical spine with iv injection of contrast medium

International Nuclear Information System (INIS)

Magnaldi, S.; Pozzi-Mucelli, R.S.; Cova, M.A.; De Morpurgo, P.

1989-01-01

Computed Tomography (CT) without contrast medium is largely applied to the study of intervertebral disk pathology in the lumbar spine, but has not been widely accepted in cervical spine, due to technical and anatomical limitations. For these reasons many neuroradiologists still prefer myelography or myelo-CT. CT may yield better results if combined with iv contrast medium injection, which allows a better visualization of disk herniation. This technique is aimed at enhancing the density of the venous plexus which is located close to the intervertebral disk the vertebral bodies and the neural foramina. A better contrast enhancement is thus obtained between the disk and the spinal cord. The authors' experience is based on 61 patients who underwent contrast enhanced CT; in 22 cases myelography and myelo-CT were also performed. The authors describe their technique and the most frequent CT findings of disk hernation: the typical finding includes a focal hypodensity surrounded by a linear blush, due to a posteriorly dislocated epidural vein. The posterior linear blush alone may be present in few cases. Contrast enhanced CT is very useful in the study of disk pathology of the cervical spine, even when compared with myelography and myelo-CT, due the increase in the density of epidural plexus it allows. However, the technique must be very accurate if the same results as those of myelo-CT are to be obtained

Early detection and intervention using neutrophil gelatinase-associated lipocalin (NGAL) may improve renal outcome of acute contrast media induced nephropathy: a randomized controlled trial in patients undergoing intra-arterial angiography (ANTI-CIN Study).

Science.gov (United States)

Schilcher, Gernot; Ribitsch, Werner; Otto, Ronald; Portugaller, Rupert H; Quehenberger, Franz; Truschnig-Wilders, Martini; Zweiker, Robert; Stiegler, Philipp; Brodmann, Marianne; Weinhandl, Klemens; Horina, Joerg H

2011-08-17

Patients with pre-existing impaired renal function are prone to develop acute contrast media induced nephropathy (CIN). Neutrophil gelatinase-associated lipocalin (NGAL), a new biomarker predictive for acute kidney injury (AKI), has been shown to be useful for earlier diagnosis of CIN; however, urinary NGAL values may be markedly increased in chronic renal failure at baseline. Results from those studies suggested that urinary NGAL values may not be helpful for the clinician. An intravenous volume load is a widely accepted prophylactic measure and possibly a reasonable intervention to prevent deterioration of renal function. The aim of our study is to evaluate NGAL as an early predictor of CIN and to investigate the clinical benefit of early post-procedural i.v. hydration. The study will follow a prospective, open-label, randomized controlled design. Patients requiring intra-arterial contrast media (CM) application will be included and receive standardized, weight-based, intravenous hydration before investigation. Subjects with markedly increased urinary NGAL values after CM application will be randomized into one of two study groups. Group A will receive 3-4 ml/kg BW/h 0.9% saline intravenously for 6 hours. Group B will undergo only standard treatment consisting of unrestricted oral fluid intake. The primary outcome measure will be CIN defined by an increase greater than 25% of baseline serum creatinine. Secondary outcomes will include urinary NGAL values, cystatin C values, contrast media associated changes in cardiac parameters such as NT-pro-BNP/troponin T, changes in urinary cytology, need for renal replacement treatment, length of stay in hospital and death.We assume that 20% of the included patients will show a definite rise in urinary NGAL. Prospective statistical power calculations indicate that the study will have 80% statistical power to detect a clinically significant decrease of CIN of 40% in the treatment arm if 1200 patients are recruited into the

The association between use of metformin and change in serum CO_2 level after administration of contrast medium

International Nuclear Information System (INIS)

Kim, S.K.; Jung, J.; Jung, J.H.; Kim, K.Y.; Baek, J.-H.; Hahm, J.R.

2016-01-01

Aim: To evaluate the changes in serum creatinine and total CO_2 levels in patients receiving metformin during administration of contrast medium. Materials and methods: Patient records from January 2012 to December 2012 after the administration of contrast medium were reviewed retrospectively. A total of 924 patients were included for the final analysis. Of them, 105 received metformin during contrast medium administration, 112 were taking other oral hypoglycaemic agents, and 707 patients were not diabetic (controls). Results: No significant change in total CO_2 levels was detected (p=0.678). Metabolic acidosis was present in 33 (31.4%) metformin users, 31 (28.6%) other oral hypoglycaemic agent users, and 153 (21.6%) control patients. In the present logistic regression analysis, age, baseline levels of creatinine, and total CO_2 levels were associated with metabolic acidosis after contrast medium exposure. Conclusion: These data indicate the presence of a coexisting risk factor, other than metformin use, associated with metabolic acidosis after contrast medium exposure. No relationship was found between the use of metformin and metabolic acidosis during contrast medium exposure. - Highlights: • The use of metformin was not associated with metabolic acidosis after contrast exposure. • The coexisting risk factors for metabolic acidosis were present in patient with metabolic acidosis after contrast exposure. • There is a need to consider the maintenance of metformin during a CT scan in patients with a low risk for lactic acidosis.

Small Molecule Inhibiting Nuclear Factor-kB Ameliorates Oxidative Stress and Suppresses Renal Inflammation in Early Stage of Alloxan-Induced Diabetic Nephropathy in Rat.

Science.gov (United States)

Borgohain, Manash P; Lahkar, Mangala; Ahmed, Sahabuddin; Chowdhury, Liakat; Kumar, Saurabh; Pant, Rajat; Choubey, Abhinav

2017-05-01

Diabetic nephropathy is one of the major microvascular complications of diabetes mellitus which ultimately gives rise to cardiovascular diseases. Prolonged hyperglycaemia and chronic renal inflammation are the two key players in the development and progression of diabetic nephropathy. Nuclear factor kB (NF-kB)-mediated inflammatory cascade is a strong contributor to the renovascular inflammation in diabetic nephropathy. Here, we studied the effects of piceatannol, a potent NF-kB inhibitor, on various oxidative stress markers and NF-kB dependent diabetic renoinflammatory cascades in rat induced by alloxan (ALX). Experimental diabetes was induced in male Wistar rats by a single intraperitoneal dose, 150 mg/kg body-weight (b.w.) of ALX. Diabetic rats were treated with Piceatannol (PCTNL) at a dose of 30 and 50 mg/kg b.w. After 14 days of oral treatment, PCTNL significantly restored blood sugar level, glomerular filtration rate, serum markers and plasma lipids. PCTNL administration also reversed the declined activity of cellular antioxidant machineries namely superoxide dismutase and glutathione and the elevated levels of malondialdehyde and nitric oxide. Moreover, piceatannol-treated groups showed marked inhibition of renal pro-inflammatory cytokines and NF-kB p65/p50 binding to DNA. Renal histopathological investigations also supported its ameliorative effects against diabetic kidney damage. Importantly, effects were more prominent at a dose of 50 mg/kg, and in terms of body-weight gain, PCTNL failed to effect significantly. However, overall findings clearly demonstrated that PCTNL provides remarkable renoprotection in diabetes by abrogating oxidative stress and NF-kB activation - and might be helpful in early stage of diabetic nephropathy. © 2016 Nordic Association for the Publication of BCPT (former Nordic Pharmacological Society).

Contrast Media-Induced Renal Inflammation Is Mediated Through HMGB1 and Its Receptors in Human Tubular Cells.

Science.gov (United States)

Guan, Xiao-Feng; Chen, Qing-Jie; Zuo, Xiao-Cong; Guo, Ren; Peng, Xiang-Dong; Wang, Jiang-Lin; Yin, Wen-Jun; Li, Dai-Yang

2017-01-01

With the rapid development of imaging diagnosis and interventional therapy, contrast media (CM) are widely used in clinics. However, contrast-induced nephropathy (CIN) is the third leading cause of hospital-acquired acute renal failure accounting for 10-12% of all causes of hospital-acquired renal failure. Recent study found that inflammation may participate in the pathogenesis of CIN, but the role of it remains unclear. HK-2 cells were treated with Iohexol, Urografin, and mannitol. Two types of CM increased the release of HMGB1 in cell supernatant accompanied by increased expression of TLR2 and CXCR4. Iohexol and Urografin also caused a significant increase in NF-κB followed by the release of IL-6 and MCP-1. To clarify the role of HMGB1, TLR2, and CXCR4, glycyrrhizin, anti-TLR2-IgG, and AMD3100 were used to inhibit HMGB1, TLR2, and CXCR4, respectively. Significant decrease in the expression of TLR2, CXCR4, nuclear NF-κB, and the release of IL-6 and MCP-1 were observed. These results indicate that TLR2 and CXCR4 signaling are involved in CM-induced HK-2 cell injury model in an HMGB1-dependent pathway, which may provide a new target for the prevention and the treatment of CIN.

Clinical experience with a commercially available negative oral contrast medium in PET/CT

International Nuclear Information System (INIS)

Hausegger, K.; Reinprecht, P.; Kau, T.; Igerc, I.; Lind, P.

2005-01-01

Purpose: to evaluate a commercially available negative oral contrast material for PET/CT. Material and methods: in a prospective series of 49 patients, Mukofalk registered , which is a vegetarian-based substance, was used as a negative oral contrast medium in whole body PET/CT studies. Mukofalk was administered during a time period of 1.5 hours before the examination. Quality of small bowl distension and eventual pathological tracer uptake in the intestine were evaluated. Results: distension of the small bowel was excellent or good in 41 (85%) and poor in 8 (15%) patients. Mild tracer uptake in the small bowel was observed in 5 patients (10.2%) and moderate uptake in another 2 patients (4%). In none of these patients did the F-18 FDG uptake interfere with image interpretation. Conclusion: Mukofalk registered can be used as a negative oral contrast medium in PET/CT studies. (orig.)

Clinical experience with a commercially available negative oral contrast medium in PET/CT

Energy Technology Data Exchange (ETDEWEB)

Hausegger, K.; Reinprecht, P. [Roentgendiagnostisches Zentralinstitut, LKH Klagenfurt (Austria); Kau, T. [Roentgendiagnostisches Zentral Inst., Klagenfurt (Austria); Igerc, I.; Lind, P. [Abt. fuer Nuklearmedizin und Spezielle Endokrinologie, LKH Klagenfurt (Austria)

2005-06-01

Purpose: to evaluate a commercially available negative oral contrast material for PET/CT. Material and methods: in a prospective series of 49 patients, Mukofalk {sup registered}, which is a vegetarian-based substance, was used as a negative oral contrast medium in whole body PET/CT studies. Mukofalk was administered during a time period of 1.5 hours before the examination. Quality of small bowl distension and eventual pathological tracer uptake in the intestine were evaluated. Results: distension of the small bowel was excellent or good in 41 (85%) and poor in 8 (15%) patients. Mild tracer uptake in the small bowel was observed in 5 patients (10.2%) and moderate uptake in another 2 patients (4%). In none of these patients did the F-18 FDG uptake interfere with image interpretation. Conclusion: Mukofalk {sup registered} can be used as a negative oral contrast medium in PET/CT studies. (orig.)

Water as a contrast medium: a re-evaluation using the multidetector-row computed tomography.

Science.gov (United States)

Makarawo, Tafadzwa P; Negussie, Edsa; Malde, Sachit; Tilak, Jacqueline; Gayagoy, Jennifer; Watson, Jenna; Francis, Faiz; Lincoln, Denis; Jacobs, Michael J

2013-07-01

Water as an intraluminal negative contrast medium produces improved image quality with reduced artefact. However, rapid absorption of oral water in the bowel relative to speed and timing of image capturing has limited its clinical application. These findings predate advances in multidetector-row computed tomography (CT). To re-evaluate differences in image quality, we studied image clarity and luminal distention between the same group of patients who received both a pancreas protocol CT (PPCT) that uses oral water and a conventional positive oral contrast scan. We reviewed 66 patients who had previously undergone both a PPCT and an oral contrast abdominal CT. CT images were independently reviewed by two board-certified radiologists who scored degree of hollow viscus distention and visualization of mural detail using a Likert 5-point scale. Results were evaluated by using the Wilcoxon-signed rank test. Student's t test was applied to evaluate the differences in radiation dosage and Spearman's correlational test was used to evaluate interrater correlation between the radiologists. In comparing the mean radiation dosage, there was no statistical difference between the two protocols, and there was good interrater association with ratios of 0.595 and 0.51 achieved for the PPCT and conventional oral scan, respectively. The Wilcoxon signed-rank test showed statistical differences in the stomach (P contrast medium causing better or equal distention in the bowel and better or equal clarity than routine barium contrast. This calls for a need to reconsider the use of water as a contrast medium in clinical practice.

GENETICS ASPECTS OF DIABETIC NEPHROPATHY

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Oana-Elena Sauca

2010-09-01

Full Text Available Diabetic nephropathy is a clinical syndrome characterized by persistent albuminuria, a relentless decline in GFR, raised arterial blood pressure, and increased relative mortality for cardiovascular diseases. The pathogenesis of diabetic nephropathy is multifactorial, with contributions from metabolic abnormalities, hemodynamic alteration, and various growth and genetic factors. The identification of the main genes would allow the detection of those individuals at high risk for diabetic nephropathy and better understanding of its pathophysiologyas well.The present review discusses the main information available in literature regarding some genetic variants (involved in the renin-angiotensin system, glucose and lipid metabolism and some cytoskeleton proteins that reaffirms the importance of genetic factors in diabetic nephropathy.

Role of hemolysis in potassium release by iodinated contrast medium

Energy Technology Data Exchange (ETDEWEB)

Hayakawa, K.; Nakamura, T.; Shimizu, Y. [Department of Radiology, Kyoto City Hospital (Japan)

1999-09-01

It has been demonstrated that an iodinated contrast medium (CM) causes release of potassium into blood vessel lumina, resulting in an increase in serum potassium. The purpose of the present study was to assess whether this potassium release is due to hemolysis. Fresh human blood was mixed in vitro with CM at a ratio of 10:2. Potassium release rates were determined, and serum haptoglobin and free hemoglobin were measured after 30 min of exposure to CM. To compare the potassium release curve between CM exposure and true hemolysis induced by distilled water, fresh human blood was also mixed with distilled water. The level of serum haptoglobin decreased due to hemodilution. Changes in haptoglobin were not correlated with potassium release rates. The serum free hemoglobin level did not increase significantly, and there was no correlation between changes in the free hemoglobin level and the rate of potassium release. Hemolysis caused by water occurred instantaneously, whereas potassium release caused by CM was a slow response, which was linearly correlated with exposure time. Potassium release from blood cannot be explained by hemolysis. (orig.) With 4 figs., 4 tabs., 3 refs.

Pure and diluted contrast medium in the evaluation of portal venous system with digital subtraction angiography

International Nuclear Information System (INIS)

Gattoni, F.; Baldini, V.; Pozzato, C.; Nessi, R.; Raiteri, R.; Uscenghi, C.; Opocher, E.; Santambrogio, R.

1990-01-01

We report the results of intra-arterial digital subtraction angiography (DSA) in 100 patients with portal hypertension. The portal venous system was evaluated; all patients underwent angiography of the celiac and superior mesenteric arteries before surgery. Forty-four of them were also examined after Warren splenorenal shunts. Therefore, a total of 144 exams was evaluated. The authors always employed low-osmolality ionic and non-ionic contrast media (iodine concentration: 300-350 mg/ml). In 70 cases pure contrast medium was injected (20/25 ml): in the extant 74 cases it was diluted with an equal volume of saline solution (osmolality and iodine concentration reduced by 50%). Intra-arterial DSA always visualized portal venous system, collateral circulation, shunt location and postoperative changes. The mayor advantage of intra-arterial DSA is the smaller amount of contrast medium injected, so that local and systemic side effects are rare. According to our experience, it is best to dilute the contrast medium and inject the same amount as in conventional angiography, at the same rate. Other well-known advantages of intra-arterial DSA are quicker execution, less injury to arteries using smaller caliber catheters, and low cost. The major disadvantage of intra-arterial DSA, as it appeared also in our study, is the field size of the intensifier, which in our case was limited to 6-9 inches. This is an insufficient coverage for the whole portal system to be studied, and some contrast medium injections become therefore necessary. An average of 3 injections were given to each patient. This problem reduces the advantage of less contrast medium per injection. At any rate, even though intra-arterial DSA exhibits this limitation, it can nevertheless yield important information in the pre- and postoperative evaluation of patients with portal hypertension

Analysis on the entrance surface dose and contrast medium dose at computed tomography and angiography in cardiovascular examination

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Seo, Young Hyun [Dept. of Cardiovascular Center, Yeocheon Jeonnam Hospital, Yeosu (Korea, Republic of); Han, Jae Bok; Choi, Nam Gil; Song, Jong Nam [Dept. of Radiological Science, Dongshin University, Naju (Korea, Republic of)

2016-12-15

This study aimed to identify dose reduction measures by retrospectively analyzing the entrance surface dose at computed tomography and angiography in cardiovascular examination and to contribute the patients with renal impairmend and a high probability of side effects to determine the inspection's direction by measuring the contrast usages actually to active actions for the dose by actually measuring the contrast medium dose. The CTDIvol value and air kerma value, which are the entrance surface doses of the two examinations, and the contrast medium dose depending on the number of slides were compared and analyzed. This study was conducted in 21 subjects (11 males; 10 females) who underwent Cardiac Computed Tomographic Angiography (CCTA) and Coronary Angiography (CAG) in this hospital during the period from May 2014 to May 2016. The subject's age was 48-85 years old (mean 65±10 years old), and the weight was 37.6~83.3 kg (mean 63±6 kg). Dose reduction could be expected in the cardiovascular examination using CCTA rather than in the examination using CAG. In terms of contrast medium dose, CAG used a smaller dose than CCTA. In particular, as the number of slides increases at CAG, the contrast medium dose increases. Therefore, in order to reduce the contrast medium dose, the number of slides suitable for the scan range must be selected.

Synergistic effects of leflunomide and benazepril in streptozotocin-induced diabetic nephropathy.

Science.gov (United States)

Jin, Hua; Piao, Shang Guo; Jin, Ji Zhe; Jin, Ying Shun; Cui, Zhen Hua; Jin, Hai Feng; Zheng, Hai Lan; Li, Jin Ji; Jiang, Yu Ji; Yang, Chul Woo; Li, Can

2014-01-01

Leflunomide (LEF) and benazepril have renoprotective effects on diabetic nephropathy (DN) through their anti-inflammatory and anti-fibrotic activities. This study investigated whether combined treatment using LEF and benazepril affords superior protection compared with the respective monotherapies. Diabetes was induced with streptozotocin (STZ, 65 mg/kg) by intraperitoneal injection in male Wistar rats. Two weeks after STZ injection, diabetic rats were treated daily for 12 weeks with LEF (10 mg/kg), benazepril (10 mg/kg), or a combination of both. Basic parameters (body weight, fasting blood glucose level, and 24 h urinary protein excretion), histopathology, inflammatory [inflammatory cell infiltration (ED-1), monocyte chemoattractant protein-1 (MCP-1), and Toll-like receptor-2 (TLR-2)] and glomerulosclerotic factors [transforming growth factor-β1 (TGF-β1) and connective tissue growth factor (CTGF)], and oxidative stress (8-hydroxy-2'-deoxyguanosine, 8-OHdG) were studied. Benazepril or LEF treatment significantly prevented body weight loss and 24 h urinary protein excretion induced by diabetes; combined treatment with LEF and benazepril further improved these parameters compared with giving each drug alone (all p benazepril and was further reduced by the combined administration of the two drugs (p benazepril provides synergistic effects in preventing DN. 2014 S. Karger AG, Basel

Transient partial amnesia complicating cardiac and peripheral arteriography with nonionic contrast medium

International Nuclear Information System (INIS)

Yildiz, A.; Yencilek, E.; Apaydin, F.D.; Duce, M.N.; Oezer, C.; Atalay, A.

2003-01-01

The aim of this study was to present a case of disruption of the blood-brain barrier during the coronary and lower extremity angiographies with radiological and clinical findings. This condition was secondary to intraarterial use of a nonionic, monomeric contrast medium. A total of 450 cc contrast media was used. Computed tomography examination showed contrast enhancement of the right occipital and frontoparietal cortical regions, which returned to normal one day after. The patient also fully recovered from the neurological symptoms within 24 h. We discussed the possible mechanism for blood-brain barrier disruption in this case. (orig.)

Transient partial amnesia complicating cardiac and peripheral arteriography with nonionic contrast medium

Energy Technology Data Exchange (ETDEWEB)

Yildiz, A.; Yencilek, E.; Apaydin, F.D.; Duce, M.N.; Oezer, C. [Dept. of Radiology, Mersin Ueniv. Tip Fakueltesi Sokak Mersin (Turkey); Atalay, A. [Dept. of Cardiology, Mersin Ueniv. Tip Fakueltesi Sokak Mersin (Turkey)

2003-12-01

The aim of this study was to present a case of disruption of the blood-brain barrier during the coronary and lower extremity angiographies with radiological and clinical findings. This condition was secondary to intraarterial use of a nonionic, monomeric contrast medium. A total of 450 cc contrast media was used. Computed tomography examination showed contrast enhancement of the right occipital and frontoparietal cortical regions, which returned to normal one day after. The patient also fully recovered from the neurological symptoms within 24 h. We discussed the possible mechanism for blood-brain barrier disruption in this case. (orig.)

Fcγ receptor deficiency attenuates diabetic nephropathy

OpenAIRE

López-Parra, Virginia; Mallavia, Beñat; López-Franco, Óscar; Ortiz-Muñoz, Guadalupe; Oguiza, Ainhoa; Recio, Carlota; Blanco, Julia A Parra; Nimmerjahn, F.; Egido de los Rios, J.; Gómez-Guerrero, Carmen

2012-01-01

Among patients with diabetes, increased production of immunoglobulins against proteins modified by diabetes is associated with proteinuria and cardiovascular risk, suggesting that immune mechanisms may contribute to the development of diabetes complications, such as nephropathy. We investigated the contribution of IgG Fcg receptors to diabetic renal injury in hyperglycemic, hypercholesterolemic mice. Weused streptozotocin to induce diabetes in apolipoprotein E–deficientmice and in...

Abnormal albuminuria and blood pressure rise in incipient diabetic nephropathy induced by exercise

DEFF Research Database (Denmark)

Christensen, Cramer

1984-01-01

The aim of the study was to evaluate the influence of light to moderate dynamic work (450 kpm/min followed by 600 kpm/min during 20 min each) on the blood pressure and renal protein handling in insulin-dependent diabetic patients with incipient nephropathy (D3) (elevated baseline albumin excretion...... diastolic blood pressure was elevated [92.1 mm Hg +/- 6.0 (mean +/- SD)] compared to D2 (80.9 mm Hg +/- 4.8, 2P = 0.003%) and C (79.5 mm Hg +/- 12.4, 2P = 1.2%). Baseline systolic blood pressure was not significantly different in the three groups, but systolic blood pressure was more elevated at 600 kpm...... blood pressure and maximal exercise induced albumin excretion was demonstrable in D3.(ABSTRACT TRUNCATED AT 250 WORDS)...

Evaluation of changes in vertebral body density following administration of contrast medium during routine CT examination

International Nuclear Information System (INIS)

Janicek, M.; Bruna, J.; Stenhova, H.

1984-01-01

The possibility is discussed of depicting changes in the density of spongiosis of the vertebral body in normal patients after intravenous administration of a bolus of 40 ml 60% Diazetrizoate in the course of a routine CT examination. The average increase in density immediately after the administration of the contrast medium is 12 H (8%), in the course of 10 minutes is reduced to 5 H (4%) against the initial values in native examination. These average changes are statistically significant, in individual patients, however, the increase in density following the administration of a contrast medium fluctuates considerably (from 0.7% to 10%). Only systematic comparison with various pathological conditions will make it possible to assess the possibilities of the evaluation of the structure of the vertebral body in routine CT with the administration of a contrast medium into the blood flow. (author)

Acute and long-term effect of antihypertensive treatment on exercise-induced albuminuria in incipient diabetic nephropathy

DEFF Research Database (Denmark)

Christensen, Cramer; Mogensen, C E

1986-01-01

. In the acute study, using placebo/metoprolol 10 mg i.v. in patients with normal UAE, the maximal SBP at 600 kpm/min was reduced by 17 mmHg +/- 10 (SD) (2p less than 1.0%) and the maximal SBP at 600 kpm/min in the patients with incipient nephropathy was reduced by 15 mmHg +/- 11 (SD) (2p less than 1.......0%). However, no difference was observed in UAE, in patients with normal UAE or those with incipient nephropathy. Five of the patients with incipient nephropathy were followed with repeated exercise tests before and during 2.6 years of antihypertensive treatment, using metoprolol 200 mg/24 h and subsequently...

Magnetic iodixanol - a novel contrast agent and its early characterization.

Science.gov (United States)

Arokiaraj, M C; Menesson, E; Feltin, N

2018-02-01

Contrast-induced nephropathy is a commonly encountered problem in clinical practice. The purpose of the study was to design and develop a novel contrast agent, which could be used to prevent contrast-induced nephropathy in the future. In total, 20-220nm magnetic nanoparticles were conjugated with iodixanol, and their radio-opacity and magnetic properties were assessed thereafter. Scanning electron microscopy pictures were acquired. Thereafter, the nanoparticles conjugate was tested in cell culture (HUVEC cells), and Quantibody ® assay was studied after cell treatment in 1:5 dilutions for 48h, compared with control. The conjugate preparation had an adequate radio-opacity. A 4mm magnetic bubble was attached to a bar magnet and the properties were studied. The magnetic bubble maintained its structural integrity in all angles including antigravity position. Scanning electron microscopy showed magnetic nanoparticles in all pictures and the particles are of 100-400nm agglomerates with primary particle sizes of roughly 20nm. 1:5 diluted particles had no effect on secretion of IL-1a, IL-1b, IL-4, IL-10, IL-13 and TNFa. Particles increased secretion of IL-8 from 24h and 48h. Secretion of IFNg was also increased when particles were added to the cells as early as 1h. Likewise, IL-6 was strongly secreted by HUVEC treated with particles from 24h incubation time. In contrast, the secretion of MCP-1 was slightly reduced on HUVEC treated with particles. There is potential for a novel iodixanol-magnetic nanoparticle conjugate to be used in cineradiography. Further investigations need to be performed to study its performance in vitro and in vivo. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Renal Kallikrein Activation and Renoprotection after Dual Blockade of Renin-Angiotensin System in Diet-Induced Diabetic Nephropathy

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Xia Zou

2015-01-01

Full Text Available Purpose. The objective of this study is to investigate the effect of dual blockage of renin-angiotensin system (RAS on renal kallikrein expression and inflammatory response in diabetic nephropathy (DN. Methods. Rats were randomly divided into 5 groups with 10 rats in each group: normal control; DN model induced by high fat and high sucrose diets; and DN treated with either benazepril 10 mg/kg/d, irbesartan 30 mg/kg/d, or both. After 8-week treatment, we examined changes in the kidney histopathology, function and immunohistochemical stain of kallikrein, macrophage marker CD68, and profibrotic markers transforming growth factor- (TGF- β and α-smooth muscle action (SMA. Results. DN rats showed enlarged kidneys with glomerulosclerosis, interstitial chronic inflammation and fibrosis, and proteinuria. All the pathological damage and functional impairments were improved after the RAS blockades (all P<0.05. Compared with monotherapy, combined treatment further alleviated the kidney impairments in parallel to increased tubular immunoreactivity for kallikrein and decreased immunopositive cells for CD68, TGF-β, and α-SMA. Conclusion. The renoprotective effects of the dual RAS blockade in diabetic nephropathy may be attributed to improved tubular kallikrein expression and interstitial inflammatory response.

Silica Nephropathy

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N Ghahramani

2010-06-01

Full Text Available Occupational exposure to heavy metals, organic solvents and silica is associated with a variety of renal manifestations. Improved understanding of occupational renal disease provides insight into environmental renal disease, improving knowledge of disease pathogenesis. Silica (SiO2 is an abundant mineral found in sand, rock, and soil. Workers exposed to silica include sandblasters, miners, quarry workers, masons, ceramic workers and glass manufacturers. New cases of silicosis per year have been estimated in the US to be 3600–7300. Exposure to silica has been associated with tubulointerstitial disease, immune-mediated multisystem disease, chronic kidney disease and end-stage renal disease. A rare syndrome of painful, nodular skin lesions has been described in dialysis patients with excessive levels of silicon. Balkan endemic nephropathy is postulated to be due to chronic intoxication with drinking water polluted by silicates released during soil erosion. The mechanism of silica nephrotoxicity is thought to be through direct nephrotoxicity, as well as silica-induced autoimmune diseases such as scleroderma and systemic lupus erythematosus. The renal histopathology varies from focal to crescentic and necrotizing glomerulonephritis with aneurysm formation suggestive of polyarteritis nodosa. The treatment for silica nephrotoxicity is non-specific and depends on the mechanism and stage of the disease. It is quite clear that further research is needed, particularly to elucidate the pathogenesis of silica nephropathy. Considering the importance of diagnosing exposure-related renal disease at early stages, it is imperative to obtain a thorough occupational history in all patients with renal disease, with particular emphasis on exposure to silica, heavy metals, and solvents.

Alteration in serum osteocalcin levels in patients with diabetic nephropathy

International Nuclear Information System (INIS)

Salem, E.S.; Abdel-Messeih, Ph.L.; Mansour, H.H.

2013-01-01

The fact that bone mass density (BMD) is not useful for assessing fracture risk in diabetic patients (DM) seems problematic, because those populations are increasing in every country. Osteocalcin (OC) is synthesized by osteoblasts and is considered to be a marker of bone formation. The present study was carried out to evaluate the usefulness of OC as noninvasive biomarker of bone formation in diabetes mellitus type 2 (uncomplicated) and diabetic nephropathy. Immunoradiometric assay(IRMA) was used for the quantitative measurement of human intact OC both N-terminal and C-terminal fragments in the serum of the control and the studied groups. OC levels in the uncomplicated diabetic group were significantly lower while in the diabetic nephropathy group was significantly higher compared to control values . There was a weak negative correlation between OC and both fasting blood glucose and glycated Hb% in the diabetic group. In diabetic nephropathy patients, a weak positive correlation was observed between OC and protein creatinine ratio. The results concluded that changes in bone remodelling marker OC are present in both DM type 2 and diabetic nephropathy explaining osteopenia and osteoporosis observed in both cases.Therefore, an effective glycaemic control should be the hallmark of prevention and treatment of diabetes mellitus induced osteoporosis

Momordica charantia polysaccharides mitigate the progression of STZ induced diabetic nephropathy in rats.

Science.gov (United States)

Raish, Mohammad; Ahmad, Ajaz; Jan, Basit L; Alkharfy, Khalid M; Ansari, Mushtaq Ahmad; Mohsin, Kazi; Jenoobi, Fahad Al; Al-Mohizea, Abdullah

2016-10-01

Diabetic nephropathy (DN) has become a primary cause of end-stage kidney disease. Several complex dynamics converge together to accelerate the advancement of DN. The present investigation was postulated to explore the mechanism of reno-protective nature of Momordica Charantia polysaccharides (MCP) by evaluating the anti-hyperglycemic, anti-lipidemic as well as markers for oxidative stress and antioxidant proficiency in streptozotocin (STZ)-induced diabetic rats. The oral administration of MCP showed a significant normalization in the levels of kidney function test in the STZ-induced diabetic rats. The levels of blood urea nitrogen (BUN), urea protein and creatinine increased by 316.58%, 195.14% and 800.97% respectively, in STZ-induced diabetic rats when compared with normal rats. MCP treatment also illustrated a significant improvement in glutathione peroxidase, superoxide dismutase and catalase levels, with a significant decline in MDA in diabetic kidneys. Immunoblots of heme-oxygenase 1 (HO-1) and Nrf2 of MCP treated diabetic rats showed a significant up-regulation of HO-1 and Nrf2 protein. Histological and ultra-structural observations also reveal that MCP efficiently protects the kidneys from hyperglycemia-mediated oxidative damage. These findings illustrate that the reno-protective nature of MCP mitigates the progression of STZ induced DN in rats by suppression of oxidative stress and amelioration of the HO-1/Nrf2 pathway. Copyright © 2016 Elsevier B.V. All rights reserved.

The Effects of Pretreatment with Various Doses of L-Arginine on Cisplatin-Induced Nephropathy of Male Rats

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B Rasoulian

2016-09-01

Full Text Available Introduction: Cisplatin is a widely used anti-cancer drug, which its application is limited by nephrotoxicity. In this study, the effect of pretreatment with different l-arginine doses on Cisplatin-induced renal functional injury was investigated. Methods: 63 male rats were divided into 7 groups: In groups 3, 4, 5 and 6, 60 min before the Cisplatin injection (5mg/kg; L-Arginine with doses of 50,100,200 or 400mg/kg was injected, respectively. In group7, normal saline was injected before Cisplatin administration. In groups 1 and 2, normal saline was injected instead of Cisplatin. In group 2, 60min before normal saline injection, 400mg/kg L-Arginine was administered and in group1, instead of L-arginine, normal saline was injected too. Injections were intraperitoneal. 72h after Cisplatin injection, blood sampling and plasma separation were done. Urine sample was collected 24 hours before blood sampling by metabolic cage. The mean of plasma urea and creatinine levels and creatinine clearance (ml/day.kg and fractional excretion of Na (FENa, % were compared among different groups as renal functional parameters. Results: In comparison to group 7, L-arginine injection in a dose of 400mg/kg led to significant amelioration of all parameters. 200 mg/kg L-arginine administration led to significant decrease in plasma urea level and FENa. 100mg/kg L-arginine caused significant improvement in fractional excretion of sodium. L-arginine injection with 50mg/kg dose, significantly ameliorate all renal function tests instead of creatinine clearance. Conclusion: Pretreatment with L-arginine administration with 400 or 50 mg/kg doses, respectively, had the highest effect on reducing Cisplatin-induced nephropathy. L-arginine injection with intermediate doses i.e. 200 or 100 mg/kg had less effect in reducing Cisplatin-induced nephropathy and it needs more investigations.

The efficacy of N-acetylcysteine plus sodium bicarbonate in the prevention of contrast-induced nephropathy after cardiac catheterization and percutaneous coronary intervention: A meta-analysis of randomized controlled trials.

Science.gov (United States)

Zhao, Shi-Jie; Zhong, Zhao-Shuang; Qi, Guo-Xian; Tian, Wen

2016-10-15

The efficacy of combining use of N-acetylcysteine (NAC) and sodium bicarbonate (SOB) in the prevention of contrast-induced nephropathy (CIN) after cardiac catheterization and percutaneous coronary intervention (PCI) is unclear. All relevant studies that compared the effect of combining the use of NAC and SOB with individual use on CIN in patients undergoing cardiac catheterization and PCI were identified by searching the databases including Pubmed, Embase, Cochrane Library, and Web of Science without time and language limitation. Only randomized controlled trials (RCTs) with full-text published were considered. Sixteen RCTs involving 4432 cases were included into this meta-analysis. The results showed there were no additional benefit in reduction of CIN in COM group (COM versus NAC: RR 0.85, 95% CI 0.70-1.03, P=0.103; COM versus SOB: RR 0.91, 95% CI 0.71-1.16, P=0.449), even in patients with diabetes mellitus (COM versus NAC: RR 1.11, 95% CI 0.71-1.75, P=0.646; COM versus SOB: RR 1.06, 95% CI 0.45-2.47, P=0.893), undergoing PCI procedure (COM versus NAC: RR0.76, 95% CI 0.39-1.47, P=0.411; COM versus SOB: RR0.96, 95% CI 0.65-1.40, P=0.814), or with baseline renal dysfunction (COM versus NAC: RR 0.89, 95% CI 0.70-1.14, P=0.366; COM versus SOB: RR 0.95, 95% CI 0.67-1.36, P=0.788). The present study demonstrated combining use of NAC and SOB was not significantly superior to individual use method in the prevention of CIN after cardiac catheterization and PCI. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Duplex-assisted carotid artery stenting without administration of contrast medium for patients with chronic kidney disease or allergic reaction.

Science.gov (United States)

Mizowaki, Takashi; Fujita, Atsushi; Imahori, Taichiro; Uyama, Atsushi; Inoue, Satoshi; Kohta, Masaaki; Hamaguchi, Hirotoshi; Sasayama, Takashi; Hosoda, Kohkichi; Kohmura, Eiji

2016-07-01

We aimed to investigate the safety and feasibility of duplex-assisted carotid artery stenting (CAS) without administration of contrast medium for the prevention of adverse reactions. Fifteen patients (9 % of all CASs) with severe carotid stenosis (≥70 %) associated with chronic kidney disease (CKD) (stage ≥3) or allergy to contrast medium underwent duplex-assisted CAS without administration of contrast medium over 4 years. The procedural success rate and perioperative complication rates were compared between the duplex-assisted CAS (n = 15) and conventional CAS (n = 153) groups. The technical success rate was 100 % in both groups. Combined stroke or death rates during the post-procedural period did not differ significantly between the duplex-assisted CAS group (0/15, 0 %) and conventional CAS group (4/153, 2.6 %). None of the 14 patients with CKD in the duplex-assisted CAS group experienced further deterioration of renal function. The mean surface radiation dose of participants in the duplex-assisted CAS group (n = 13, 312 ± 131 mGy) was significantly lower than that of the conventional CAS group (n = 31, 1036 ± 571 mGy) (p duplex-assisted CAS group (156 ± 39.7 min) and the conventional CAS group (156 ± 37.4 min). Duplex-assisted CAS without administration of contrast medium could be an alternative option in selected patients deemed to be at high risk for renal failure from nephrotoxic contrast medium or who have an allergy to contrast medium.

Digital subtraction angiography and intraarterial contrast medium injection for coronary examinations

Energy Technology Data Exchange (ETDEWEB)

Tobio, R; Kallmeyer, C; Castello, J

1985-01-01

Digital subtraction angiography (DSA) is an established method of vasography, most extensively used as i.v. DSA. Intraarterial injection, however, applying selective or non-selective contrast medium injection, seems to be at least as important a technique although it has not yet met with corresponding interest. The article explains advantages of the technique for angiographic examinations, in particular of coronary angiography.

The Protective Effect of Fucoidan in Rats with Streptozotocin-Induced Diabetic Nephropathy

Directory of Open Access Journals (Sweden)

Jing Wang

2014-05-01

Full Text Available Diabetic nephropathy (DN has long been recognized as the leading cause of end-stage renal disease, but the efficacy of available strategies for the prevention of DN remains poor. The aim of this study was to investigate the possible beneficial effects of fucoidan (FPS in streptozotocin (STZ-induced diabetes in rats. Wistar rats were made diabetic by injection of STZ after removal of the right kidney. FPS was administered to these diabetic rats for 10 weeks. Body weight, physical activity, renal function, and renal morphometry were measured after 10 weeks of treatment. In the FPS-treated group, the levels of blood glucose, BUN, Ccr and Ucr decreased significantly, and microalbumin, serum insulin and the β2-MG content increased significantly. Moreover, the FPS-treated group showed improvements in renal morphometry. In summary, FPS can ameliorate the metabolic abnormalities of diabetic rats and delay the progression of diabetic renal complications.

Lisinopril Protects Against the Adriamycin Nephropathy and Reverses the Renalase Reduction: Potential Role of Renalase in Adriamycin Nephropathy

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Pengxun Han

2013-09-01

Full Text Available Aims: To investigate the potential role of renalase in adriamycin nephropathy and the effect of lisinopril on the regulation of renalase. Methods: Adriamycin nephropathy was induced in male Wistar rats (n=12 by a single injection of adriamycin at 2 mg/kg body weight. Rats were then randomly assigned to a model group or a treatment group, to which were administered distilled water or the angiotensin converting enzyme inhibitor lisinopril, respectively, for 12 weeks. Six normal rats served as controls. At the end of study, physiological parameters and systolic blood pressure were measured. Glomerulosclerosis and tubulointerstitial injury were assessed by histopathology Renalase protein expression in kidney was quantified by immunohistochemistry and immunoblotting. The serum concentration and urinary excretion of renalase were determined by enzyme-linked immunosorbent assay. Results: In model group rats, proteinuria and systolic blood pressure were elevated. Increased serum renalase concentration was observed; however, renalase protein expression in the kidney was significantly decreased. Compared with the model group, decreased proteinuria, lower systolic blood pressure, and fewer morphologic lesions were detected in the treatment group. Although levels of serum renalase were similar, accumulation of renalase in urine and kidney tissue increased notably in the treatment group compared with the model group. Conclusions: This study suggests that renalase may be involved in the process of adriamycin-induced renal injuries. Lisinopril may attenuate adriamycin-induced kidney injury by controlling blood pressure, which may be partially attributed to the renalase expression and secretion.

Automated contrast medium monitoring system for computed tomography--Intra-institutional audit.

Science.gov (United States)

Lauretti, Dario Luca; Neri, Emanuele; Faggioni, Lorenzo; Paolicchi, Fabio; Caramella, Davide; Bartolozzi, Carlo

2015-12-01

The aim of this study was to analyze the usage and the data recorded by a RIS-PACS-connected contrast medium (CM) monitoring system (Certegra(®), Bayer Healthcare, Leverkusen, Germany) over 19 months of CT activity. The system used was connected to two dual syringe power injectors (each associated with a 16-row and a high definition 64-row multidetector CT scanner, respectively), allowing to manage contrast medium injection parameters and to send and retrieve CT study-related information via RIS/PACS for any scheduled contrast-enhanced CT examination. The system can handle up to 64 variables and can be accessed via touchscreen by CT operators as well as via a web interface by registered users with three different hierarchy levels. Data related to CM injection parameters (i.e. iodine concentration, volume and flow rate of CM, iodine delivery rate and iodine dose, CM injection pressure, and volume and flow rate of saline), patient weight and height, and type of CT study over a testing period spanning from 1 June 2013 to 10 January 2015 were retrieved from the system. Technical alerts occurred for each injection event (such as system disarm due to technical failure, disarm due to operator's stop, incomplete filling of patient data fields, or excessively high injection pressure), as well as interoperability issues related to data sending and receiving to/from the RIS/PACS were also recorded. During the testing period, the CM monitoring system generated a total of 8609 reports, of which 7629 relative to successful injection events (88.6%). 331 alerts were generated, of which 40 resulted in injection interruption and 291 in CM flow rate limitation due to excessively high injection pressure (>325 psi). Average CM volume and flow rate were 93.73 ± 17.58 mL and 3.53 ± 0.89 mL/s, and contrast injection pressure ranged between 5 and 167 psi. A statistically significant correlation was found between iodine concentration and peak IDR (rs=0.2744, psystems can provide a full

Contrast-induced enphropathy in patients undergoing intravenous contrast-enhanced computed tomography in Korea; A multi-institutional study in 101487 patients

Energy Technology Data Exchange (ETDEWEB)

Lee, Joong Yub [Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul (Korea, Republic of); Cho, Jeong Yeon [Dept. of Radiology, Seoul National University College of Medicine, Seoul (Korea, Republic of); Jeong, Yong Yeon [Dept. of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun (Korea, Republic of); and others

2014-08-15

To evaluate the prevalence of known risk factors for contrast-induced nephropathy (CIN) and their association with the actual occurrence of CIN in patients undergoing intravenous contrast-enhanced computed tomography (CECT) in Korea. Patients who underwent CECT in 2008 were identified in the electronic medical records of 16 tertiary hospitals of Korea. Data on demographics, comorbidities, prescriptions and laboratory test results of patients were collected following a standard data extraction protocol. The baseline renal function was assessed using the estimated glomerular filtration rate (eGFR). We identified the prevalence of risk factors along the eGFR strata and evaluated their influence on the incidence of CIN, defined as a 0.5 mg/dL or 25% increase in serum creatinine after CECT. Of 432425 CECT examinations in 272136 patients, 140838 examinations in 101487 patients met the eligibility criteria for analysis. The mean age of the participants was 57.9 ± 15.5 years; 25.1% of the patients were older than 70 years. The prevalence of diabetes mellitus was 11.9%, of hypertension 13.7%, of gout 0.55% and of heart failure was 1.7%. Preventive measures were used in 40238 CECT examinations (28.6%). The prevalence of risk factors and use of preventive measures increased as the renal function became worse. A CIN was occurred after 3103 (2.2%) CECT examinations, revealing a significant association with decreased eGFR, diabetes mellitus, and congestive heart failure after adjustment. Risk factors for CIN are prevalent among the patients undergoing CECT. Preventive measures were seemingly underutilized and a system is needed to improve preventive care.

Proliferative retinopathy predicts nephropathy

DEFF Research Database (Denmark)

Karlberg, Charlotte; Falk, Christine; Green, Anders

2012-01-01

We wanted to examine proliferative retinopathy as a marker of incident nephropathy in a 25-year follow-up study of a population-based cohort of Danish type 1 diabetic patients and to examine cross-sectional associations between nephropathy and retinopathy in long-term surviving patients of the same...... cohort. All type 1 diabetic patients from Fyn County, Denmark, were identified as of 1 July 1973. One hundred and eighty four patients were examined in 1981-1982 (baseline) and in 2007-2008 (follow-up). The level of retinopathy was graded by ophthalmoscopy at baseline and nine-field digital colour fundus...... and proliferative retinopathy, respectively. In conclusion, proliferative retinopathy is an independent marker of long-term nephropathy in type 1 diabetes. Upcoming studies should examine whether these microvascular complications are also causally linked in type 1 diabetes....

Enhancement effects of test injection with a small amount of MR contrast medium in the oral and maxillofacial region

International Nuclear Information System (INIS)

Yanagi, Yoshinobu; Asaumi, Jun-ichi; Konouchi, Hironobu; Hisatomi, Miki; Matsuzaki, Hidenobu; Murakami, Jun; Maki, Yuu; Unetsubo, Teruhisa; Kishi, Kanji

2006-01-01

Purpose: To examine whether the signal intensity of dynamic contrast-enhanced MRI (DCE-MRI) is altered by test injection of 1 ml of contrast medium, and if so, whether this change affects the DCE-MRI analysis. Materials and methods: Six healthy volunteers were examined by DCE-MRI using a Magnevist syringe and/or an Omniscan syringe for the injection of contrast medium. Each scan was performed 10 times using steady-state free precession (3D-FISP), a sequence for DCE-MRI, before and after intravenous injection of 1 ml of the contrast medium. The internal pterygoid muscle, masseter muscle, tongue, parotid gland, submandibular gland, bone marrow of the mandible, subcutaneous adipose tissue, and common carotid artery were determined to be regions of interest (ROI), and the ROI internal average signal intensity was measured. The 10 data sets obtained before or after contrast medium administration for each ROI were evaluated using the paired t-test. Results: The test injection increased the signal intensities of six of eight ROIs, with all 20 experiments in the submandibular gland showing significant differences. There was no significant difference in the two ROIs corresponding to the carotid artery and subcutaneous adipose tissue of the cheek. Conclusions: The enhanced signal intensity in the tissue might have been caused by the small amount of contrast medium in the test injection. To eliminate this discrepancy caused by the test injection, a pre-contrast scan should be performed when the average signal intensity of an ROI is measured. We therefore believe that the data obtained before a test injection may be important in the analysis of DCE-MRI

Lecithine as an adjuvant in resorption of contrast medium in oral cholecystography

International Nuclear Information System (INIS)

Lindgren, I.

1978-01-01

No or poor filling of the gallbladder was obtained in 21 patients at cholecystography. They were re-examined after 10 days or later with the addition of lecithine to the contrast medium. The filling of the gallbladder, which was without abnormality, was improved in all cases. The mechanism of this effect is discussed. (Auth.)

Original Article

African Journals Online (AJOL)

clinical trial is needed to verify our encouraging results. Keywords: contrast induced nephropathy, chronic kidney disease, continuous venovenous hemofiltration. Introduction. The incidence of contrast induced nephropathy (CIN) is now increasing, owing to the growing use of radiocontrast media (CM) in diagnostic as well ...

Klotho ameliorates cyclosporine A-induced nephropathy via PDLIM2/NF-kB p65 signaling pathway.

Science.gov (United States)

Jin, Meihua; Lv, Pengfei; Chen, Guanyu; Wang, Peng; Zuo, Zhongfu; Ren, Lili; Bi, Jing; Yang, Chul-Woo; Mei, Xifan; Han, Donghe

2017-04-29

Klotho, an antiaging protein, can extend the lifespan and modulate cellular responses to inflammation and oxidative stress which can ameliorate chronic kidney diseases (CKD). To investigate the molecular mechanism of Klotho on inflammation in cyclosporine A (CsA) induced nephropathy, the mice were transfected with adenovirus mediated Klotho gene and treated with cyclosporine A (CsA; 30 mg/kg/day) for 4 weeks. Also, primary human renal proximal tubule epithelial cells (RPTECs) were treated with soluble Klotho protein and LPS. The results showed that Ad-klotho significantly reduced serum creatinine (Scr) and blood urea nitrogen (BUN) caused by CsA, and significantly increased creatinine clearance. Tubule interstitial fibrosis score (TIF), renal 8-OHdG excretion, macrophage infiltration and MCP-1 were decreased after Ad-klotho gene transfer. In addition, the overexpression of Klotho led to increase in the expression of PDLIM2, decreased in the amount of NF-kB p65, and inhibited the production of inflammatory cytokines (TNFα, IL-6, IL-12) and iNOS. Accordingly, in vitro results showed, Klotho enhanced PDLIM2 expression and reduced NF-kB p65 expression, while PDLIM2 siRNA could block the inhibitory effects of Klotho on expression of NF-kB p65. Secretion of inflammatory cytokines was also inhibited by Klotho treatment, and PDLIM2 siRNA hindered regulatory effects of Klotho on the cytokines. Real-time PCR and Luciferase assay showed that Klotho markedly increased expression of PDLIM2 mRNA and PDLIM2 reporter activity in a dose-dependent manner. These findings suggest that Klotho can modulate inflammation via PDLIM2/NF-kB p65 pathway in CsA-induced nephropathy. Copyright © 2017 Elsevier Inc. All rights reserved.

Clinicopathological analysis of biopsy-proven diabetic nephropathy based on the Japanese classification of diabetic nephropathy.

Science.gov (United States)

Furuichi, Kengo; Shimizu, Miho; Yuzawa, Yukio; Hara, Akinori; Toyama, Tadashi; Kitamura, Hiroshi; Suzuki, Yoshiki; Sato, Hiroshi; Uesugi, Noriko; Ubara, Yoshifumi; Hohino, Junichi; Hisano, Satoshi; Ueda, Yoshihiko; Nishi, Shinichi; Yokoyama, Hitoshi; Nishino, Tomoya; Kohagura, Kentaro; Ogawa, Daisuke; Mise, Koki; Shibagaki, Yugo; Makino, Hirofumi; Matsuo, Seiichi; Wada, Takashi

2018-06-01

The Japanese classification of diabetic nephropathy reflects the risks of mortality, cardiovascular events and kidney prognosis and is clinically useful. Furthermore, pathological findings of diabetic nephropathy are useful for predicting prognoses. In this study, we evaluated the characteristics of pathological findings in relation to the Japanese classification of diabetic nephropathy and their ability to predict prognosis. The clinical data of 600 biopsy-confirmed diabetic nephropathy patients were collected retrospectively from 13 centers across Japan. Composite kidney events, kidney death, cardiovascular events, all-cause mortality, and decreasing rate of estimated GFR (eGFR) were evaluated based on the Japanese classification of diabetic nephropathy. The median observation period was 70.4 (IQR 20.9-101.0) months. Each stage had specific characteristic pathological findings. Diffuse lesions, interstitial fibrosis and/or tubular atrophy (IFTA), interstitial cell infiltration, arteriolar hyalinosis, and intimal thickening were detected in more than half the cases, even in Stage 1. An analysis of the impacts on outcomes in all data showed that hazard ratios of diffuse lesions, widening of the subendothelial space, exudative lesions, mesangiolysis, IFTA, and interstitial cell infiltration were 2.7, 2.8, 2.7, 2.6, 3.5, and 3.7, respectively. Median declining speed of eGFR in all cases was 5.61 mL/min/1.73 m 2 /year, and the median rate of declining kidney function within 2 years after kidney biopsy was 24.0%. This study indicated that pathological findings could categorize the high-risk group as well as the Japanese classification of diabetic nephropathy. Further study using biopsy specimens is required to clarify the pathogenesis of diabetic kidney disease.

Update on Diabetic Nephropathy: Core Curriculum 2018.

Science.gov (United States)

Umanath, Kausik; Lewis, Julia B

2018-06-01

Diabetic kidney disease and diabetic nephropathy are the leading cause of end-stage kidney disease in the United States and most developed countries. Diabetes accounts for 30% to 50% of the incident cases of end-stage kidney disease in the United States. Although this represents a significant public health concern, it is important to note that only 30% to 40% of patients with diabetes develop diabetic nephropathy. Specific treatment of patients with diabetic nephropathy can be divided into 4 major arenas: cardiovascular risk reduction, glycemic control, blood pressure control, and inhibition of the renin-angiotensin system (RAS). Recommendations for therapy include targeting a hemoglobin A 1c concentration diabetic nephropathy is therapy with a RAS-blocking medication. This Core Curriculum outlines and discusses in detail the epidemiology, pathophysiology, diagnosis, and management of diabetic nephropathy. Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Protective effect of C-peptide on experimentally induced diabetic nephropathy and the possible link between C-peptide and nitric oxide.

Science.gov (United States)

Elbassuoni, Eman A; Aziz, Neven M; El-Tahawy, Nashwa F

2018-06-01

Diabetic nephropathy one of the major microvascular diabetic complications. Besides hyperglycemia, other factors contribute to the development of diabetic complications as the proinsulin connecting peptide, C-peptide. We described the role of C-peptide replacement therapy on experimentally induced diabetic nephropathy, and its potential mechanisms of action by studying the role of nitric oxide (NO) as a mediator of C-peptide effects by in vivo modulating its production by N G -nitro-l-arginine methyl ester (L-NAME). Renal injury markers measured were serum urea, creatinine, tumor necrosis factor alpha, and angiotensin II, and malondialdehyde, total antioxidant, Bcl-2, and NO in renal tissue. In conclusion, diabetic induction resulted in islet degenerations and decreased insulin secretion with its metabolic consequences and subsequent renal complications. C-Peptide deficiencies in diabetes might have contributed to the metabolic and renal error, since C-peptide treatment to the diabetic rats completely corrected these errors. The beneficial effects of C-peptide are partially antagonized by L-NAME coadministration, indicating that NO partially mediates C-peptide effects.

Preventing diabetic nephropathy

DEFF Research Database (Denmark)

Hansen, H P; Lund, S S; Rossing, P

2001-01-01

In type 1 diabetic patients with microalbuminuria not receiving antihypertensive treatment, an increase in urinary albumin excretion rate (AER) of 6% to 14%/year and a risk for the development of diabetic nephropathy of 3% to 30%/year have previously been reported. The aim of the present study...... was to audit the effect of angiotensin converting enzyme (ACE) inhibition on the progression of microalbuminuria and development of diabetic nephropathy. We consecutively identified 227 type 1 diabetic patients with persistent microalbuminuria (urinary AER between 30 and 300mg/24h, ELISA). According...... been reported in intervention trials....

Minimizing Contrast Medium Doses to Diagnose Pulmonary Embolism with 80-kVp Multidetector Computed Tomography in Azotemic Patients

Energy Technology Data Exchange (ETDEWEB)

Holmquist, F. (Dept. of Diagnostic Radiology, Malmoe Univ. Hospital, Univ. of Lund, Malmoe (Sweden)); Hansson, K.; Pasquariello, F. (Dept. of Internal Medicine, Lasarettet Trelleborg, Univ. of Lund, Trelleborg (Sweden)); Bjoerk, J. (Competence Center for Clinical Research, Univ. Hospital, Univ. of Lund, Lund (Sweden)); Nyman, U. (Dept. of Radiology, Lasarettet Trelleborg, Univ. of Lund, Trelleborg (Sweden))

2009-02-15

Background: In diagnosing acute pulmonary embolism (PE) in azotemic patients, scintigraphy and magnetic resonance imaging are frequently inconclusive or not available in many hospitals. Computed tomography is readily available, but relatively high doses (30-50 g I) of potentially nephrotoxic iodine contrast media (CM) are used. Purpose: To report on the diagnostic quality and possible contrast-induced nephropathy (CIN) after substantially reduced CM doses to diagnose PE in azotemic patients using 80-peak kilovoltage (kVp) 16-row multidetector computed tomography (MDCT) combined with CM doses tailored to body weight, fixed injection duration adapted to scan time, automatic bolus tracking, and saline chaser. Material and Methods: Patients with estimated glomerular filtration rate (eGFR) <50 ml/min were scheduled to undergo 80-kVp MDCT using 200 mg I/kg, and those with eGFR =50 ml/min, 120-kVp MDCT with 320 mg I/kg. Both protocols used an 80-kg maximum dose weight and a fixed 15-s injection time. Pulmonary artery density and contrast-to-noise ratio were measured assuming 70 Hounsfield units (HU) for a fresh clot. CIN was defined as a plasma creatinine rise >44.2 mumol/l from baseline. Results: 89/148 patients (63/68 females) underwent 80-/120-kVp protocols, respectively, with 95% of the examinations being subjectively excellent or adequate. Mean values in the 80-/120-kVp cohorts regarding age were 82/65 years, body weight 66/78 kg, effective mAs 277/117, CM dose 13/23 g I, pulmonary artery density 359/345 HU, image noise (1 standard deviation) 24/21 HU, contrast-to-noise ratio 13/13, and dose-length product 173/258 mGycm. Only 1/65 and 2/119 patients in the 80- and 120-kVp cohorts, respectively, with negative CT and no anticoagulation suffered non-fatal thromboembolism during 3-month follow-up. No patient developed CIN. Conclusion: 80-kVp 16-row MDCT with optimization of injection parameters may be performed with preserved diagnostic quality, using markedly reduced CM

Comparison of in vitro histamine release by ionic and nonionic radiographyic contrast media

International Nuclear Information System (INIS)

Faraj, B.A.; Martin, L.G.

1989-01-01

This paper discusses a study whose results showed that in 53 hospitalized patients undergoing cardiovascular catheterization, incubation of their blood samples with varying concentrations of an ionic contrast medium (Angiovist-370, 60--631 mM) induced a significant (P < .005) amount of histamine release from whole blood (3.5%--10%), as compared with the histamine release following incubation with a nonionic contrast medium. Data suggest that the use of nonionic contrast media may induce minimal histamine release and thereby involve less patient risk from the histamine-mediated allergic and hemodynamic side effects associated with radiographic contrast media procedures

Are intravenous injections of contrast media really less nephrotoxic than intra-arterial injections?

Energy Technology Data Exchange (ETDEWEB)

Nyman, Ulf [University of Lund, Department of Diagnostic Radiology, Trelleborg (Sweden); Almen, Torsten [Skaane University Hospital, Department of Clinical Sciences/Medical Radiology, University of Lund, Malmoe (Sweden); Jacobsson, Bo [University of Gothenburg and the Sahlgrenska Academy, Department of Diagnostic Radiology, The Queen Silvia Children' s Hospital, Goeteborg (Sweden); Aspelin, Peter [Karolinska Institute and University Hospital, Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Stockholm (Sweden)

2012-06-15

We oppose the opinion that the intra-arterial administration of iodine-based contrast media (CM) appears to pose a greater risk of contrast medium-induced nephropathy (CIN) than intravenous administration since (1) in intra-arterial coronary procedures and most other intra-arterial angiographic examinations, CM injections are also intravenous relative to the kidneys, (2) there is a lack of comparative trials studying the risk of CIN between intra-arterial and intravenous procedures with matched risk factors and CM doses, (3) a bias selection of patients with fewer risk factors may explain the seemingly lower rate of CIN after CT in comparison with coronary interventions, (4) the rate of CIN following intra-arterial coronary procedures may also be exaggerated owing to other causes of acute kidney failure, such as haemodynamic instability and microembolisation, (5) roughly the same gram-iodine/GFR ratio ({approx}1:1) as a limit of relatively safe CM doses has preliminarily been found for both intravenous CT and intra-arterial coronary procedures and (6) the substantially higher injected intravenous CM dose rate during CT relative to an intra-arterial coronary procedure might actually pose a higher risk of CIN following CT. Key Points circle Most intra-arterial injections of contrast media are intravenous relative to the kidneys. circle No evidence that intravenous CM injections should be less nephrotoxic than intra-arterial. circle Considerably higher dose rates of CM are used for CT relative to intra-arterial procedures. circle Higher dose rates may pose higher nephrotoxic risk for intravenous based CT studies. (orig.)

[Preclinical diagnostics and correction of the disturbed renal blood flow in the children presenting with diabetic nephropathy].

Science.gov (United States)

Aver'ianov, A P; Tkacheva, E N; Bolotova, N V; Filina, N Iu; Ivanova, Iu V; Nikolaeva, N V; Tikhonova, L A

2011-01-01

The present study included 86 children aged between 7 and 17 years with type 1 diabetes mellitus from 1 to 15 years in duration. In all the patients, renal blood flow was investigated with the use of ultrasonic dopplerography. The results of the study suggest disturbances of intrarenal hemodynamics that manifested themselves as enhanced resistance of renal arteries from periphery to the centre in the patients at the hyperfiltration stage of diabetic nephropathy (DN) in conjunction with the reduced velocity of blood flow in inter-lobular and segmental arteries. In contrast, the patients at the microalbuminuric stage of diabetic nephropathy exhibited increased resistance and reduced velocity of blood flow in the main renal veins. In 35 patients presenting with diabetic nephropathy, hemodynamic correction was achieved by the application of the traveling pulsed magnetic field (TP-MF) to the renal region using an AMO-ATOS-E apparatus (Russia). This treatment resulted in normalization of the characteristics of renal blood flow. It is concluded that TPMF has good prospects for the use as a component of the combined treatment of diabetic nephropathy.

Iopamidol, a new non-ionic X-ray contrast medium

International Nuclear Information System (INIS)

Hagen, B.

1982-01-01

Iopamidol, a new non-ionic, monomeric contrast medium with low osmolality has been well established in our angiographic routine procedures according to the favourable results obtained in more than 300 controlled trials. The general tolerance (demonstrated by the rate of systemic adverse reactions) of the lower concentrated solution (300 mg iodine/ml is a little bit better than that of the higher concentrated one (370 mg iodine/ml). We could demonstrate a significant difference between the two preparations related to local side effects such as pain and heat sensations. The results of 100 intraindividual double blind studies (only peripheral angiography) specially referred to local side effects showed the high significant decrease of pain and heat sensations after application of Iopamidol compared to the results gained by the ionic Ioxitalamate and Ioglicinate. There was no remarkable difference between Iopamidol and Ioxaglate which is a dimeric but likewise low osmolar substance. The role of osmolality in the generation of side effects is pointed out. In consequence the advantages of using contrast media of reducted osmolality particularly in peripheral angiography must be emphasized. (orig.)

Practical issues in the prevention and treatment of contrast ...

African Journals Online (AJOL)

Kidney dysfunction is a serious complication that can occur following the administration of contrast media (CM). Although the incidence of contrast nephropathy (CN) is low in the general population (1 - 2%) it poses a serious risk to those with impaired kidney function. Other risks include diabetes, old age and dehydration.

A Review: Radiographic Iodinated Contrast Media-Induced Thyroid Dysfunction

Science.gov (United States)

Leung, Angela M.; Braverman, Lewis E.; Brent, Gregory A.; Pearce, Elizabeth N.

2015-01-01

Context: Thyroid hormone production is dependent on adequate iodine intake. Excess iodine is generally well-tolerated, but thyroid dysfunction can occur in susceptible individuals after excess iodine exposure. Radiological iodinated contrast media represent an increasingly common source of excess iodine. Objective: This review will discuss the thyroidal response after acute exposure to excess iodine; contrast iodine-induced thyroid dysfunction; risks of iodine-induced thyroid dysfunction in vulnerable populations, such as the fetus, neonate, and patients with impaired renal function; and recommendations for the assessment and treatment of contrast iodine-induced thyroid dysfunction. Methods: Data for this review were identified by searching PubMed, Google Scholar, and references from relevant articles from 1948 to 2014. Conclusions: With the increase in the use of computed tomography scans in the United States, there is increasing risk of contrast-induced thyroid dysfunction. Patients at risk of developing iodine-induced thyroid dysfunction should be closely monitored after receiving iodinated contrast media and should be treated as needed. PMID:25375985

Effect of barium sulfate contrast medium on rheology and sensory texture attributes in a model food.

Science.gov (United States)

Ekberg, O; Bulow, M; Ekman, S; Hall, G; Stading, M; Wendin, K

2009-03-01

The swallowing process can be visualized using videoradiography, by mixing food with contrast medium, e.g., barium sulfate (BaSO(4)), making it radiopaque. The sensory properties of foods may be affected by adding this medium. To evaluate if and to what extent sensory and rheological characteristics of mango purée were altered by adding barium sulfate to the food. This study evaluated four food samples based on mango purée, with no or added barium sulfate contrast medium (0%, 12.5%, 25.0%, and 37.5%), by a radiographic method, and measured sensory texture properties and rheological characteristics. The sensory evaluation was performed by an external trained panel using quantitative descriptive analysis. The ease of swallowing the foods was also evaluated. The sensory texture properties of mango purée were significantly affected by the added barium in all evaluated attributes, as was the perception of particles. Moreover, ease of swallowing was significantly higher in the sample without added contrast medium. All samples decreased in extensional viscosity with increasing extension rate, i.e., all samples were tension thinning. Shear viscosity was not as dependent on the concentration of BaSO(4) as extensional viscosity. Addition of barium sulfate to a model food of mango purée has a major impact on perceived sensory texture attributes as well as on rheological parameters.

Chronic nephropathies of cocaine and heroin abuse: a critical review.

Science.gov (United States)

Jaffe, Jared A; Kimmel, Paul L

2006-07-01

Renal disease in cocaine and heroin users is associated with the nephrotic syndrome, acute glomerulonephritis, amyloidosis, interstitial nephritis, and rhabdomyolysis. The pathophysiologic basis of cocaine-related renal injury involves renal hemodynamic changes, glomerular matrix synthesis and degradation, and oxidative stress and induction of renal atherogenesis. Heroin is the most commonly abused opiate in the United States. Previous studies identified a spectrum of renal diseases in heroin users. The predominant renal lesion in black heroin users is focal segmental glomerulosclerosis and in white heroin users is membranoproliferative glomerulonephritis. Although the prevalence of heroin use in the United States has increased, the incidence of "heroin nephropathy" has declined. Because reports of heroin nephropathy predated the surveillance of hepatitis C virus and HIV, the varied findings might be related to the spectrum of viral illnesses that are encountered in injection drug users. Socioeconomic conditions, cultural and behavioral practices, or differences in genetic susceptibilities may be more associated with the development of nephropathy in heroin users than the drug's pharmacologic properties. Administration of cocaine in animal models results in nonspecific glomerular, interstitial, and tubular cell lesions, but there is no animal model of heroin-associated renal disease. The heterogeneity of responses that are associated with heroin is not consistent with a single or simple notion of nephropathogenesis. There are no well-designed, prospective, epidemiologic studies to assess the incidence and the prevalence of renal disease in populations of opiate users and to establish the validity of a syndrome such as heroin nephropathy. It is concluded although there is a paucity of evidence to support a heroin-associated nephropathy, the evidence from in vitro cellular and animal studies to support the existence of cocaine-induced renal changes is more convincing.

Prevention of incipient diabetic nephropathy by high-dose thiamine and benfotiamine.

Science.gov (United States)

Babaei-Jadidi, Roya; Karachalias, Nikolaos; Ahmed, Naila; Battah, Sinan; Thornalley, Paul J

2003-08-01

Accumulation of triosephosphates arising from high cytosolic glucose concentrations in hyperglycemia is the trigger for biochemical dysfunction leading to the development of diabetic nephropathy-a common complication of diabetes associated with a high risk of cardiovascular disease and mortality. Here we report that stimulation of the reductive pentosephosphate pathway by high-dose therapy with thiamine and the thiamine monophosphate derivative benfotiamine countered the accumulation of triosephosphates in experimental diabetes and inhibited the development of incipient nephropathy. High-dose thiamine and benfotiamine therapy increased transketolase expression in renal glomeruli, increased the conversion of triosephosphates to ribose-5-phosphate, and strongly inhibited the development of microalbuminuria. This was associated with decreased activation of protein kinase C and decreased protein glycation and oxidative stress-three major pathways of biochemical dysfunction in hyperglycemia. Benfotiamine also inhibited diabetes-induced hyperfiltration. This was achieved without change in elevated plasma glucose concentration and glycated hemoglobin in the diabetic state. High-dose thiamine and benfotiamine therapy is a potential novel strategy for the prevention of clinical diabetic nephropathy.

Contrast induced hyperthyroidism due to iodine excess

OpenAIRE

Mushtaq, Usman; Price, Timothy; Laddipeerla, Narsing; Townsend, Amanda; Broadbridge, Vy

2009-01-01

Iodine induced hyperthyroidism is a thyrotoxic condition caused by exposure to excessive iodine. Historically this type of hyperthyroidism has been described in areas of iodine deficiency. With advances in medicine, iodine induced hyperthyroidism has been observed following the use of drugs containing iodine—for example, amiodarone, and contrast agents used in radiological imaging. In elderly patients it is frequently difficult to diagnose and control contrast related hyperthyroidism, as most...

Magnetic resonance tomography for focal lesions in the liver using the para-magnetic contrast medium gadolinium DTPA

International Nuclear Information System (INIS)

Hamm, B.; Roemer, T.; Felix, R.; Wolf, K.J.; Klinikum Charlottenburg, Berlin

1986-01-01

The use of the para-magnetic contrast medium gadolinium DTPA for magnetic resonance tomography of focal lesions in the liver was investigated in 31 patients. Two dosage schedules of the contrast medium (0.1 and 0.2 mmol/kg body weight) were used with field strengths of 0.35 and 0.5 Tesla. Using T 1 sequences, gadolinium DTPA showed increased signal intensity in the liver and in tumours, but this was significantly more marked in the tumour. On T 1 spin-echo sequences, previously iso-intense lesions became visible after administration of contrast. On the other hand, contrast-enhanced lesions were less well seen on inversion recovery sequences because of a reduction in the contrast between tumour and liver tissue. The contrast between tumour and liver tissue was not improved by gadolinium DTPA in comparison with precontrast inversion recovery sequences and T 2 spin-echo sequences. The perfusion of intra-hepatic tumours could be elucidated by magnetic resonance tomography after the administration of gadolinium DTPA. (orig.) [de

Membranous nephropathy

Science.gov (United States)

... skin-lightening creams Systemic lupus erythematosus , rheumatoid arthritis, Graves disease, and other autoimmune disorders The disorder occurs at ... diagnosis. The following tests can help determine the cause of membranous nephropathy: Antinuclear antibodies test Anti-double- ...

The strategy of performing non-prophylactic hemodialysis therapy after administration of contrast media in renal insufficiency patients

International Nuclear Information System (INIS)

Hokama, Sanehiro; Oda, Masami; Kadekawa, Katsumi

2007-01-01

Acute renal failure induced by contrast media is an important problem in renal insufficiency patients. Prophylactic hemodialysis is usually undertaken after the administration of radiocontrast media. However, we decided to cease giving prophylactic hemodialysis from February, 2002 in line with the guidelines regarding dialysis and contrast media administration provided by the European Society of Urogenital Radiology. We reported our policy at the doctor's meeting of hemodialysis therapy and at the meeting of clinical engineering technologists which were held in Okinawa. After the presentation, a questionnaire survey in 28 hospitals was undertaken by telephone. In all the hospitals, prophylactic hemodialysis after the administration of radiocontrast media was still being continued, with the exception of one hospital. We need to enlighten medical staff that the strategy of performing hemodialysis immediately after the administration of contrast media in patients with reduced renal function does not diminish the rate of radiocontrast media-induced nephropathy. (author)

Sarcopenia in diabetic nephropathy: a cross-sectional study.

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Çeliker, Meral; Selçuk, Mustafa Yavuz; Olt, Serdar

2018-06-01

To investigate the relationship between sarcopenia and diabetic nephropathy. 56 diabetic patients without complications, 50 diabetic patients with nephropathy, 53 healthy controls included in this present study. Demographic characteristics such as sex, age, anthropometric measurements such as weight, body mass index [BMI], hip circumference, waist circumference and upper arm circumference were measured. Sarcopenia diagnosis was based on European Working Group on Sarcopenia in Older People [EWGSOP] criteria which consist of hand grip strength, 6-meter walking test and muscle mass. The frequency of sarcopenia increased gradually from 15.1% in healthy control group to 21.4% in the diabetes group, and 34% in diabetic nephropathy group (X2 for trend, p = 0.029). The frequency of sarcopenia was similar in diabetes and diabetic nephropathy group. However, the frequency of sarcopenia was higher in diabetic nephropathy than healthy controls (OR = 2.89, CI [1.11-7.51] in logistic regression). In the present study, the prevalence of sarcopenia was higher in patients with diabetic nephropathy compared to healthy controls.

Study on Association of Pentraxin 3 and Diabetic Nephropathy in a Rat Model

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Xuehai Chen

2018-01-01

Full Text Available Diabetic nephropathy (DN is a serious microvascular complication of diabetes. Compared with other therapies for diabetic patients, islet transplantation can effectively prevent and reverse diabetes-induced microvascular disease, such as diabetic retinopathy and nephropathy. PTX3 is the only long pentraxin that can be detected in renal tissue. In this study, we investigated the expression of PTX3 when early DN was reversed after islet transplantation. Methods. Diabetes was induced in rats by injecting streptozotocin (STZ. Twelve weeks later, the diabetic rats were divided into 2 groups: the islet transplantation group (IT and the diabetic nephropathy group (DN. Renal injury, renal function, and the expression of PTX3 in the plasma and the kidneys were assessed with urinalysis, immunohistochemical staining, and Western blot, respectively. Results. The expression of PTX3 in the kidney was significantly decreased in the DN group but increased in the IT group because of the reversal of DN. Conclusions. Our data showed that the level of PTX3 in renal tissue is closely related to renal injury in DN. This may be used to quantify the extent of renal injury in DN, provide a potential early indicator of renal tubular injury in early DN patients, and assess DN clinical progression.

Mice deficient in PAPP-A show resistance to the development of diabetic nephropathy.

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Mader, Jessica R; Resch, Zachary T; McLean, Gary R; Mikkelsen, Jakob H; Oxvig, Claus; Marler, Ronald J; Conover, Cheryl A

2013-10-01

We investigated pregnancy-associated plasma protein-A (PAPP-A) in diabetic nephropathy. Normal human kidney showed specific staining for PAPP-A in glomeruli, and this staining was markedly increased in diabetic kidney. To assess the possible contribution of PAPP-A in the development of diabetic nephropathy, we induced diabetes with streptozotocin in 14-month-old WT and Papp-A knockout (KO) mice. Renal histopathology was evaluated after 4 months of stable hyperglycemia. Kidneys from diabetic WT mice showed multiple abnormalities including thickening of Bowman's capsule (100% of mice), increased glomerular size (80% of mice), tubule dilation (80% of mice), and mononuclear cell infiltration (90% of mice). Kidneys of age-matched non-diabetic WT mice had similar evidence of tubule dilation and mononuclear cell infiltration to those of diabetic WT mice, indicating that these changes were predominantly age-related. However, thickened Bowman's capsule and increased glomerular size appeared specific for the experimental diabetes. Kidneys from diabetic Papp-A KO mice had significantly reduced or no evidence of changes in Bowman's capsule thickening and glomerular size. There was also a shift to larger mesangial area and increased macrophage staining in diabetic WT mice compared with Papp-A KO mice. In summary, elevated PAPP-A expression in glomeruli is associated with diabetic nephropathy in humans and absence of PAPP-A is associated with resistance to the development of indicators of diabetic nephropathy in mice. These data suggest PAPP-A as a potential therapeutic target for diabetic nephropathy.

Gallic acid attenuates type I diabetic nephropathy in rats.

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Garud, Mayuresh Sudamrao; Kulkarni, Yogesh Anant

2018-02-25

Literature suggests that TGF-β1 has a central role in the progression of diabetic nephropathy and its down regulation can improve the disease condition. Oxidative stress, generation of advanced glycation end products and activation of renin angiotensin system are the connecting links between hyperglycemia and TGF-β1 over expression. Gallic acid is a phytochemical having wide range of biological activities. Gallic acid is reported to have antioxidant and advanced glycation inhibitory activity. It has also shown inhibitory effects on angiotensin converting enzyme. Gallic acid qualifies as a drug candidate to be tested in the diabetic nephropathy, one of the important complication of diabetes. Streptozotocin (55 mg/kg body weight, i.p.) induced diabetic nephropathy was used as an experimental model. Gallic acid was evaluated for its possible effect at the dose of 20 and 40 mg/kg body weight. Gallic acid treatment significantly lowered plasma levels of the creatinine and blood urea nitrogen and elevated the levels of the protein and albumin. Gallic acid also improved creatinine clearance. Determination of oxidative stress parameters showed that the oxidative stress in kidney tissues was reduced significantly in gallic acid treated animals. Results of the plasma, urine and oxidative stress parameters were also reflected in the histopathological evaluation showing improvement in kidney pathophysiology. ELISA assay for circulating TGF-β1 evaluation and immunohistochemical study for determination of kidney expression of TGF-β1 revealed that gallic acid significantly lowered both the circulating and tissue levels of TGF-β1. Results support the hypothesis that gallic acid can be effectively used in the treatment of diabetic nephropathy. Copyright © 2018 Elsevier B.V. All rights reserved.

A case of palpable purpura and nephropathy: Occam's Razor or Hickam's Dictum.

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Mandhadi, Ranadeep; Kodumuri, Vamsi; Arora, Rohit; Puneet Singh, Param; Adigopula, Shashi; Chua, Serafin

2013-01-01

Vasculitis causing palpable purpura, nephropathy, and hematologic abnormalities is a well-known entity. However, sometimes, vasculitis may not be the primary cause but is part of a systemic disease. Literature suggests that infections like HIV can induce nephropathy and antineutrophilic cytoplasmic antibody-positive vasculitis, which is different from the well-known entity of "antineutrophilic cytoplasmic antibody-associated vasculitis." We present a 46-year-old female patient with a history of intravenous drug abuse who reported with a rash, swelling, and palpable purpura of the lower extremities. Peripheral smear showed no evidence of disseminated intravascular coagulation or thrombotic thrombocytopenic purpura; metabolic profile showed acute kidney injury. She was found to be HIV- and hepatitis C-positive. Immunologic workup was positive for both MPO and PR3 antineutrophilic cytoplasmic antibodies and negative for cryoglobulins; complement levels were low. Skin biopsy showed leukocytoclastic vasculitis but kidney biopsy was negative for any immunologic involvement; it showed only glomerulosclerosis. Thus, it was thought that nephropathy and vasculitis, in this case, are two distinct pathologic processes, both induced by infection (HIV and/or hepatitis C). The patient responded to low-dose steroid therapy. She was later started on the definitive therapy, the highly active antiretroviral therapy regimen. This case illustrates the fact that low-dose steroids can still be a good alternative in acute situations in patients at risk from immunosuppression.

Comparison between two positive and one negative oral contrast medium for abdominal CT diagnosis

International Nuclear Information System (INIS)

Zwaan, M.; Gmelin, E.

1989-01-01

In a prospective randomised study three groups of 30 patients each were subjected to CT of the entire abdomen. The oral intestinal contrast media used were iodine solution (2%), barium suspension (1.5%) and paraffin emulsion (25%). The results were evaluated according to imaging, artifacts, assessability of the intestinal wall, taste and side effects. All three contrast media are suitable for marking the gastrointestinal tract; paraffin shows advantages in the upper part of the tract and is the only medium that enables assessment of the wall, while causing the lowest rate of artifacts. Barium has a high acceptance and the best tolerance of all contrast agents. (orig.) [de

Smoking in diabetic nephropathy: sparks in the fuel tank?

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Chakkarwar, Vishal Arvind

2012-12-15

Diabetic nephropathy is associated with high morbidity and mortality and the prevalence of this disease is continuously increasing worldwide. Long-term diabetes increases the likelihood of developing secondary complications like nephropathy, the most common cause of end stage renal disease. Usually, other factors like hypertension, alcoholism and smoking also partly contribute to the progression of diabetic nephropathy. Among this, cigarette smoking in diabetes has been repeatedly confirmed as an independent risk factor for the onset and progression of diabetic nephropathy. Various studies suggest that smoking is a major fuel in the development of high oxidative stress and subsequently hyperlipidemia, accumulation of advanced glycation end products, activation of the renin angiotensin system and Rho-kinase, which are observed to play a pathogenic role in the progression of diabetic nephropathy. Furthermore, cigarette smoking in diabetic patients with vascular complications produces a variety of pathological changes in the kidney, such as thickening of the glomerular basement membrane and mesangial expansion with progression in glomerulosclerosis and interstitial fibrosis, which ultimately results in end stage renal failure. Strong associations are consistently found between chronic cigarette smoking and diabetic microvascular complications. A diverse group of studies unveil potential mechanisms that may explain the role of cigarette smoking in the progression of diabetic nephropathy. Tremendous efforts are being made to control smoking mediated progression of diabetic nephropathy, but no promising therapy is yet available. The present review critically discusses the possible detrimental role of chronic cigarette smoking in the progression of diabetic nephropathy and various possible pharmacological interventions to attenuate the exacerbation of diabetic nephropathy.

Angiotensin converting enzyme 2 amplification limited to the circulation does not protect mice from development of diabetic nephropathy

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Wysocki, Jan; Ye, Minghao; Khattab, Ahmed M.; Fogo, Agnes; Martin, Aline; David, Nicolae Valentin; Kanwar, Yashpal; Osborn, Mark; Batlle, Daniel

2016-01-01

Blockers of the renin-angiotensin system are effective in the treatment of experimental and clinical diabetic nephropathy. An approach different from blocking the formation or action of angiotensin II(1-8) that could also be effective involves fostering its degradation. Angiotensin converting enzyme 2 (ACE2) is a monocarboxypeptidase than cleaves angiotensin II (1-8) to form angiotensin (1-7). Therefore, we examined the renal effects of murine recombinant ACE2 in mice with streptozotocin-induced diabetic nephropathy as well as that of amplification of circulating ACE2 using minicircle DNA delivery prior to induction of experimental diabetes. This delivery resulted in a long-term sustained and profound increase in serum ACE2 activity and enhanced ability to metabolize an acute angiotensin II (1-8) load. In mice with streptozotocin-induced diabetes pretreated with minicircle ACE2, ACE2 protein in plasma increased markedly and this was associated with a more than 100-fold increase in serum ACE2 activity. However, minicircle ACE2 did not result in changes in urinary ACE2 activity as compared to untreated diabetic mice. In both diabetic groups, glomerular filtration rate increased significantly and to the same extent as compared to non-diabetic controls. Albuminuria, glomerular mesangial expansion, glomerular cellularity and glomerular size, were all increased to a similar extent in minicircle ACE2-treated and untreated diabetic mice, as compared to non-diabetic controls. Recombinant mouse ACE2 given for 4 weeks by intraperitoneal daily injections in mice with streptozotocin-induced diabetic nephropathy also failed to improve albuminuria or kidney pathology. Thus, a profound augmentation of ACE2 confined to the circulation failed to ameliorate the glomerular lesions and hyperfiltration characteristic of early diabetic nephropathy. These findings emphasize the importance of targeting the kidney rather than the circulatory renin angiotensin system to combat diabetic

Kinetics of intravenous radiographic contrast medium injections as used on CT: simulation with time delay differential equations in a basic human cardiovascular multicompartment model.

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Violon, D

2012-12-01

To develop a multicompartment model of only essential human body components that predicts the contrast medium concentration vs time curve in a chosen compartment after an intravenous injection. Also to show that the model can be used to time adequately contrast-enhanced CT series. A system of linked time delay instead of ordinary differential equations described the model and was solved with a Matlab program (Matlab v. 6.5; The Mathworks, Inc., Natick, MA). All the injection and physiological parameters were modified to cope with normal or pathological situations. In vivo time-concentration curves from the literature were recalculated to validate the model. The recalculated contrast medium time-concentration curves and parameters are given. The results of the statistical analysis of the study findings are expressed as the median prediction error and the median absolute prediction error values for both the time delay and ordinary differential equation systems; these are situated well below the generally accepted maximum 20% limit. The presented program correctly predicts the time-concentration curve of an intravenous contrast medium injection and, consequently, allows an individually tailored approach of CT examinations with optimised use of the injected contrast medium volume, as long as time delay instead of ordinary differential equations are used. The presented program offers good preliminary knowledge of the time-contrast medium concentration curve after any intravenous injection, allowing adequate timing of a CT examination, required by the short scan time of present-day scanners. The injected volume of contrast medium can be tailored to the individual patient with no more contrast medium than is strictly needed.

Late adverse reactions to intravascular iodinated contrast media

International Nuclear Information System (INIS)

Webb, Judith A.W.; Stacul, Fulvio; Thomsen, Henrik S.; Morcos, Sameh K.

2003-01-01

Late adverse reactions to intravascular iodinated contrast media are defined as reactions occurring 1 h to 1 week after contrast medium injection. They have received increasing interest over the past decade, but their prevalence remains uncertain and their pathophysiology is not fully understood. The Contrast Media Safety Committee of the European Society of Urogenital Radiology decided to review the literature and to issue guidelines. An extensive literature search was carried out and summarized in a report. Based on the available information, simple guidelines have been drawn up. The report and guidelines were discussed at the 8th European Symposium on Urogenital Radiology in Genoa. Late adverse reactions after intravascular iodinated contrast medium include symptoms such as nausea, vomiting, headache, itching, skin rash, musculoskeletal pain, and fever. A significant proportion of these reactions is unrelated to the contrast medium; however, allergy-like skin reactions are well-documented side effects of contrast media with an incidence of approximately 2%. Late reactions appear to be commoner after non-ionic dimers. The majority of late skin reactions after contrast medium exposure are probably T-cell-mediated allergic reactions. Patients at increased risk of late skin reactions are those with a history of previous contrast medium reaction and those on interleukin-2 treatment. Most skin reactions are self-limiting and resolve within a week. Management is symptomatic and similar to the management of other drug-induced skin reactions. (orig.)

Lingzhilactones from Ganoderma lingzhi ameliorate adriamycin-induced nephropathy in mice.

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Yan, Yong-Ming; Wang, Xin-Long; Zhou, Li-Li; Zhou, Feng-Jiao; Li, Rong; Tian, Yuan; Zuo, Zhi-Li; Fang, Ping; Chung, Arthur C K; Hou, Fan-Fan; Cheng, Yong-Xian

2015-12-24

Several Ganoderma fungi are well-known for their medical uses to treat cancer, insomnia and kidney disease in East Asia. Triperpenoids and polysaccharides have been considered for a long time to be the major active components of the genus Ganoderma. The present study is to examine the effects of lingzhilactones from G. lingzhi on adriamycin-induced nephropathy in mice. A combination of various chromatography led to the isolation of lingzhilactones A-C, their structures were identified by spectroscopic and computational methods. The intracellular reactive oxygen species (ROS) was detected with the carboxymethyl-H2-dichlorofluorescein diacetate fluoroprobe. The fibrotic markers were analyzed by real-time RT-PCR and Western blot analyses. Detection of SEAP was conducted with the chemiluminescent. Urine albumin was measured using an ELISA assay. Histology and immunohistochemical staining was used to assess fibrotic lesions in mice. Three new lingzhilactones A-C (1-3) containing a fused lactone moiety were isolated from G. lingzhi. We found that 2 could inhibit ROS generation in a dose-dependent manner, inhibit mRNA expression of collagen IV, fibronectin, IL-6 and increase expression of Nrf2 in rat tubular epithelial cells. Furthermore, we found that 2 could reduce urinary albumin levels, abrogate myofibroblastic activation and inhibit the phosphorylation of Smad3 in adriamycin-induced mice. The in vitro and in vivo results suggested that lingzhilactone B could protect against renal injuries by increasing the activities of antioxidants and inhibiting inflammation. The inhibition of Smad3 phosphorylation suggested that this substance displays in vivo antifibrotic activity by a mechanism that is dependent on disruption of Smad3. These results promote understanding of the traditional usage of G. lingzhi and provide promising findings which may be beneficial for anti-kidney disease drug design. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Measuring medium-induced gluons via jet grooming

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Tywoniuk, Konrad; Mehtar-Tani, Yacine

2017-11-01

Jet substructure observables and applications of jet grooming techniques in heavy-ion collisions are still in its infancy and provide new alleys for studying medium modifications of perturbative degrees of freedom. We note that these measurements, given the right transverse momentum range, can be uniquely sensitive to rare medium-induced emissions inside of the jet cone. This corresponds to an infrared enhancement that would, for instance, affect the distribution of the groomed momentum-sharing variable zg measured using the SoftDrop procedure.

MO-E-17A-02: Incorporation of Contrast Medium Dynamics in Anthropomorphic Phantoms: The Advent of 5D XCAT Models

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Sahbaee, P [NC State University, Raleigh, NC (United States); Samei, E [Duke University Medical Center, Durham, NC (United States); Segars, W [Duke University, Durham, NC (United States)

2014-06-15

Purpose: To develop a unique method to incorporate the dynamics of contrast-medium propagation into the anthropomorphic phantom, to generate a five-dimensional (5D) patient model for multimodality imaging studies. Methods: A compartmental model of blood circulation network within the body was embodied into an extended cardiac-torso (4D-XCAT) patient model. To do so, a computational physiologic model of the human cardiovascular system was developed which includes a series of compartments representing heart, vessels, and organs. Patient-specific cardiac output and blood volume were used as inputs influenced by the weight, height, age, and gender of the patient's model. For a given injection protocol and given XCAT model, the contrast-medium transmission within the body was described by a series of mass balance differential equations, the solutions to which provided the contrast enhancement-time curves for each organ; thereby defining the tissue materials including the contrastmedium within the XCAT model. A library of time-dependent organ materials was then defined. Each organ in each voxelized 4D-XCAT phantom was assigned to a corresponding time-varying material to create the 5D-XCAT phantom in which the fifth dimension is blood/contrast-medium within the temporal domain. Results: The model effectively predicts the time-varying concentration behavior of various contrast-medium administration in each organ for different patient models as function of patient size (weight/height) and different injection protocol factors (injection rate and pattern, iodine concentration or volume). The contrast enhanced XCAT patient models was developed based on the concentration of iodine as a function of time after injection. Conclusion: Majority of medical imaging systems take advantage of contrast-medium administration in terms of better image quality, the effect of which was ignored in previous optimization studies. The study enables a comprehensive optimization of contrast

Early pre-eclampsia unmasks underlying IgA nephropathy

Directory of Open Access Journals (Sweden)

Mona Singh

2010-12-01

Full Text Available Mona Singh, Akhenaton Pappoe, Burl R DonDivision of Nephrology, University of California Davis Medical Center, Sacramento, CA, USAAbstract: Pre-eclampsia is the most ominous complication of pregnancy, and primary glomerular diseases can mimic pre-eclampsia in presentation. A patient presented at 21 weeks gestation with signs and symptoms of both pre-eclampsia and primary glomerular nephropathy. A critical clinical decision whether to continue or terminate the pregnancy was dependent on results of a renal biopsy. The biopsy noted the presence of both pre-eclampsia and immunoglobulin A (IgA nephropathy. Thus, the onset of pre-eclampsia unmasked the presence of unrecognized IgA nephropathy, and the IgA nephropathy was a risk factor for this patient developing pre-eclampsia. The results of a renal biopsy are key in distinguishing pre-eclampsia from other kidney diseases and instituting appropriate clinical management.Keywords: proteinuria, IgA nephropathy, renal biopsy, pre-eclampsia

Combination therapy with rituximab, low-dose cyclophosphamide, and prednisone for idiopathic membranous nephropathy: a case series.

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Cortazar, Frank B; Leaf, David E; Owens, Charles T; Laliberte, Karen; Pendergraft, William F; Niles, John L

2017-02-01

Membranous nephropathy is a common cause of the nephrotic syndrome. Treatment with standard regimens fails to induce complete remission in most patients. We evaluated the efficacy of combination therapy with rituximab, low-dose, oral cyclophosphamide, and an accelerated prednisone taper (RCP) for the treatment of idiopathic membranous nephropathy. We analyzed 15 consecutive patients with idiopathic membranous nephropathy treated with RCP at Massachusetts General Hospital. Seven patients (47%) received RCP as initial therapy, and the other eight patients (53%) received RCP for relapsing or refractory disease. All patients had at least 1 year of follow-up. The co-primary outcomes were attainment of partial and complete remission. Partial remission was defined as a urinary protein to creatinine ratio (UPCR) RCP resulted in high rates of complete remission. Larger studies evaluating this regimen are warranted.

Incipient and overt diabetic nephropathy in African Americans with NIDDM.

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Dasmahapatra, A; Bale, A; Raghuwanshi, M P; Reddi, A; Byrne, W; Suarez, S; Nash, F; Varagiannis, E; Skurnick, J H

1994-04-01

OBJECTIVE--To determine the prevalence of incipient and overt nephropathy in African-American subjects with non-insulin-dependent diabetes mellitus (NIDDM) attending a hospital clinic. Contributory factors, such as blood pressure (BP), duration and age at onset of diabetes, hyperglycemia, hyperlipidemia, and body mass index (BMI) also were evaluated. RESEARCH DESIGN AND METHODS--We recruited 116 African-American subjects with NIDDM for this cross-sectional, descriptive, and analytical study. BP, BMI, 24-h urine albumin excretion, creatinine clearance, serum creatinine, lipids, and GHb levels were measured. Albumin excretion rate (AER) was calculated, and subjects were divided into three groups: no nephropathy (AER 200 micrograms/min). Frequency of hypertension and nephropathy was analyzed by chi 2 testing, group means were compared using analysis of variance, and linear correlations were performed between AER and other variables. Multiple regression analysis was used to examine the association of these variables while controlling for the effects of other variables. RESULTS--Increased AER was present in 50% of our subjects; 31% had incipient and 19% had overt nephropathy. Hypertension was present in 72.4%; nephropathy, particularly overt nephropathy, was significantly more prevalent in the hypertensive group. Mean BP and diastolic blood pressure (dBP) were higher in the groups with incipient and overt nephropathy, and systolic blood pressure (sBP) was increased in overt nephropathy. Men with either form of nephropathy had higher sBP, dBP, and mean BP, whereas only women with overt nephropathy had increased sBP and mean BP. Subjects with incipient or overt nephropathy had a longer duration of diabetes, and those with overt nephropathy had a younger age at onset of diabetes. By multiple regression analysis, AER correlated with younger age at diabetes onset, but not with diabetes duration. No correlation with age, lipid levels, or GHb was noted. BMI correlated with AER

Effects of changes in analytic variables and contrast medium on estimation of glomerular filtration rates by computed tomography in healthy dogs.

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Matsuda, Yuri; Kishimoto, Miori; Kushida, Kazuya; Yamada, Kazutaka; Shimizu, Miki; Itoh, Hiroshi

2017-09-01

OBJECTIVE To investigate effects of changes in analytic variables and contrast medium osmolality on glomerular filtration rate estimated by CT (CT-GFR) in dogs. ANIMALS 4 healthy anesthetized Beagles. PROCEDURES GFR was estimated by inulin clearance, and dogs underwent CT-GFR with iodinated contrast medium (iohexol or iodixanol) in a crossover-design study. Dynamic renal CT scanning was performed. Patlak plot analysis was used to calculate GFR with the renal cortex or whole kidney selected as the region of interest. The renal cortex was analyzed just prior to time of the second cortical attenuation peak. The whole kidney was analyzed 60, 80, 100, and 120 seconds after the appearance of contrast medium. Automated GFR calculations were performed with preinstalled perfusion software including 2 noise reduction levels (medium and strong). The CT-GFRs were compared with GFR estimated by inulin clearance. RESULTS There was no significant difference in CT-GFR with iohexol versus iodixanol in any analyses. The CT-GFR at the renal cortex, CT-GFR for the whole kidney 60 seconds after appearance of contrast medium, and CT-GFR calculated by perfusion software with medium noise reduction did not differ significantly from GFR estimated by inulin clearance. The CT-GFR was underestimated at ≥ 80 seconds after contrast medium appearance (whole kidney) and when strong noise reduction was used with perfusion CT software. CONCLUSIONS AND CLINICAL RELEVANCE Selection of the renal cortex as region of interest or use of the 60-second time point for whole-kidney evaluation yielded the best CT-GFR results. The perfusion software used produced good results with appropriate noise reduction. IMPACT FOR HUMAN MEDICINE The finding that excessive noise reduction caused underestimation of CT-GFR suggests that this factor should also be considered in CT-GFR examination of human patients.

Differences between Drug-Induced and Contrast Media-Induced Adverse Reactions Based on Spontaneously Reported Adverse Drug Reactions.

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Ryu, JiHyeon; Lee, HeeYoung; Suh, JinUk; Yang, MyungSuk; Kang, WonKu; Kim, EunYoung

2015-01-01

We analyzed differences between spontaneously reported drug-induced (not including contrast media) and contrast media-induced adverse reactions. Adverse drug reactions reported by an in-hospital pharmacovigilance center (St. Mary's teaching hospital, Daejeon, Korea) from 2010-2012 were classified as drug-induced or contrast media-induced. Clinical patterns, frequency, causality, severity, Schumock and Thornton's preventability, and type A/B reactions were recorded. The trends among causality tools measuring drug and contrast-induced adverse reactions were analyzed. Of 1,335 reports, 636 drug-induced and contrast media-induced adverse reactions were identified. The prevalence of spontaneously reported adverse drug reaction-related admissions revealed a suspected adverse drug reaction-reporting rate of 20.9/100,000 (inpatient, 0.021%) and 3.9/100,000 (outpatients, 0.004%). The most common adverse drug reaction-associated drug classes included nervous system agents and anti-infectives. Dermatological and gastrointestinal adverse drug reactions were most frequently and similarly reported between drug and contrast media-induced adverse reactions. Compared to contrast media-induced adverse reactions, drug-induced adverse reactions were milder, more likely to be preventable (9.8% vs. 1.1%, p contrast media-induced adverse reactions (56.6%, p = 0.066). Causality patterns differed between the two adverse reaction classes. The World Health Organization-Uppsala Monitoring Centre causality evaluation and Naranjo algorithm results significantly differed from those of the Korean algorithm version II (p contrast media-induced adverse reactions. The World Health Organization-Uppsala Monitoring Centre and Naranjo algorithm causality evaluation afforded similar results.

Clinical application of urodilatin in Type 2 diabetic nephropathy

International Nuclear Information System (INIS)

Zhu Yihua; Cao Xingjian; Chen Yuxiang; Zhang Kexia; Jin Yan

2011-01-01

Objective: To investigate the clinical application of urodilatin (URO) in tubular injury of DM2. Methods: 41 healthy controls, 33 type 2 diabetics without nephropathy, 37 patients with early stage of diabetic nephropathy and 26 patients with clinical diabetic nephropathy were enrolled in the study and categorized into four groups. Urodilatin was measured by radioimmunoassay (RIA). The changes of urodilatin levels among four groups were analyzed, and correlation analyses were performed between urodilatin and urinary micro-albumin/urine creatinine(mA/UCr). The efficiency index of URO were evaluated by receiver operation characteristic (ROC). Results: Compared with those in the controls,diabetics without nephropathy, early stage of diabetic nephropathy and clinical diabetic nephropathy, the urodilatin level decreased significantly in the course of diabetic nephropathy (P<0.001). The value of URO was significantly correlated with mA/UCr (r=-0.626, P<0.01). In early phase of DM2, The area under curve was 0.759. When the cut-off vaule of URO was ≤51.5 pg/ml, The sensitivity and specificity were 67.14% and 70.29%, respectively. Furthermore, Urodilatin had similar diagnosis efficiency with mA/UCr. Conclusion: The decrease of urodilatin level had clinical value in pristine tubular injury of DM2 and can serve as an evaluation parameter. (authors)

Metabonomics revealed xanthine oxidase-induced oxidative stress and inflammation in the pathogenesis of diabetic nephropathy.

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Liu, Jingping; Wang, Chengshi; Liu, Fang; Lu, Yanrong; Cheng, Jingqiu

2015-03-01

Diabetic nephropathy (DN) is a serious complication of diabetes mellitus (DM), which is a major public health problem in the world. To reveal the metabolic changes associated with DN, we analyzed the serum, urine, and renal extracts obtained from control and streptozotocin (STZ)-induced DN rats by (1)H NMR-based metabonomics and multivariate data analysis. A significant difference between control and DN rats was revealed in metabolic profiles, and we identified several important DN-related metabolites including increased levels of allantoin and uric acid (UA) in the DN rats, suggesting that disturbed purine metabolism may be involved in the DN. Combined with conventional histological and biological methods, we further demonstrated that xanthine oxidase (XO), a key enzyme for purine catabolism, was abnormally activated in the kidney of diabetic rats by hyperglycemia. The highly activated XO increased the level of intracellular ROS, which caused renal injury by direct oxidative damage to renal cells, and indirect inducing inflammatory responses via activating NF-κB signaling pathway. Our study highlighted that metabonomics is a promising tool to reveal the metabolic changes and the underlying mechanism involved in the pathogenesis of DN.

A Multicenter Randomized Controlled Trial of Rituximab versus Cyclosporine in the Treatment of Idiopathic Membranous Nephropathy (MENTOR).

Science.gov (United States)

Fervenza, Fernando C; Canetta, Pietro A; Barbour, Sean J; Lafayette, Richard A; Rovin, Brad H; Aslam, Nabeel; Hladunewich, Michelle A; Irazabal, Maria V; Sethi, Sanjeev; Gipson, Debbie S; Reich, Heather N; Brenchley, Paul; Kretzler, Matthias; Radhakrishnan, Jai; Hebert, Lee A; Gipson, Patrick E; Thomas, Leslie F; McCarthy, Ellen T; Appel, Gerald B; Jefferson, J Ashley; Eirin, Alfonso; Lieske, John C; Hogan, Marie C; Greene, Eddie L; Dillon, John J; Leung, Nelson; Sedor, John R; Rizk, Dana V; Blumenthal, Samuel S; Lasic, Lada B; Juncos, Luis A; Green, Dollie F; Simon, James; Sussman, Amy N; Philibert, David; Cattran, Daniel C

2015-01-01

Idiopathic membranous nephropathy remains the leading cause of nephrotic syndrome in Caucasian adults. Immunosuppressive therapy with cyclosporine (CSA) is often successful in reducing proteinuria, but its use is associated with a high relapse rate. Rituximab, a monoclonal antibody that specifically targets CD20 on the surface of B-cells, is effective in achieving a complete remission of proteinuria in patients with idiopathic membranous nephropathy. However, whether rituximab is as effective as CSA in inducing and maintaining complete or partial remission of proteinuria in these patients is unknown. The membranous nephropathy trial of rituximab (MENTOR) hypothesizes that B-cell targeting with rituximab is non-inferior to CSA in inducing long-term remission of proteinuria. Patients with idiopathic membranous nephropathy, proteinuria ≥5 g/24 h, and a minimum of 3 months of Angiotensin-II blockade will be randomized into a 12-month treatment period with i.v. rituximab, 1,000 mg (2 infusions, 14 days apart; repeated at 6 months if a substantial reduction in proteinuria (equal to or >25%) is seen at 6 months) or oral CSA 3.5-5 mg/kg/day for 6 months (continued for another 6 months if a substantial reduction in proteinuria (equal to or >25%) is seen at 6 months). The efficacy of treatment will be assessed by the remission status (based on changes in proteinuria) at 24 months from randomization. Patient safety will be assessed via collection of adverse event data and evaluation of pre- and posttreatment laboratory data. At the 6-month post-randomization visit, patients who have been randomized to either CSA or rituximab but who do not have a reduction in proteinuria ≥25% (confirmed on repeat measurements within 2 weeks) will be considered treatment failures and exit the study. This study will test for the first time whether treatment with rituximab is non-inferior to CSA in inducing long-term remission (complete or partial) of proteinuria in patients with idiopathic

Abnormal albuminuria and blood pressure rise in incipient diabetic nephropathy induced by exercise

DEFF Research Database (Denmark)

Christensen, Cramer

1984-01-01

The aim of the study was to evaluate the influence of light to moderate dynamic work (450 kpm/min followed by 600 kpm/min during 20 min each) on the blood pressure and renal protein handling in insulin-dependent diabetic patients with incipient nephropathy (D3) (elevated baseline albumin excretion...

Acute postirradiation nephropathy

International Nuclear Information System (INIS)

Trojanowski, Z.

1982-01-01

The pathogenesis, morphological and clinical signs of acute postirradiation nephropathy are described with particular attention paid to the relationship between the clinical signs of renal involvement and the dose of radiation. (author)

Endothelin receptor a blockade is an ineffective treatment for adriamycin nephropathy.

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Roderick J Tan

Full Text Available Endothelin is a vasoconstricting peptide that plays a key role in vascular homeostasis, exerting its biologic effects via two receptors, the endothelin receptor A (ETA and endothelin receptor B (ETB. Activation of ETA and ETB has opposing actions, in which hyperactive ETA is generally vasoconstrictive and pathologic. Selective ETA blockade has been shown to be beneficial in renal injuries such as diabetic nephropathy and can improve proteinuria. Atrasentan is a selective pharmacologic ETA blocker that preferentially inhibits ETA activation. In this study, we evaluated the efficacy of ETA blockade by atrasentan in ameliorating proteinuria and kidney injury in murine adriamycin nephropathy, a model of human focal segmental glomerulosclerosis. We found that ETA expression was unaltered during the course of adriamycin nephropathy. Whether initiated prior to injury in a prevention protocol (5 mg/kg/day, i.p. or after injury onset in a therapeutic protocol (7 mg/kg or 20 mg/kg three times a week, i.p., atrasentan did not significantly affect the initiation and progression of adriamycin-induced albuminuria (as measured by urinary albumin-to-creatinine ratios. Indices of glomerular damage were also not improved in atrasentan-treated groups, in either the prevention or therapeutic protocols. Atrasentan also failed to improve kidney function as determined by serum creatinine, histologic damage, and mRNA expression of numerous fibrosis-related genes such as collagen-I and TGF-β1. Therefore, we conclude that selective blockade of ETA by atrasentan has no effect on preventing or ameliorating proteinuria and kidney injury in adriamycin nephropathy.

Autophagy: A Novel Therapeutic Target for Diabetic Nephropathy.

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Kume, Shinji; Koya, Daisuke

2015-12-01

Diabetic nephropathy is a leading cause of end stage renal disease and its occurance is increasing worldwide. The most effective treatment strategy for the condition is intensive treatment to strictly control glycemia and blood pressure using renin-angiotensin system inhibitors. However, a fraction of patients still go on to reach end stage renal disease even under such intensive care. New therapeutic targets for diabetic nephropathy are, therefore, urgently needed. Autophagy is a major catabolic pathway by which mammalian cells degrade macromolecules and organelles to maintain intracellular homeostasis. The accumulation of damaged proteins and organelles is associated with the pathogenesis of diabetic nephropathy. Autophagy in the kidney is activated under some stress conditions, such as oxidative stress and hypoxia in proximal tubular cells, and occurs even under normal conditions in podocytes. These and other accumulating findings have led to a hypothesis that autophagy is involved in the pathogenesis of diabetic nephropathy. Here, we review recent findings underpinning this hypothesis and discuss the advantages of targeting autophagy for the treatment of diabetic nephropathy.

Autophagy: A Novel Therapeutic Target for Diabetic Nephropathy

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Shinji Kume

2015-12-01

Full Text Available Diabetic nephropathy is a leading cause of end stage renal disease and its occurance is increasing worldwide. The most effective treatment strategy for the condition is intensive treatment to strictly control glycemia and blood pressure using renin-angiotensin system inhibitors. However, a fraction of patients still go on to reach end stage renal disease even under such intensive care. New therapeutic targets for diabetic nephropathy are, therefore, urgently needed. Autophagy is a major catabolic pathway by which mammalian cells degrade macromolecules and organelles to maintain intracellular homeostasis. The accumulation of damaged proteins and organelles is associated with the pathogenesis of diabetic nephropathy. Autophagy in the kidney is activated under some stress conditions, such as oxidative stress and hypoxia in proximal tubular cells, and occurs even under normal conditions in podocytes. These and other accumulating findings have led to a hypothesis that autophagy is involved in the pathogenesis of diabetic nephropathy. Here, we review recent findings underpinning this hypothesis and discuss the advantages of targeting autophagy for the treatment of diabetic nephropathy.

The Family Investigation of Nephropathy and Diabetes (FIND): design and methods.

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Knowler, William C; Coresh, Josef; Elston, Robert C; Freedman, Barry I; Iyengar, Sudha K; Kimmel, Paul L; Olson, Jane M; Plaetke, Rosemarie; Sedor, John R; Seldin, Michael F

2005-01-01

The Family Investigation of Nephropathy and Diabetes (FIND) is a multicenter study designed to identify genetic determinants of diabetic nephropathy. It is conducted in eight U.S. clinical centers and a coordinating center, and with four ethnic groups (European Americans, African Americans, Mexican Americans, and American Indians). Two strategies are used to localize susceptibility genes: a family-based linkage study and a case-control study using mapping by admixture linkage disequilibrium (MALD). In the family-based study, probands with diabetic nephropathy are recruited with their parents and selected siblings. Linkage analyses will be conducted to identify chromosomal regions containing genes that influence the development of diabetic nephropathy or related quantitative traits such as serum creatinine concentration, urinary albumin excretion, and plasma glucose concentrations. Regions showing evidence of linkage will be examined further with both genetic linkage and association studies to identify genes that influence diabetic nephropathy or related traits. Two types of MALD studies are being done. One is a case-control study of unrelated individuals of Mexican American heritage in which both cases and controls have diabetes, but only the case has nephropathy. The other is a case-control study of African American patients with nephropathy (cases) and their spouses (controls) unaffected by diabetes and nephropathy; offspring are genotyped when available to provide haplotype data. Identification of genes that influence susceptibility to diabetic nephropathy will lead to a better understanding of how nephropathy develops. This should eventually lead to improved treatment and prevention.

Analytical optimization of digital subtraction mammography with contrast medium using a commercial unit.

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Rosado-Méndez, I; Palma, B A; Brandan, M E

2008-12-01

Contrast-medium-enhanced digital mammography (CEDM) is an image subtraction technique which might help unmasking lesions embedded in very dense breasts. Previous works have stated the feasibility of CEDM and the imperative need of radiological optimization. This work presents an extension of a former analytical formalism to predict contrast-to-noise ratio (CNR) in subtracted mammograms. The goal is to optimize radiological parameters available in a clinical mammographic unit (x-ray tube anode/filter combination, voltage, and loading) by maximizing CNR and minimizing total mean glandular dose (D(gT)), simulating the experimental application of an iodine-based contrast medium and the image subtraction under dual-energy nontemporal, and single- or dual-energy temporal modalities. Total breast-entrance air kerma is limited to a fixed 8.76 mGy (1 R, similar to screening studies). Mathematical expressions obtained from the formalism are evaluated using computed mammographic x-ray spectra attenuated by an adipose/glandular breast containing an elongated structure filled with an iodinated solution in various concentrations. A systematic study of contrast, its associated variance, and CNR for different spectral combinations is performed, concluding in the proposal of optimum x-ray spectra. The linearity between contrast in subtracted images and iodine mass thickness is proven, including the determination of iodine visualization limits based on Rose's detection criterion. Finally, total breast-entrance air kerma is distributed between both images in various proportions in order to maximize the figure of merit CNR2/D(gT). Predicted results indicate the advantage of temporal subtraction (either single- or dual-energy modalities) with optimum parameters corresponding to high-voltage, strongly hardened Rh/Rh spectra. For temporal techniques, CNR was found to depend mostly on the energy of the iodinated image, and thus reduction in D(gT) could be achieved if the spectral energy

The Role of Autophagy in the Pathogenesis of Diabetic Nephropathy

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Kosuke Yamahara

2013-01-01

Full Text Available Diabetic nephropathy is a leading cause of end-stage renal disease worldwide. The multipronged drug approach targeting blood pressure and serum levels of glucose, insulin, and lipids fails to fully prevent the onset and progression of diabetic nephropathy. Therefore, a new therapeutic target to combat diabetic nephropathy is required. Autophagy is a catabolic process that degrades damaged proteins and organelles in mammalian cells and plays a critical role in maintaining cellular homeostasis. The accumulation of proteins and organelles damaged by hyperglycemia and other diabetes-related metabolic changes is highly associated with the development of diabetic nephropathy. Recent studies have suggested that autophagy activity is altered in both podocytes and proximal tubular cells under diabetic conditions. Autophagy activity is regulated by both nutrient state and intracellular stresses. Under diabetic conditions, an altered nutritional state due to nutrient excess may interfere with the autophagic response stimulated by intracellular stresses, leading to exacerbation of organelle dysfunction and diabetic nephropathy. In this review, we discuss new findings showing the relationships between autophagy and diabetic nephropathy and suggest the therapeutic potential of autophagy in diabetic nephropathy.

Contrast-induced nephrotoxicity: possible synergistic effect of stress hyperglycemia.

LENUS (Irish Health Repository)

O'Donnell, David H

2010-07-01

Oxidative stress on the renal tubules has been implicated as a mechanism of injury in both stress hyperglycemia and contrast-induced nephrotoxicity. The purpose of this study was to determine whether the combination of these effects has a synergistic effect on accentuating renal tubular apoptosis and therefore increasing the risk of contrast-induced nephrotoxicity.

Lipid Abnormalities in Type 2 Diabetes Mellitus Patients with Overt Nephropathy

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Viswanathan, Vijay

2017-01-01

Background Diabetic nephropathy is a major complication of diabetes and an established risk factor for cardiovascular events. Lipid abnormalities occur in patients with diabetic nephropathy, which further increase their risk for cardiovascular events. We compared the degree of dyslipidemia among type 2 diabetes mellitus (T2DM) subjects with and without nephropathy and analyzed the factors associated with nephropathy among them. Methods In this retrospective study, T2DM patients with overt nephropathy were enrolled in the study group (n=89) and without nephropathy were enrolled in the control group (n=92). Both groups were matched for age and duration of diabetes. Data on total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), urea and creatinine were collected from the case sheets. TG/HDL-C ratio, a surrogate marker for small, dense, LDL particles (sdLDL) and estimated glomerular filtration rate (eGFR) were calculated using equations. Multivariate analysis was done to determine the factors associated with eGFR. Results Dyslipidemia was present among 56.52% of control subjects and 75.28% of nephropathy subjects (P=0.012). The percentage of subjects with atherogenic dyslipidemia (high TG+low HDL-C+sdLDL) was 14.13 among controls and 14.61 among nephropathy subjects. Though serum creatinine was not significantly different, mean eGFR value was significantly lower among nephropathy patients (P=0.002). Upon multivariate analysis, it was found that TC (P=0.007) and HDL-C (P=0.06) were associated with eGFR among our study subjects. Conclusion Our results show that dyslipidemia was highly prevalent among subjects with nephropathy. Regular screening for dyslipidemia may be beneficial in controlling the risk for adverse events among diabetic nephropathy patients. PMID:28447439

Magnetic Resonance Imaging in degenerative disease of the lumbar spine: Fat Saturation technique and contrast medium.

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D'Aprile, Paola; Nasuto, Michelangelo; Tarantino, Alfredo; Cornacchia, Samantha; Guglielmi, Giuseppe; Jinkins, J Randy

2018-01-19

To examine both anterior and posterior elements of the lumbar spine in patients with low back pain using MRI T2-weighted sequences with Fat Saturation (FS) and contrast enhanced T1-weighted sequences with FS. Two thousand eight hundred and twenty (2820) patients (1628 male, 1192 female, mean age 54) presenting low back pain underwent MRI standard examination (Sagittal T1w TSE and T2w TSE, axial T1 SE) with the addition of sagittal and axial T2w Fat Sat (FS) sequences. Among all the patients, 987 (35%) have been studied adding Contrast Enhanced (CE) T1w FS sequences after administration of contrast medium. Among 987 patients studied with contrast medium, we found: active-inflammatory intervertebral osteochondrosis in 646 (65%) patients; degenerative-inflammatory changes in facet joints (facet joint effusion, synovitis, synovial cysts) in 462 (47%); spondylolysis in 69 (7%); degenerative-inflammatory changes of the flava, interspinous and supraspinous ligaments in 245 (25%); inflammatory changes of posterior perispinal muscles in 84 (8%) patients. In patients with suspected no-disc-related low back pain, the implementation of T2w FS and CE T1w FS sequences to the standard MR protocol could allow a better identification of degenerative-inflammatory changes more likely associated to the pain.

Hemodynamic and tubular changes induced by contrast media.

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Caiazza, Antonella; Russo, Luigi; Sabbatini, Massimo; Russo, Domenico

2014-01-01

The incidence of acute kidney injury induced by contrast media (CI-AKI) is the third cause of AKI in hospitalized patients. Contrast media cause relevant alterations both in renal hemodynamics and in renal tubular cell function that lead to CI-AKI. The vasoconstriction of intrarenal vasculature is the main hemodynamic change induced by contrast media; the vasoconstriction is accompanied by a cascade of events leading to ischemia and reduction of glomerular filtration rate. Cytotoxicity of contrast media causes apoptosis of tubular cells with consequent formation of casts and worsening of ischemia. There is an interplay between the negative effects of contrast media on renal hemodynamics and on tubular cell function that leads to activation of renin-angiotensin system and increased production of reactive oxygen species (ROS) within the kidney. Production of ROS intensifies cellular hypoxia through endothelial dysfunction and alteration of mechanisms regulating tubular cells transport. The physiochemical characteristics of contrast media play a critical role in the incidence of CI-AKI. Guidelines suggest the use of either isoosmolar or low-osmolar contrast media rather than high-osmolar contrast media particularly in patients at increased risk of CI-AKI. Older age, presence of atherosclerosis, congestive heart failure, chronic renal disease, nephrotoxic drugs, and diuretics may multiply the risk of CI-AKI.

A case of pulmonary edema developed after intraarterial injection of iodinated contrast medium

International Nuclear Information System (INIS)

Min, Byoung Chol; Chun, Kang Woo; Koh, Jae Hyu; Yoon, Jong Sup

1982-01-01

Pulmonary edema is a rare adverse reaction to the iodinated contrast medium. Complaining of huge abdominal mass, a 52 years old female was admitted to the Hangang Sungsim Hospital. On physical examination, the patient appeared to be healthy. She had stable vital signs, i.e. BP: 120/80 mmHg, pulse rate: 80/min.etc. An adult head sized mass was palpated in the left mid and lower abdomen. Otherwise nonspecific. On laboratory studies the positive findings were 8-10 WBC/HPF in urine, 25.6 mg/dl for BUN and PVC in EKG. It was negative for urine protein, serum creatinline and liver function test. We injected 100 ml and 30 ml of Urografin 60 through the abdominal aorta dividing 3 times and major branches of the abdominal aorta, respectively. Immediately after complicating angiography, interstitial pulmonary edema was found, showing blurring of the vascular margins, perivascular haziness and thickening of the interlobular septal lines in the both lower lung fields. The blood pressure was dropped to 80/60 mmHg, but pulse rate was normal. She did not complain of dyspnea, and cyanosis was not developed. The urine volume was normally maintained. She was treated for pulmonary edema, which was completely absorbed after 20 hours. And the blood pressure was also normalized. We have experienced a case of pulmonary edema developed after intraarterial injection of the iodinated contrast medium without underlying cardiac, renal and hepatic problems, and reviewed the literatures on mechanisms of pulmonary edema caused by intravascular injection of the iodinated contrast materials

Fluctuations in eGFR in relation to unenhanced and enhanced MRI and CT outpatients

DEFF Research Database (Denmark)

Azzouz, Manal; Rømsing, Janne; Thomsen, Henrik S

2014-01-01

OBJECTIVE: To study fluctuations in estimated glomerular filtration rate (eGFR) in relation to contrast medium (CM) enhanced magnetic resonance imaging (MRI) and computed tomography (CT) compared to control groups in outpatients. MATERIALS AND METHODS: eGFR was determined right before the imaging......-induced nephropathy (CIN) requirement when the definition s-creatinine ≥44μmol/l (0.5mg/dl) was used. CONCLUSIONS: eGFR in outpatients undergoing MRI or CT did vary independently of whether the patient received contrast or not. The findings probably reflect the natural variations in s-creatinine levels. This should...

Inhibition of STAT3 Signaling Reduces IgA1 Autoantigen Production in IgA Nephropathy

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Koshi Yamada

2017-11-01

Discussion: Our results revealed that IL-6−induced aberrant activation of STAT3-mediated overproduction of galactose-deficient IgA1. STAT3 signaling pathway may thus represent a new target for disease-specific therapy of IgA nephropathy.

Clinical cardiovascular experiences with iopamidol: a new non-ionic contrast medium

International Nuclear Information System (INIS)

Partridge, J.B.; Robinson, P.J.; Turnbull, C.M.; Stoker, J.B.; Morrison, G.W.; Boyle, R.M.

1981-01-01

Iopamidol, a new non-ionic water-soluble contrast medium, has been compared with standard ionic media in a number of cardiovascular applications. It is stable in aqueous solution, is much less viscous and only slightly more osmolar than metrizamide. Compared to sodium meglumine diatrizoate in a series of 40 coronary arteriograms, it produced a consistent and highly significant decrease in the incidence and severity of hypotension and bradycardia following intracoronary injection. In the same group and in 62 children undergoing ventricular or great vessel angiocardiography, a subjective assessment of patient reaction showed that iopamidol was better tolerated than the ionic medium. There was a very strong patient preference for iopamidol in a group of 10 of the adult patients who had also consented to femoral artery injections of both media. Throughout these series there was no detectable difference in arterial image quality between the media. Venous phase opacification during arterioportography was assessed in 11 cases comparing iopamidol with sodium meglumine iothalamate. No significant difference was found. We conclude that iopamidol is clearly preferable to ionic media for routine cardiovascular applications. (author)

Rice bran protein hydrolysates attenuate diabetic nephropathy in diabetic animal model.

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Boonloh, Kampeebhorn; Lee, Eun Soo; Kim, Hong Min; Kwon, Mi Hye; Kim, You Mi; Pannangpetch, Patchareewan; Kongyingyoes, Bunkerd; Kukongviriyapan, Upa; Thawornchinsombut, Supawan; Lee, Eun Young; Kukongviriyapan, Veerapol; Chung, Choon Hee

2018-03-01

Diabetic nephropathy (DN) is an important microvascular complication of uncontrolled diabetes. The features of DN include albuminuria, extracellular matrix alterations, and progressive renal insufficiency. Rice bran protein hydrolysates (RBPs) have been reported to have antihyperglycemic, lipid-lowering, and anti-inflammatory effects in diabetic rats. Our study was to investigate the renoprotective effects of RBP in diabetic animals and mesangial cultured cells. Eight-week-old male db/m and db/db mice were orally treated with tap water or RBP (100 or 500 mg/kg/day) for 8 weeks. At the end of the experiment, diabetic nephropathy in kidney tissues was investigated for histological, ultrastructural, and clinical chemistry changes, and biomarkers of angiogenesis, fibrosis, inflammation, and antioxidant in kidney were analyzed by Western blotting. Protection against proangiogenic proteins and induction of cytoprotection by RBP in cultured mesangial cells was evaluated. RBP treatment improved insulin sensitivity, decreased elevated fasting serum glucose levels, and improved serum lipid levels and urinary albumin/creatinine ratios in diabetic mice. RBP ameliorated the decreases in podocyte slit pore numbers, thickening of glomerular basement membranes, and mesangial matrix expansion and suppressed elevation of MCP-1, ICAM-1, HIF-1α, VEGF, TGF-β, p-Smad2/3, and type IV collagen expression. Moreover, RBP restored suppressed antioxidant Nrf2 and HO-1 expression. In cultured mesangial cells, RBP inhibited high glucose-induced angiogenic protein expression and induced the expression of Nrf2 and HO-1. RBP attenuates the progression of diabetic nephropathy and restored renal function by suppressing the expression of proangiogenic and profibrotic proteins, inhibiting proinflammatory mediators, and restoring the antioxidant and cytoprotective system.

Clinically Significant Contrast Induced Acute Kidney Injury after Non-Emergent Cardiac Catheterization - Risk Factors and Impact on Length of Hospital Stay

International Nuclear Information System (INIS)

Kashif, W.; Yaqub, S.; Khawaja, A.

2013-01-01

Objective: To evaluate the frequency and risk factors associated with clinically significant contrast-induced nephropathy (CIN) in patients undergoing non-emergent coronary angiography. Study Design: Descriptive study. Place and Duration of Study: The Aga Khan University Hospital, Karachi, from January 2005 to December 2007. Methodology: Case records of patients who underwent coronary angiography with a serum creatinine of >= 1.5 mg/dl at the time of procedure were evaluated. Clinically significant contrast induced nephropathy (CSCIN) was defined as either doubling of serum creatinine from baseline value within a week following the procedure or need for emergency hemodialysis after the procedure. Results: One hundred and sixteen patients met the inclusion criteria. Mean age was 64.0 +- 11.5 years, 72% were males. Overall prevalence of CIN was 17% (rise of serum creatinine by A= 0.5 mg/dl) while that of clinically significant CIN (CSCIN) was 9.5% (11 patients). Patients with CSCIN had significantly lower left ventricular ejection fraction (p = 0.03, OR: 0.24; 95% CI = 0.06 A= 0.91) and higher prevalence of cerebrovascular disease (p < 0.001, OR: 14.66; 95% CI = 3.30 - 65.08). Mean baseline serum creatinine was significantly higher, 3.0 +- 1.5 vs. 2.0 +- 1.1 mg/dl (p = 0.03, OR: 1.47; 95% CI = 1.03 - 2.11) whereas mean GFR estimated by Cockcroft-Gault formula was significantly lower at 25 +- 7.4 vs. 41.0 +- 14.6 ml/minute (p = 0.001, OR = 0.89, 95% CI = 0.84 A= 0.95) at the time of procedure in patients with CSCIN. Mean length of hospital stay was significantly higher in this group compared to those without CIN, 9.0 +- 5.1 vs. 3.0 +- 3.2 days (p = 0.001, OR = 1.31, 95% CI = 1.12 - 1.54). Multivariate analysis revealed low GFR (p = 0.001, OR = 0.88; 95% CI = 0.82 - 0.95) and low ejection fraction (p = 0.03, OR = 0.20; 95% CI = 0.04 - 0.91) to be independent factors associated with CSCIN. No significant differences were noted between the two groups in patients with

Contrast-induced acute kidney injury: how much contrast is safe?

LENUS (Irish Health Repository)

Keaney, John J

2013-02-14

Iodinated contrast media (CM) are used in many investigations that a patient may undergo during the course of an in-patient stay. For the vast majority of patients, exposure to CM has no sequelae; however, in a small percentage, it can result in a worsening in renal function termed contrast-induced acute kidney injury (CI-AKI). CI-AKI is one of the leading causes of in-hospital renal dysfunction. It is associated with a significant increase in morbidity and mortality as well as an increased length of hospital stay and costs. Unfortunately, the results of extensive research into pharmacological inventions to prevent CI-AKI remain disappointing. In this article, we briefly outline the pathophysiological mechanisms by which iodinated CM may cause CI-AKI and discuss the evidence for reducing CI-AKI by limiting contrast volumes. In particular, we review the data surrounding the use of contrast volume to glomerular filtration rate ratios, which can be used by clinicians to effectively lower the incidence of CI-AKI in their patients.

Abdominal multi-detector row CT: Effectiveness of determining contrast medium dose on basis of body surface area

International Nuclear Information System (INIS)

Onishi, Hiromitsu; Murakami, Takamichi; Kim, Tonsok; Hori, Masatoshi; Osuga, Keigo; Tatsumi, Mitsuaki; Higashihara, Hiroki; Maeda, Noboru; Tsuboyama, Takahiro; Nakamoto, Atsushi; Tomoda, Kaname; Tomiyama, Noriyuki

2011-01-01

Purpose: To investigate the validity of determining the contrast medium dose based on body surface area (BSA) for the abdominal contrast-enhanced multi-detector row CT comparing with determining based on body weight (BW). Materials and methods: Institutional review committee approval was obtained. In this retrospective study, 191 patients those underwent abdominal contrast-enhanced multi-detector row CT were enrolled. All patients received 96 mL of 320 mg I/mL contrast medium at the rate of 3.2 mL. The iodine dose required to enhance 1 HU of the aorta at the arterial phase and that of liver parenchyma at portal venous phase per BSA were calculated (EU BSA ) and evaluated the relationship with BSA. Those per BW were also calculated (EU BW ) and evaluated. Estimated enhancement values (EEVs) of the aorta and liver parenchyma with two protocols for dose decision based on BSA and BW were calculated and patient-to-patient variability was compared between two protocols using the Levene test. Results: The mean of EU BSA and EU BW were 0.0621 g I/m 2 /HU and 0.00178 g I/kg/HU for the aorta, and 0.342 g I/m 2 /HU and 0.00978 g I/kg/HU for the liver parenchyma, respectively. In the aortic enhancement, EU BSA was almost constant regardless of BSA, and the mean absolute deviation of the EEV with the BSA protocol was significantly lower than that with the BW protocol (P < .001), although there was no significant difference between two protocols in the hepatic parenchymal enhancement (P = .92). Conclusion: For the aortic enhancement, determining the contrast medium dose based on BSA was considered to improve patient-to-patient enhancement variability.

Cytogenetic effects of cardioangiography on blood lymphocytes in children and in vitro effects of contrast medium and low dose radiation

International Nuclear Information System (INIS)

Nikula, E.; Kiviniitty, K.

1987-01-01

Structural chromosome aberrations were analysed in the peripheral blood lymphocytes of 15 children, aged 1 to 13 years, before, immediately after, 24 hours after and 6 to 8 months after cardioangiographic examination. Statistically significant increases were only demonstrated in the frequency of gaps and, consequently, in the frequency of aberrant cells immediately after cardioangiography. Most of the chromosome damage clearly disappeared within 24 hours. In addition, whole blood cultures were exposed in vitro to low dose radiation, a contrast medium, and radiation together with the contrast medium. No statistically significant differences could be observed in the chromosome aberration frequencies. It was concluded that the modern radiographic procedure, which uses very low radiation doses and less contrast medium, does not cause a consistent, permanent increase of chromosomal damage in the lymphocytes of children. However, the situation may be different if the child undergoes many radiography examinations or the radiation doses are high. (orig./MG)

Relationship between serum IV-C, β2-m levels and diabetic nephropathy

International Nuclear Information System (INIS)

Liu Lu; Zhang Mukun

2005-01-01

Objective: To investigate the relationship between the serum type IV collagen (IV-C), β 2 -micro globulin (β 2 -m) levels and diabetic nephropathy. Methods: Serum IV-C, β 2 -m levels were measured with RIA in 30 controls and 86 patients with type 2 diabetics mellitus (35 with diabetic nephropathy and 51 without nephropathy). Results: the serum levels of IV-C and β 2 -m in diabetic patients with nephropathy were significantly higher than those in controls (P 0.05). Conclusion: Serum IV-C and β 2 -m levels increased gradually as the diabetic nephropathy got more severe. They could be a sensitive marker for early diagnosis of development of diabetic nephropathy. (authors)

Adriamycin nephrosis and contrast media

International Nuclear Information System (INIS)

Thomsen, H.S.; Golman, K.; Hemmingsen, L.; Larsen, S.; Skaarup, P.; Koebenhavns Amts Sygehus, Herlev; Koebenhavns Amts Sygehus, Herlev; Centralsygehuset, Nykoebing Falster; Malmoe Allmaenna Sjukhus

1990-01-01

Urine profiles (albumin, glucose, NAG, LDH, GGT and sodium) were followed for 9 days after intravenous injection of either diatrizoate, iohexol, or saline in 27 Wistar rats with nephrosis induced by Adriamycin 42 days before. Another 9 rats exposed to neither Adriamycin nor contrast media served as controls. None of the contrast media caused further increased albuminuria of significance, whereas both induced significantly increased excretion of all 5 tubular components. The excretion of NAG and sodium was significantly higher following diatrizoate than following iohexol. From 24 h post injection there was no significantly greater excretion of any of the components after either diatrizoate or iohexol than after saline among the rats given Adriamycin. At the end of day 9 after contrast medium injection neither serum sodium, potassium, glucose, urea, creatinine, nor albumin revealed any contrast media related changes. Kidney histology showed quantitatively larger lesions in kidneys exposed to Adriamycin and contrast media than in kidneys exposed to Adriamycin and saline. There were no differences between the two contrast media groups. It is thus concluded, that both high osmolar ionic and low osmolar non-ionic contrast media cause temporary tubular dysfunction but no further glomerular dysfunction in rats with nephrosis induced by Adriamycin. The histologic findings indicate that both media may worsen non-reversible renal lesions. (orig.)

Effect of pregnancy on diabetic nephropathy and retinopathy

International Nuclear Information System (INIS)

Irfan, S.; Arain, M.; Shahid, A.; Shaukat, A.

2004-01-01

Objective: To determine whether pregnancy worsens renal function in women with diabetic nephropathy and the effect of pregnancy on diabetic retinopathy. Subject and Methods: Thirty-five patients (aged 20-36 years) identified with diabetic nephropathy and moderate to severe renal dysfunction (creatinine Cr) - > 1.4 mg/dl) at pregnancy onset by retrospective chart review. Alterations in glomerular filtration rate (GFR) were estimated. An equal number of non-pregnant premenopausal type I diabetic women with similar degrees of renal dysfunction served as controls for non-pregnant rate of decline of renal function and potential contributing factors. Student's t-test and repeated measures analysis of variance were analyzed. Results: Mean serum Cr rose from 1.8 mg/dl pre pregnancy to 2.5 mg/dl in the third trimester. Renal function was stable in 27%, showed transient worsening in pregnancy in 27%, and demonstrated a permanent decline in 45%. Proteinuria increased in pregnancy in 79%. Exacerbation of hypertension or pre-eclampsia occurred in 73% and 71% of these showed acceleration of disease during the pregnancy. All the patients had diabetic retinopathy, though proliferative retinopathy was diagnosed and treated in only 54.5.% pre pregnancy. The retinopathy progressed, requiring laser therapy, in 45.4%. Macular edema was noted in 6 of the patients. Other diabetic complications included peripheral and autonomic neuropathy in 8 patients. Conclusion: Pregnancy induced progression is seen in the decline of renal functions. Patients with diabetic nephropathy were found to have a > 40% chance of accelerated progression of their disease as a result of pregnancy. Forty-five percent of the patients had permanent decline in GFR in association with pregnancy. (author)

Grave's disease associated with immunoglobulin A nephropathy: A rare association.

Science.gov (United States)

Khan, I; Bhat, R A; Khan, I; Hameed, I

2015-01-01

Immunoglobulin A (Ig A) nephropathy is the most common form of primary glomerulonephritis. The association of Ig A nephropathy with Grave's disease has not been reported so far. We report a case of 20-year-old female with Grave's disease who presented with edema, facial puffiness, and decreased urine output. She was found to be hypertensive with renal failure and nephrotic range proteinuria. Renal biopsy revealed features of Ig A nephropathy. The patient was treated with oral corticosteroids (1 mg/kg/day). To our knowledge, this is the first case showing association of Grave's disease with Ig A nephropathy.

Polysorbate 80 and low-osmolality water-soluble contrast medium enema in diagnosis and treatment of faecal obstruction in malignant phaeochromocytoma

International Nuclear Information System (INIS)

Ratcliffe, J.F.

1986-01-01

Stercoral obstruction in a young woman with disseminated phaeochromocytoma was diagnosed and treated successfully using an enema of isosmolar iohexol (Omnipaque) and 1% polysorbate 80 (Tween 80) without complication. Surgical intervention was thus avoided. A low osmolality water-soluble contrast medium (iohexol 150 mg I/ml) with a wetting agent (1% Tween 80) was used because a barium suspension would have inspissated, exacerbating the constipation and a hyperosmolar contrast medium might have precipitated a hypertensive crisis and destablished her critical salt and water balance. (orig.)

Perforations during contrast enema

International Nuclear Information System (INIS)

Vogel, H.; Steinkamp, U.; Grabbe, E.; Allgemeines Krankenhaus Ochsenzoll, Hamburg

1983-01-01

During contrast enema, perforation into the retroperitoneal space can be differentiated from perforation into the peritoneum and perforation into the intestinal wall associated with formation of barium granulomas or submucosal spreading of the contrast medium. Other special forms are perforation with contrast medium embolism of diverticula; of the processus vermiformis; penetration of contrast medium into fistulous systems and from the operated areas. Risk factors are: balloon catheter, intestinal tubes with a hard tip, preternatural anus, excessive enema pressure, contrast medium additions, preceding manipulations, intestinal diseases, advanced age and delegation of manipulations to assistants and unskilled staff. Children are particularly at risk. (orig.) [de

Antioxidant treatment attenuates lactate production in diabetic nephropathy

DEFF Research Database (Denmark)

Laustsen, Christoffer; Nielsen, Per Mose; Stokholm Nørlinger, Thomas

2017-01-01

-IDEAL spiral sequence. Untreated diabetic rats showed increased renal lactate production compared with that shown by the controls. However, chronic TEMPOL treatment significantly attenuated diabetes-induced lactate production. No significant effects of diabetes or TEMPOL were observed on [13C]alanine levels......, indicating an intact glucose-alanine cycle, or [13C]bicarbonate, indicating normal flux through the Krebs cycle. In conclusion, this study demonstrates that diabetes-induced pseudohypoxia, as indicated by an increased lactate-to-pyruvate ratio, is significantly attenuated by antioxidant treatment......The early progression of diabetic nephropathy is notoriously difficult to detect and quantify before the occurrence of substantial histological damage. Recently, hyperpolarized [1-13C]pyruvate has demonstrated increased lactate production in the kidney early after the onset of diabetes, implying...

Electromagnetically Induced Transparency In Rydberg Atomic Medium

Science.gov (United States)

Deng, Li; Cong, Lu; Chen, Ai-Xi

2018-03-01

Due to possessing big principal quantum number, Rydberg atom has some unique properties, for example: its radiative lifetime is long, dipole moment is large, and interaction between atoms is strong and so on. These properties make one pay attention to Rydberg atoms. In this paper we investigate the effects of Rydberg dipole-dipole interactions on electromagnetically induced transparency (EIT) schemes and group velocity in three-level systems of ladder type, which provides theoretical foundation for exploring the linear and nonlinear characteristics of light in a Rydberg electromagnetically-induced-transparency medium.

Prolonged carotid sinus reflex is a risk factor for contrast-induced nephropathy following carotid artery stenting.

Science.gov (United States)

Kato, T; Sakai, H; Tsujimoto, M; Nishimura, Y

2011-03-01

Although many studies have demonstrated that CIN is associated with in-hospital and long-term mortality, the incidence of CIN following CAS is unclear. We investigated the incidence of CIN, defined as an increase from a baseline creatinine value of at least 0.5 mg/dL or 25% within 72 hours of contrast administration, and we also examined renal function in the late phase after CAS. We examined 80 patients who underwent CAS between April 2005 and December 2009. Clinical background, laboratory data, contrast volume, and clinical course were collected and analyzed. The incidence of CIN was 8.8% (7/80), and no patients required hemodialysis. In the group that developed CIN, prolonged CSR after CAS was found in 57.1% (4/7) of cases; this incidence differed significantly (P = .001) from that in the group without development of CIN. Neither preoperative renal function, contrast volume, nor history was related to the incidence of CIN, while on multivariate analysis, prolonged CSR was found to be an independent risk factor for CIN. The incidence of elevation in creatinine values at 6 months after CAS was 8.2% (6/73). All patients who developed delayed renal impairment had pre-existing CKD; this finding differed significantly (P = .04) from that in the group without development of delayed renal impairment. Because patients who develop prolonged CSR after CAS are at increased risk of perioperative major adverse clinical events including CIN, patients at high risk for this condition should be carefully managed to prevent increased morbidity and mortality.

Nuclear magnetic resonance diagnosis of cerebral tumours with the use of the contrast medium gadolinium-DTPA

International Nuclear Information System (INIS)

Schoerner, W.; Felix, R.; Claussen, C.; Fiegler, W.; Kazner, E.; Speck, U.; Niendorf, H.P.

1984-01-01

This study examines the effect of the NMR contrast medium gadolinium-DTPA on image contrast in cerebral tumours. Sixteen patients with space-occupying cerebral lesions were examined on a 0.35 Tesla superconducting scanner, using a T1-weighted spinecho sequence prior to and after the intravenous application of gadolinium-DTPA. In 8 patients T2-weighted spinecho-sequences were obtained before the administration of contrast. The tomograms were evaluated visually and according to quantitative criteria. The use of gadolinium-DTPA helps to evaluate the blood-brain barrier and improves diagnosis by differentiating tumour tissue from edema and from normal brain tissue. (orig.) [de

Lycium chinense leaves extract ameliorates diabetic nephropathy by suppressing hyperglycemia mediated renal oxidative stress and inflammation.

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Olatunji, Opeyemi Joshua; Chen, Hongxia; Zhou, Yifeng

2018-06-01

Diabetic nephropathy is one of the most serious and most frequently encountered diabetic complication, accounting for the highest cause of end-stage renal disease. This present study was aimed at exploring the protective/attenuative effect of Lycium chinense leaf extract (MELC) on streptozotocin induced diabetic nephropathy in experimental Sprague Dawley rats. The oral administration of diabetic rats with MELC markedly ameliorated renal dysfunction as observed in the significant reduction in the serum levels of creatinine, blood urea nitrogen (BUN), albumin and TGF-β1 as compared to the untreated diabetic control rats. In addition, the elevated levels of renal oxidative stress markers and pro-inflammatory parameters (GSH, SOD, CAT, MDA, TNF-α, IL-6 and IL-1β) were significantly reduced in MELC treated diabetic rats. The results obtained in this study suggests that L. chinense leaf might have the potential as possible pharmacological agent against diabetic nephropathy by suppressing renal oxidative stress and inflammation. Copyright © 2018. Published by Elsevier Masson SAS.

20-HETE and EETs in Diabetic Nephropathy: A Novel Mechanistic Pathway

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Eid, Stephanie; Maalouf, Rita; Jaffa, Ayad A.; Nassif, Joseph; Hamdy, Ahmed; Rashid, Awad; Ziyadeh, Fuad N.; Eid, Assaad A.

2013-01-01

Diabetic nephropathy (DN), a major complication of diabetes, is characterized by hypertrophy, extracellular matrix accumulation, fibrosis and proteinuria leading to loss of renal function. Hypertrophy is a major factor inducing proximal tubular epithelial cells injury. However, the mechanisms leading to tubular injury is not well defined. In our study, we show that exposure of rats proximal tubular epithelial cells to high glucose (HG) resulted in increased extracellular matrix accumulation and hypertrophy. HG treatment increased ROS production and was associated with alteration in CYPs 4A and 2C11 expression concomitant with alteration in 20-HETE and EETs formation. HG-induced tubular injury were blocked by HET0016, an inhibitor of CYPs 4A. In contrast, inhibition of EETs promoted the effects of HG on cultured proximal tubular cells. Our results also show that alteration in CYPs 4A and 2C expression and 20HETE and EETs formation regulates the activation of the mTOR/p70S6Kinase pathway, known to play a major role in the development of DN. In conclusion, we show that hyperglycemia in diabetes has a significant effect on the expression of Arachidonic Acid (AA)-metabolizing CYPs, manifested by increased AA metabolism, and might thus alter kidney function through alteration of type and amount of AA metabolites. PMID:23936373

Genetic Deletion of Soluble Epoxide Hydrolase Attenuates Inflammation and Fibrosis in Experimental Obstructive Nephropathy

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Chin-Wei Chiang

2015-01-01

Full Text Available Soluble epoxide hydrolase (sEH is abundantly expressed in kidney and plays a potent role in regulating inflammatory response in inflammatory diseases. However, the role of sEH in progression of chronic kidney diseases such as obstructive nephropathy is still elusive. In current study, wild-type (WT and sEH deficient (sEH−/− mice were subjected to the unilateral ureteral obstruction (UUO surgery and the kidney injury was evaluated by histological examination, western blotting, and ELISA. The protein level of sEH in kidney was increased in UUO-treated mice group compared to nonobstructed group. Additionally, UUO-induced hydronephrosis, renal tubular injury, inflammation, and fibrosis were ameliorated in sEH−/− mice with the exception of glomerulosclerosis. Moreover, sEH−/− mice with UUO showed lower levels of inflammation-related and fibrosis-related protein such as monocyte chemoattractant protein-1, macrophage inflammatory protein-2, interleukin-1β (IL-1β, IL-6, inducible nitric oxide synthase, collagen 1A1, and α-actin. The levels of superoxide anion radical and hydrogen peroxide as well as NADPH oxidase activity were also decreased in UUO kidneys of sEH−/− mice compared to that observed in WT mice. Collectively, our findings suggest that sEH plays an important role in the pathogenesis of experimental obstructive nephropathy and may be a therapeutic target for the treatment of obstructive nephropathy-related diseases.

Barium sulfate aspiration: Severe chemical pneumonia induced by a massive reflux of contrast medium during small bowel barium enema.

Science.gov (United States)

Zhang, Lin; Yang, Yi; Zhang, Ji; Zhou, Xiaowei; Dong, Hongmei; Zhou, Yiwu

2015-08-01

Barium contrast radiography is a conventional procedure aimed at revealing lesions of the alimentary tract using barium sulfate on X-ray irradiation. Although it is widely used in clinics, adverse effects and complications are observed, such as anaphylaxis, granuloma, fecalithes, abdomen-leaking, embolism, bacterial contamination, and aspiration. We report a case of death due to a massive barium sulfate aspiration resulted from an air-barium double contrast enema radiography. A 25-year-old female patient was hospitalized with symptoms of abdominal distention, nausea, vomiting and diarrhea for three days. A progressive respiratory distress presented only 1h after a small bowel air-barium double contrast enema. The patient died 11h later. The result of autopsy revealed the cause of death to be severe chemical pneumonitis induced by gastric fluid which was aspirated into her lungs. Barium sulfate is generally recognized to be chemically inert for the respiratory system, but a mixture of barium sulfate with gastric contents is fatal. Here we intend to suggest that, when determining the potential cause of death, medical examiners should consider a patient's status quo as well as the possible adverse effects and complications caused by the barium sulfate preparation during gastrointestinal radiography. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Radiation-induced organogenesis: effects of irradiated medium and its components on tobacco tissue culture

International Nuclear Information System (INIS)

Degani, N.

1975-01-01

Gamma irradiated medium induces the formation of buds in non-irradiated dark growth tobacco callus (Nicotiana tabacum Var. Wisconsin No.38). Experiments were conducted to determine the component(s) of the medium that is effective in this radiation-induced organogenesis. Fraction of medium were irradiated singly and in combination, then combined with non-irradiated fractions to form the complete growth medium. The results showed that irradiated indoleacetic acid (IAA) was not the effective component in the induction of organogensis. Omission of IAA from the medium resulted in the formation of buds, as expected. Irradiated myo-inositol induced organogenesis more consistently than the other irradiated components. The age of the inoculum tissue and its passage number from the tobacco stem affected the potency of the tobacco callus to organise. (author)

Decrease in toe pinch force in male type 2 diabetic patients with diabetic nephropathy.

Science.gov (United States)

Kataoka, Hiroaki; Miyatake, Nobuyuki; Kitayama, Naomi; Murao, Satoshi; Tanaka, Satoshi

2018-06-01

The purpose of this cross-sectional study was to investigate the toe pinch force (TPF) of type 2 diabetic patients with diabetic nephropathy by disease stage, and to clarify the factors affecting the TPF. Seventy-four men with diabetic nephropathy (age: 62.7 ± 8.9 years, duration of diabetes: 14.2 ± 8.6 years) were enrolled. According to the staging of diabetic nephropathy, TPF and knee extension force (KEF) were compared among three groups: normoalbuminuria, microalbuminuria, and overt nephropathy. In addition, we investigated factors influencing TPF and KEF by performing multiple regression analysis. Normoalbuminuria group, microalbuminuria group, and overt nephropathy group included 26, 25, and 23 patients, respectively. The TPF of the overt nephropathy group (3.15 ± 0.75 kg) was significantly lower than that of the normoalbuminuria (4.2 ± 0.7 kg, p diabetic polyneuropathy (DPN) and diabetic nephropathy were determinant factors of the TPF; and age, body mass index, and diabetic nephropathy were determinant factors of the KEF. We found in male patients with diabetic nephropathy, the TPF and KEF decreased with progression of diabetic nephropathy. Furthermore, our findings suggest diabetic nephropathy and DPN are critically involved in the reduction of TPF and KEF.

Microvascular resistance in response to iodinated contrast media in normal and functionally impaired kidneys.

Science.gov (United States)

Kurihara, Osamu; Takano, Masamichi; Uchiyama, Saori; Fukuizumi, Isamu; Shimura, Tetsuro; Matsushita, Masato; Komiyama, Hidenori; Inami, Toru; Murakami, Daisuke; Munakata, Ryo; Ohba, Takayoshi; Hata, Noritake; Seino, Yoshihiko; Shimizu, Wataru

2015-12-01

Contrast-induced nephropathy (CIN) is considered to result from intrarenal vasoconstriction, and occurs more frequently in impaired than in normal kidneys. It was hypothesized that iodinated contrast media would markedly change renal blood flow and vascular resistance in functionally impaired kidneys. Thirty-six patients were enrolled (32 men; mean age, 75.3 ± 7.6 years) undergoing diagnostic coronary angiography and were divided into two groups based on the presence of chronic kidney disease (CKD), defined as an estimated glomerular filtration rate (eGFR) of contrast media. The APV and the RI were positively and inversely correlated with the eGFR at baseline, respectively (APV, R = 0.545, P = 0.001; RI, R = -0.627, P contrast media administration in the non-CKD group, but not in the CKD group (APV, P = 0.258; RI, P = 0.707). Although renal arterial resistance was higher in patients with CKD, it was not affected by contrast media administration, suggesting that patients with CKD could have an attenuated response to contrast media. © 2015 The Authors. Clinical and Experimental Pharmacology and Physiology Published by Wiley Publishing Asia Pty Ltd.

Experimental investigations on the influence of the contrast medium Iopamiro 300 mixed with vegetal mucus on the nasolacrimal system and external eye tissues

International Nuclear Information System (INIS)

Rubaj, B.; Koper, S.; Wolski, T.; Toczowski, J.; Wolski, J.; Langwinska-Wosko, E.

1994-01-01

Using low osmolality, nonionized contrast medium Iopamiro-300, Bracco mixed with the mucus prepared from the seed flax (''Linum usitatissimum, L.''), a dacryocistorhinography was performed experimentally on 8 healthy mongrel dogs. Assessing the occurrence of local and general complications was the aim of the investigation. On the basis of a radiographic examination it has been shown that the mixture of the contrast medium and seed flax mucus appeared to be a very useful compound for dacryocistorhinography, especially for the evaluation of nasolacrimal duct system course and its patency. Clinical observations and a histological examination proved that this compound of the contrast medium was well tolerated by the mucous membrane of the nasolacrimal system and the external eye tissues. (author). 21 refs, 4 figs

Endemic Nephropathy Around the World.

Science.gov (United States)

Gifford, Fiona J; Gifford, Robert M; Eddleston, Michael; Dhaun, Neeraj

2017-03-01

There have been several global epidemics of chronic kidney disease of unknown etiology (CKD u ). Some, such as Itai-Itai disease in Japan and Balkan endemic nephropathy, have been explained, whereas the etiology of others remains unclear. In countries such as Sri Lanka, El Salvador, Nicaragua, and India, CKD u is a major public health problem and causes significant morbidity and mortality. Despite their geographical separation, however, there are striking similarities between these endemic nephropathies. Young male agricultural workers who perform strenuous labor in extreme conditions are the worst affected. Patients remain asymptomatic until end-stage renal failure. Biomarkers of tubular injury are raised, and kidney biopsy shows chronic interstitial nephritis with associated tubular atrophy. In many of these places access to dialysis and transplantation is limited, leaving few treatment options. In this review we briefly describe the major historic endemic nephropathies. We then summarize the epidemiology, clinical features, histology and clinical course of CKD u in Mesoamerica, Sri Lanka, India, Egypt, and Tunisia. We draw comparisons between the proposed etiologies and supporting research. Recognition of the similarities may reinforce the international drive to establish causality and to effect prevention.

Endemic Nephropathy Around the World

Directory of Open Access Journals (Sweden)

Fiona J. Gifford

2017-03-01

Full Text Available There have been several global epidemics of chronic kidney disease of unknown etiology (CKDu. Some, such as Itai-Itai disease in Japan and Balkan endemic nephropathy, have been explained, whereas the etiology of others remains unclear. In countries such as Sri Lanka, El Salvador, Nicaragua, and India, CKDu is a major public health problem and causes significant morbidity and mortality. Despite their geographical separation, however, there are striking similarities between these endemic nephropathies. Young male agricultural workers who perform strenuous labor in extreme conditions are the worst affected. Patients remain asymptomatic until end-stage renal failure. Biomarkers of tubular injury are raised, and kidney biopsy shows chronic interstitial nephritis with associated tubular atrophy. In many of these places access to dialysis and transplantation is limited, leaving few treatment options. In this review we briefly describe the major historic endemic nephropathies. We then summarize the epidemiology, clinical features, histology and clinical course of CKDu in Mesoamerica, Sri Lanka, India, Egypt, and Tunisia. We draw comparisons between the proposed etiologies and supporting research. Recognition of the similarities may reinforce the international drive to establish causality and to effect prevention.

XbaI GLUT1 Gene Polymorphism and the Risk of Type 2 Diabetes with Nephropathy

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Ioannis Stefanidis

2009-01-01

Full Text Available Altered expression of the facilitated glucose transporter GLUT1 affects pathways implicated in the pathogenesis of diabetic nephropathy. There is indication that variation of GLUT1 gene (SLC2A1 contributes to development of microangiopathy in diabetes mellitus type 2 (DM patients. A genetic association study involving Caucasians was carried out to investigate the role of XbαI polymorphism in the GLUT1 gene in diabetic nephropathy (DN. Study population (n = 240 consisted of 148 unrelated patients with DM (92 cases with diabetic nephropathy (DN, and of 92 matched healthy control subjects. Diabetic nephropathy was defined as persistent albuminuria (> 300 mg/24 h and/or renal failure, in the absence of non-diabetes induced renal disease. The analysis showed that the risk of developing DM and DN in XbaI(− carriers, when healthy individuals were considered as controls, was two-fold: odds ratio (OR 2.08 [95% confidence interval (1.14–3.79]. However, there was no evidence of association between XbaI(− and DN when patients with DM and without DN were considered as controls: OR = 1.12 (0.55–2.26. Thus, the GLUT1 XbaI(− allele is associated with DM, and possibly with a more severe form of the disease that can lead to development of DN.

Renal involvement in the antiphospholipid syndrome (APS)-APS nephropathy.

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Tektonidou, Maria G

2009-06-01

Although the kidney represents a major target organ in antiphospholipid syndrome (APS), renal involvement in APS was poorly recognized until recently. The most well-recognized renal manifestations of APS are the renal artery thrombosis/stenosis, renal infarction, hypertension, renal vein thrombosis, end-stage renal disease, increased allograft vascular thrombosis, some types of glomerular disease, and a small-vessel vaso-occlusive nephropathy, recently defined as APS nephropathy. APS nephropathy was first described in primary APS patients, characterized by acute thrombotic lesions in glomeruli and/or arterioles (thrombotic microangiopathy) and chronic vascular lesions such as fibrous intimal hyperplasia of arterioles and interlobular arteries, organized thrombi with or without recanalization, and fibrous arterial and arteriolar occlusions or focal cortical atrophy. APS nephropathy was also detected in further studies including patients with systemic lupus erythematosus (SLE)-related APS and SLE/non-APS patients with positive antiphospholipid antibodies, independently of lupus nephritis. The same histologic lesions, especially thrombotic mictroangiopathy, were also observed in patients with catastrophic APS. The most frequent clinical and laboratory characteristics of APS nephropathy in all the above groups of patients are hypertension (often severe), proteinuria (ranging from mild to nephrotic range), hematuria, and acute or chronic renal insufficiency.

Case Report - Analgesic nephropathy as a cause of end‑stage renal ...

African Journals Online (AJOL)

Analgesic nephropathy is a subtle but significant cause of chronic renal failure. There is paucity of data on analgesic nephropathy in Nigeria. This case presentation is to highlight the need to have high index of suspicion in patients at risk of developing analgesic nephropathy. In March 2009 a 55‑year‑old businessman was ...

All That Glitters Yellow Is Not Gold: Presentation and Pathophysiology of Bile Cast Nephropathy.

Science.gov (United States)

Pitlick, Mitchell; Rastogi, Prerna

2017-10-01

Acute kidney injury (AKI) often manifests in patients with liver disease because of a prerenal cause and presents as acute tubular necrosis or hepatorenal syndrome. Distinguishing between these entities is important for prognosis and treatment. Some patients may develop AKI related to their underlying liver disease: for example, membranoproliferative glomerulonephritis or IgA nephropathy. Bile cast nephropathy is an often ignored differential diagnosis of AKI in the setting of obstructive jaundice. It is characterized by the presence of bile casts in renal tubules, which can possibly cause tubular injury through obstructive and direct toxic effects. Thus, AKI in patients with liver disease may have a structural component in addition to a functional one. In this study, we describe 2 patients with severe hyperbilirubinemia who developed AKI and underwent a kidney biopsy that revealed bile casts in tubular lumens, consistent with bile cast nephropathy. One patient was treated aggressively for alcoholic hepatitis and required hemodialysis for AKI. The second patient was treated conservatively for drug-induced liver injury and did not require dialysis. Both patients saw a reduction in their bilirubin and creatinine toward baseline. Bile cast nephropathy is an important pathological entity that may account for the renal dysfunction in some patients with liver disease. It requires kidney biopsy for diagnosis and may often be overlooked given the scarcity of kidney biopsy in this particular clinical setting. The etiology is multifactorial, and it is often difficult to predict without the aid of a renal biopsy.

Role of Nutrient-Sensing Signals in the Pathogenesis of Diabetic Nephropathy

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Shinji Kume

2014-01-01

Full Text Available Diabetic nephropathy is the leading cause of end-stage renal disease worldwide. The multipronged drug approach still fails to fully prevent the onset and progression of diabetic nephropathy. Therefore, a new therapeutic target to improve the prognosis of diabetic nephropathy is urgently required. Nutrient-sensing signals and their related intracellular machinery have evolved to combat prolonged periods of starvation in mammals; and these systems are conserved in the kidney. Recent studies have suggested that the activity of three nutrient-sensing signals, mTORC1, AMPK, and Sirt1, is altered in the diabetic kidney. Furthermore, autophagy activity, which is regulated by the above-mentioned nutrient-sensing signals, is also altered in both podocytes and proximal tubular cells under diabetic conditions. Under diabetic conditions, an altered nutritional state owing to nutrient excess may disturb cellular homeostasis regulated by nutrient-responsible systems, leading to exacerbation of organelle dysfunction and diabetic nephropathy. In this review, we discuss new findings showing relationships between nutrient-sensing signals, autophagy, and diabetic nephropathy and suggest the therapeutic potential of nutrient-sensing signals in diabetic nephropathy.

Vascularization of liver tumors - preliminary results with Coded Harmonic Angio (CHA), phase inversion imaging, 3D power Doppler and contrast medium-enhanced B-flow with second generation contrast agent (Optison).

Science.gov (United States)

Jung, E M; Kubale, R; Jungius, K-P; Jung, W; Lenhart, M; Clevert, D-A

2006-01-01

To investigate the dynamic value of contrast medium-enhanced ultrasonography with Optison for appraisal of the vascularization of hepatic tumors using harmonic imaging, 3D-/power Doppler and B-flow. 60 patients with a mean age of 56 years (range 35-76 years) with 93 liver tumors, including histopathologically proven hepatocellular carcinoma (HCC) [15 cases with 20 lesions], liver metastases of colorectal tumors [17 cases with 33 lesions], metastases of breast cancer [10 cases with 21 lesions] and hemangiomas [10 cases with 19 lesions] were prospectively investigated by means of multislice CT as well as native and contrast medium-enhanced ultrasound using a multifrequency transducer (2.5-4 MHz, Logig 9, GE). B scan was performed with additional color and power Doppler, followed by a bolus injection of 0.5 ml Optison. Tumor vascularization was evaluated with coded harmonic angio (CHA), pulse inversion imaging with power Doppler, 3D power Doppler and in the late phase (>5 min) with B-flow. In 15 cases with HCC, i.a. DSA was performed in addition. The results were also correlated with MRT and histological findings. Compared to spiral-CT/MRT, only 72/93 (77%) of the lesions could be detected in the B scan, 75/93 (81%) with CHA and 93/93 (100%) in the pulse inversion mode. Tumor vascularization was detectable in 43/93 (46%) of lesions with native power Doppler, in 75/93 (81%) of lesions after administering contrast medium in the CHA mode, in 81/93 (87%) of lesions in the pulse inversion mode with power Doppler and in 77/93 (83%) of lesions with contrast-enhanced B-flow. Early arterial and capillary perfusion was best detected with CHA, particularly in 20/20 (100%) of the HCC lesions, allowing a 3D reconstruction. 3D power Doppler was especially useful in investigating the tumor margins. Up to 20 min after contrast medium injection, B-flow was capable of detecting increased metastatic tumor vascularization in 42/54 (78%) of cases and intratumoral perfusion in 17/20 (85

Late adverse reactions to intravascular iodine based contrast media

DEFF Research Database (Denmark)

Bellin, Marie-France; Stacul, Fulvio; Webb, Judith A W

2011-01-01

DEFINITION: Late adverse reactions (LAR) to contrast media (CM) are defined as reactions occurring 1 h to 1 week after exposure. NEED FOR REVIEW: In view of more prospective studies of LAR and new data about their pathophysiology, the Contrast Medium Safety Committee (CMSC) of the European Society...... or delayed reading intradermal). The main risk factors for LAR are a previous reaction to contrast medium, a history of allergy, and interleukin-2 treatment. Most skin reactions are mild or moderate and self-limiting. MANAGEMENT: Management is symptomatic and similar to the management of other drug......-induced skin reactions. To reduce the risk of repeat reactions avoidance of the relevant CM and any cross-reacting agents identified by skin testing is recommended....

Iodinated contrast media and patients with high-risk kidneys. Aiming at rational prevention

International Nuclear Information System (INIS)

Fontaine, B.; Frouge, C.; Gagey, N.

1994-01-01

Acute renal failure induced by iodinated contrast media (CM) accounts for about 10% of all hospital cases of renal failure, especially in azotemic patients. The specific anatomy and physiology of the inner medulla renalis render it particularly sensitive to even a moderate reduction in blood supply. Renal function will be estimated by measuring serum creatinine levels, before and within 72 hours after administration of the iodinated contrast medium. Hypovolaemia, diabetes mellitus-induced microangiopathy, nephrotoxic drugs and especially dehydratation may provoke renal accidents. Proper hydration, choosing a low osmolality medium and adequately spacing exposures to CM are elementary measures to be adopted to prevent renal failure. (authors)

Measuring and slowing decoherence in Electromagnetically induced transparency medium

International Nuclear Information System (INIS)

Shuker, M.; Firstenberg, O.; Sagi, Y.; Ben-Kish, A.; Fisher, A.; Ron, A.; Davidson, N.

2005-01-01

Full Text:Electromagnetically induced transparency is a unique light-matter interaction that exhibits extremely narrow-band spectroscopic features along with low absorption. Recent interest in this phenomenon is driven by its possible applications in quantum information (slow light, storage of light), atomic clocks and precise magnetometers. The Electromagnetically induced transparency phenomenon takes place when an atomic ensemble is driven to a coherent superposition of its ground state sub-levels by two phase-coherent radiation fields. A key parameter of the Electromagnetically induced transparency medium, that limits its applicability, is the coherence lifetime of this superposition (decoherence rate). We have developed a simple technique to measure decay rates within the ground state of an atomic ensemble, and specifically the decoherence rate of the Electromagnetically induced transparency coherent superposition. Detailed measurements were performed in a Rubidium vapor cell at 60 - 80 with 30 Torr of Neon buffer gas. We have found that the Electromagnetically induced transparency decoherence is dominated by spin-exchange collisions between Rubidium atoms. We discuss the sensitivity of various quantum states of the atomic ensemble to spin exchange decoherence, and find a set of quantum states that minimize this effect. Finally, we demonstrate a unique quantum state which is both insensitive to spin exchange decoherence and constitutes an Electromagnetically induced transparency state of the medium

Correlation of secreted protein acidic and rich in cysteine with diabetic nephropathy

OpenAIRE

Li, Lei; Song, Hai-Yan; Liu, Kai; An, Meng-Meng

2015-01-01

To detect the serum concentrations of secreted protein acidic and rich in cysteine (SPARC) in patients with diabetic nephropathy and SPARC mRNA and protein expressions in renal tissue of db/db mice (C57BL/KsJ, diabetic nephropathy mice), thus preliminary exploration on the role of secreted protein acidic riches in cysteine in the development of diabetic nephropathy were carried out. Serum SPARC levels in normal subjects, patients with type 2 diabetes mellitus (without diabetic nephropathy), c...

The influence of different contrast medium concentrations and injection protocols on quantitative and clinical assessment of FDG–PET/CT in lung cancer

Energy Technology Data Exchange (ETDEWEB)

Verburg, Frederik A., E-mail: fverburg@ukaachen.de [RWTH Aachen University Hospital, Department of Nuclear Medicine, Pauwelsstraße 30, 52074 Aachen (Germany); Maastricht University Medical Center, Department of Nuclear Medicine, P. Debyelaan 25, 6229 HX Maastricht (Netherlands); Kuhl, Christiane K. [RWTH Aachen University Hospital, Department of Diagnostic and Interventional Radiology, Pauwelsstraße 30, 52074 Aachen (Germany); Pietsch, Hubertus [Bayer Pharma AG, Berlin, Müllerstrasse 178, 13353 Berlin (Germany); Palmowski, Moritz [RWTH Aachen University Hospital, Department of Nuclear Medicine, Pauwelsstraße 30, 52074 Aachen (Germany); Mottaghy, Felix M. [RWTH Aachen University Hospital, Department of Nuclear Medicine, Pauwelsstraße 30, 52074 Aachen (Germany); Maastricht University Medical Center, Department of Nuclear Medicine, P. Debyelaan 25, 6229 HX Maastricht (Netherlands); Behrendt, Florian F. [RWTH Aachen University Hospital, Department of Nuclear Medicine, Pauwelsstraße 30, 52074 Aachen (Germany)

2013-10-01

Objectives: To compare the effects of two different contrast medium concentrations for use in computed X-ray tomography (CT) employing two different injection protocols on positron emission tomography (PET) reconstruction in combined 2-{sup 18}F-desoxyglucose (FDG) PET/CT in patients with a suspicion of lung cancer. Methods: 120 patients with a suspicion of lung cancer were enrolled prospectively. PET images were reconstructed with the non-enhanced and venous phase contrast CT obtained after injection of iopromide 300 mg/ml or 370 mg/ml using either a fixed-dose or a body surface area adapted injection protocol. Maximum and mean standardized uptake values (SUVmax and SUVmean) and contrast enhancement (HU) were determined in the subclavian vein, ascending aorta, abdominal aorta, inferior vena cava, portal vein, liver and kidney and in the suspicious lung lesion. PET data were evaluated visually for the presence of malignancy and image quality. Results: At none of the sites a significant difference in the extent of the contrast enhancement between the four different protocols was found. However, the variability of the contrast enhancement at several anatomical sites was significantly greater in the fixed dose groups than in the BSA groups for both contrast medium concentrations. At none of the sites a significant difference was found in the extent of the SUVmax and SUVmean increase as a result of the use of the venous phase contrast enhanced CT for attenuation. Visual clinical evaluation of lesions showed no differences between contrast and non-contrast PET/CT (P = 0.32). Conclusions: Contrast enhanced CT for attenuation correction in combined PET/CT in lung cancer affects neither the clinical assessment nor image quality of the PET-images. A body surface adapted contrast medium protocol reduces the interpatient variability in contrast enhancement.

Intraarterial CT Angiography Using Ultra Low Volume of Iodine Contrast – Own Experiences

International Nuclear Information System (INIS)

Garcarek, Jerzy; Kurcz, Jacek; Guziński, Maciej; Banasik, Mirosław; Miś, Marcin; Gołębiowski, Tomasz

2015-01-01

High volume of intravenous contrast in CT-angiography may result in contrast-induced nephropathy. Intraarterial ultra-low volume of contrast medium results in its satisfactory blood concentration with potentially good image quality. The first main purpose was to assess the influence of the method on function of transplanted kidney in patients with impaired graft function. The second main purpose of the study was to evaluate the usefulness of this method for detection of gastrointestinal and head-and-neck haemorrhages. Between 2010 and 2013 intraarterial CT-angiography was performed in 56 patients, including 28 with chronic kidney disease (CKD). There were three main subgroups: 18 patients after kidney transplantation, 10 patients with gastrointestinal hemorrhage, 8 patients with head-and-neck hemorrhage. Contralateral or ipsilateral inguinal arterial approach was performed. The 4-French vascular sheaths and 4F-catheters were introduced under fluoroscopy. Intraarterial CT was performed using 64-slice scanner. The scanning protocol was as follows: slice thickness 0.625 mm, pitch 1.3, gantry rotation 0.6 sec., scanning delay 1–2 sec. The extent of the study was established on the basis of scout image. In patients with CKD 6–8 mL of Iodixanol (320 mg/mL) diluted with saline to 18–24 mL was administered at a speed of 4–5 mL/s. Vasculature was properly visualized in all patients. In patients with impaired renal function creatinine/eGFR levels remained stable in all but one case. Traditional arteriography failed and CT-angiography demonstrated the site of bleeding in 3 of 10 patients with symptoms of gastrointestinal bleeding (30%). In 8 patients with head-and-neck bleeding CT-angiography did not prove beneficial when compared to traditional arteriography. 1. Ultra-low contrast intraarterial CT-angiography does not deteriorate the function of transplanted kidneys in patients with impaired graft function. 2. 3D reconstructions allow for excellent visualization of

Effects of high iodine doses given parenterally as contrast medium on parameter of the pro/antioxidative balance

International Nuclear Information System (INIS)

Winkler, R.; Griebenow, S.; Scheidleder, B.; Bailer, H.

2002-01-01

The aim of this study was to investigate effects of high iodine doses given parenterally as contrast medium on parameters of lipid status and thyroid hormone status as well as on parameters of the pro/antioxidative balance of spa patients. 29 patients with a comparable indication who had to undergo an angiography were chosen. The blood parameters of these patients were determined before and after the angiographic treatment. No provable changes of the thyroid parameters f-T 3 , f-T 4 and TSH were found after the angiography. In case of enzyme activities, the protective enzymes SOD and GSHPX showed no changes, while the concentrations of peroxides and MDA were increased significantly. Corresponding to this, the total antioxidative status and the vitamin E level decreased significantly. Altogether these results stand for a moderate deterioration of the antioxidative protective potential by the highly iodine containing contrast medium. (author)

The use of dilute calogen[reg] as a fat density oral contrast medium in upper abdominal computed tomography, compared with the use of water and positive oral contrast media

International Nuclear Information System (INIS)

Ramsay, Duncan W.; Markham, Derrian H.; Morgan, Bruno; Rodgers, Peter M.; Liddicoat, Amanda J.

2001-01-01

AIM: Oral contrast media are commonly given prior to computed tomography (CT) examination of the upper abdomen. Although positive oral contrast media are normally used, there is increasing interest in using negative agents such as water and less commonly fat density products. The aim of this study was to compare a positive oral contrast medium, water, and a diluted emulsion of arachis oil (Calogen[reg], a fat density food supplement) for assessment of the upper abdomen. MATERIALS AND METHODS: Seventy-one patients referred for upper abdominal CT were randomized to receive either 500 ml water, 2% sodium diatrizoate or a dilute suspension of Calogen[reg]. The CT images were scored independently by three radiologists. Distension and anatomical identification was assessed for the stomach, duodenum and jejunum; with anatomical identification recorded for the pancreas, retroperitoneum, liver, gallbladder and spleen. RESULTS: Dilute Calogen[reg] produced a significant improvement (P < 0.01) in distension and anatomical visualization of the stomach and proximal duodenum. Only minimal differences were demonstrated between the three contrast media for visualization of more distal small bowel or identification of the other upper abdominal viscera. Significantly more artifacts were caused by positive contrast media than with the Calogen[reg] mixture. CONCLUSION: A dilute suspension of Calogen[reg] as an oral contrast medium is recommended when disease is suspected within the stomach or proximal duodenum. Ramsay, D.W. et al. (2001)

Angiotensin-converting enzyme 2 amplification limited to the circulation does not protect mice from development of diabetic nephropathy.

Science.gov (United States)

Wysocki, Jan; Ye, Minghao; Khattab, Ahmed M; Fogo, Agnes; Martin, Aline; David, Nicolae Valentin; Kanwar, Yashpal; Osborn, Mark; Batlle, Daniel

2017-06-01

Blockers of the renin-angiotensin system are effective in the treatment of experimental and clinical diabetic nephropathy. An approach different from blocking the formation or action of angiotensin II (1-8) that could also be effective involves fostering its degradation. Angiotensin-converting enzyme 2 (ACE2) is a monocarboxypeptidase that cleaves angiotensin II (1-8) to form angiotensin (1-7). Therefore, we examined the renal effects of murine recombinant ACE2 in mice with streptozotocin-induced diabetic nephropathy as well as that of amplification of circulating ACE2 using minicircle DNA delivery prior to induction of experimental diabetes. This delivery resulted in a long-term sustained and profound increase in serum ACE2 activity and enhanced ability to metabolize an acute angiotensin II (1-8) load. In mice with streptozotocin-induced diabetes pretreated with minicircle ACE2, ACE2 protein in plasma increased markedly and this was associated with a more than 100-fold increase in serum ACE2 activity. However, minicircle ACE2 did not result in changes in urinary ACE2 activity as compared to untreated diabetic mice. In both diabetic groups, glomerular filtration rate increased significantly and to the same extent as compared to non-diabetic controls. Albuminuria, glomerular mesangial expansion, glomerular cellularity, and glomerular size were all increased to a similar extent in minicircle ACE2-treated and untreated diabetic mice, as compared to non-diabetic controls. Recombinant mouse ACE2 given for 4 weeks by intraperitoneal daily injections in mice with streptozotocin-induced diabetic nephropathy also failed to improve albuminuria or kidney pathology. Thus, a profound augmentation of ACE2 confined to the circulation failed to ameliorate the glomerular lesions and hyperfiltration characteristic of early diabetic nephropathy. These findings emphasize the importance of targeting the kidney rather than the circulatory renin angiotensin system to combat diabetic

SGLT2 Protein Expression Is Increased in Human Diabetic Nephropathy

Science.gov (United States)

Wang, Xiaoxin X.; Levi, Jonathan; Luo, Yuhuan; Myakala, Komuraiah; Herman-Edelstein, Michal; Qiu, Liru; Wang, Dong; Peng, Yingqiong; Grenz, Almut; Lucia, Scott; Dobrinskikh, Evgenia; D'Agati, Vivette D.; Koepsell, Hermann; Kopp, Jeffrey B.; Rosenberg, Avi Z.; Levi, Moshe

2017-01-01

There is very limited human renal sodium gradient-dependent glucose transporter protein (SGLT2) mRNA and protein expression data reported in the literature. The first aim of this study was to determine SGLT2 mRNA and protein levels in human and animal models of diabetic nephropathy. We have found that the expression of SGLT2 mRNA and protein is increased in renal biopsies from human subjects with diabetic nephropathy. This is in contrast to db-db mice that had no changes in renal SGLT2 protein expression. Furthermore, the effect of SGLT2 inhibition on renal lipid content and inflammation is not known. The second aim of this study was to determine the potential mechanisms of beneficial effects of SGLT2 inhibition in the progression of diabetic renal disease. We treated db/db mice with a selective SGLT2 inhibitor JNJ 39933673. We found that SGLT2 inhibition caused marked decreases in systolic blood pressure, kidney weight/body weight ratio, urinary albumin, and urinary thiobarbituric acid-reacting substances. SGLT2 inhibition prevented renal lipid accumulation via inhibition of carbohydrate-responsive element-binding protein-β, pyruvate kinase L, SCD-1, and DGAT1, key transcriptional factors and enzymes that mediate fatty acid and triglyceride synthesis. SGLT2 inhibition also prevented inflammation via inhibition of CD68 macrophage accumulation and expression of p65, TLR4, MCP-1, and osteopontin. These effects were associated with reduced mesangial expansion, accumulation of the extracellular matrix proteins fibronectin and type IV collagen, and loss of podocyte markers WT1 and synaptopodin, as determined by immunofluorescence microscopy. In summary, our study showed that SGLT2 inhibition modulates renal lipid metabolism and inflammation and prevents the development of nephropathy in db/db mice. PMID:28196866

Estimation of shear velocity contrast for dipping or anisotropic medium from transmitted Ps amplitude variation with ray-parameter

Science.gov (United States)

Kumar, Prakash

2015-12-01

Amplitude versus offset analysis of P to P reflection is often used in exploration seismology for hydrocarbon exploration. In the present work, the feasibility to estimate crustal velocity structure from transmitted P to S wave amplitude variation with ray-parameter has been investigated separately for dipping layer and anisotropy medium. First, for horizontal and isotropic medium, the approximation of P-to-s conversion is used that is expressed as a linear form in terms of slowness. Next, the intercept of the linear regression has been used to estimate the shear wave velocity contrast (δβ) across an interface. The formulation holds good for isotropic and horizontal layer medium. Application of such formula to anisotropic medium or dipping layer data may lead to erroneous estimation of δβ. In order to overcome this problem, a method has been proposed to compensate the SV-amplitude using shifted version of SH-amplitude, and subsequently transforming SV amplitudes equivalent to that from isotropic or horizontal layer medium as the case may be. Once this transformation has been done, δβ can be estimated using isotropic horizontal layer formula. The shifts required in SH for the compensation are π/2 and π/4 for dipping layer and anisotropic medium, respectively. The effectiveness of the approach has been reported using various synthetic data sets. The methodology is also tested on real data from HI-CLIMB network in Himalaya, where the presence of dipping Moho has already been reported. The result reveals that the average shear wave velocity contrast across the Moho is larger towards the Indian side compared to the higher Himalayan and Tibetan regions.

Meta-analysis: Serum creatinine changes following contrast enhanced CT imaging

International Nuclear Information System (INIS)

Kooiman, Judith; Pasha, Sharif M.; Zondag, Wendy; Sijpkens, Yvo W.J.; Molen, Aart J. van der; Huisman, Menno V.; Dekkers, Olaf M.

2012-01-01

Purpose: Contrast induced nephropathy (CIN) is defined as a decrease in renal function following administration of contrast media. The aim of this meta-analysis was to asses the overall risk of CIN, chronic loss of kidney function and the need for renal replacement therapy (RRT) after intravenous contrast enhanced CT-scan. Secondly, we aimed to identify subgroups at increased risk for CIN. Materials and methods: A literature search in Pubmed, Medline, Embase and Cochrane databases was performed. Data extraction was carried out independently by two reviewers. Meta-analysis and meta-regression were performed using an exact likelihood approach. Results: Forty studies evaluating the incidence of CIN after CT were included. The pooled incidence of CIN was 6.4% (95% CI 5.0–8.1). The risk of RRT after CIN was low, 0.06% (95% CI 0.01–0.4). The decline in renal function persisted in 1.1% of patients (95% CI 0.6–2.1%). Patients with chronic kidney disease (odds ratio 2.26, p < 0.001) or diabetes mellitus (odds ratio 3.10, p < 0.001) were at increased risk for the development of CIN. Conclusion: CIN occurred in 6% of patients after contrast enhanced CT. In 1% of all patients undergoing contrast enhanced CT the decline in renal function persisted

Meta-analysis: Serum creatinine changes following contrast enhanced CT imaging

Energy Technology Data Exchange (ETDEWEB)

Kooiman, Judith, E-mail: j.kooiman@lumc.nl [Department of Thrombosis and Haemostasis, LUMC, Leiden (Netherlands); Pasha, Sharif M., E-mail: s.m.pasha@lumc.nl [Department of Thrombosis and Haemostasis, LUMC, Leiden (Netherlands); Zondag, Wendy, E-mail: w.zondag@lumc.nl [Department of Thrombosis and Haemostasis, LUMC, Leiden (Netherlands); Sijpkens, Yvo W.J., E-mail: ysijpens@bronovo.nl [Department of Nephrology, Bronovo Hospital, The Hague (Netherlands); Molen, Aart J. van der, E-mail: molen@lumc.nl [Department of Radiology, LUMC, Leiden (Netherlands); Huisman, Menno V., E-mail: m.v.huisman@lumc.nl [Department of Thrombosis and Haemostasis, LUMC, Leiden (Netherlands); Dekkers, Olaf M., E-mail: o.m.dekkers@lumc.nl [Department of Clinical Epidemiology and Department of Endocrinology, LUMC, Leiden (Netherlands)

2012-10-15

Purpose: Contrast induced nephropathy (CIN) is defined as a decrease in renal function following administration of contrast media. The aim of this meta-analysis was to asses the overall risk of CIN, chronic loss of kidney function and the need for renal replacement therapy (RRT) after intravenous contrast enhanced CT-scan. Secondly, we aimed to identify subgroups at increased risk for CIN. Materials and methods: A literature search in Pubmed, Medline, Embase and Cochrane databases was performed. Data extraction was carried out independently by two reviewers. Meta-analysis and meta-regression were performed using an exact likelihood approach. Results: Forty studies evaluating the incidence of CIN after CT were included. The pooled incidence of CIN was 6.4% (95% CI 5.0–8.1). The risk of RRT after CIN was low, 0.06% (95% CI 0.01–0.4). The decline in renal function persisted in 1.1% of patients (95% CI 0.6–2.1%). Patients with chronic kidney disease (odds ratio 2.26, p < 0.001) or diabetes mellitus (odds ratio 3.10, p < 0.001) were at increased risk for the development of CIN. Conclusion: CIN occurred in 6% of patients after contrast enhanced CT. In 1% of all patients undergoing contrast enhanced CT the decline in renal function persisted.

Studies on the consistency of internally taken contrast medium for pancreas CT

Energy Technology Data Exchange (ETDEWEB)

Matsushima, Kishio; Mimura, Seiichi; Tahara, Seiji; Kitayama, Takuichi; Inamura, Keiji; Mikami, Yasutaka; Hashimoto, Keiji; Hiraki, Yoshio; Aono, Kaname

1985-02-01

A problem of Pancreatic CT scanning is the discrimination between the pancreas and the adjacent gastrointestinal tract. Generally we administer a dilution of gastrografin internally to make the discrimination. The degree of dilution has been decided by experience at each hospital. When the consistency of the contrast medium is low in density, an enhancement effect cannot be expected, but when the consistency is high, artifacts appear. We have experimented on the degree of the dilution and CT-No to decide the optimum consistency of gastrografin for the diagnosis of pancreatic disease. Statistical analysis of the results show the optimum dilution of gastrografin to be 1.5%.

Contrast distortion induced by modulation voltage in scanning capacitance microscopy

Science.gov (United States)

Chang, M. N.; Hu, C. W.; Chou, T. H.; Lee, Y. J.

2012-08-01

With a dark-mode scanning capacitance microscopy (SCM), we directly observed the influence of SCM modulation voltage (MV) on image contrasts. For electrical junctions, an extensive modulated area induced by MV may lead to noticeable changes in the SCM signal phase and intensity, resulting in a narrowed junction image and a broadened carrier concentration profile. This contrast distortion in SCM images may occur even if the peak-to-peak MV is down to 0.3 V. In addition, MV may shift the measured electrical junction depth. The balance of SCM signals components explain these MV-induced contrast distortions.

Acute oxalate nephropathy after ingestion of star fruit.

Science.gov (United States)

Chen, C L; Fang, H C; Chou, K J; Wang, J S; Chung, H M

2001-02-01

Acute oxalate nephropathy associated with ingestion of star fruit (carambola) has not been reported before. We report the first two cases. These patients developed nausea, vomiting, abdominal pain, and backache within hours of ingesting large quantities of sour carambola juice; then acute renal failure followed. Both patients needed hemodialysis for oliguric acute renal failure, and pathologic examinations showed typical changes of acute oxalate nephropathy. The renal function recovered 4 weeks later without specific treatment. Sour carambola juice is a popular beverage in Taiwan. The popularity of star fruit juice is not compatible with the rare discovery of star fruit-associated acute oxalate nephropathy. Commercial carambola juice usually is prepared by pickling and dilution processes that reduce oxalate content markedly, whereas pure fresh juice or mild diluted postpickled juice for traditional remedies, as used in our cases, contain high quantities of oxalate. An empty stomach and dehydrated state may pose an additional risk for development of renal injury. To avoid acute oxalate nephropathy, pure sour carambola juice or mild diluted postpickled juice should not be consumed in large amounts, especially on an empty stomach or in a dehydrated state.

Methyl isobutyl ketone (MIBK) induction of α2u-globulin nephropathy in male, but not female rats

International Nuclear Information System (INIS)

Borghoff, S.J.; Hard, G.C.; Berdasco, N.M.; Gingell, R.; Green, S.M.; Gulledge, W.

2009-01-01

Male F-344 rats were administered corn oil (vehicle control), d-limonene (positive control, 300 mg/kg), or MIBK (1000 mg/kg) and female F-344 rats corn oil (vehicle control) or MIBK for 10 consecutive days by oral gavage. Approximately 24 h after the final dose the kidneys were excised and the left kidney prepared and evaluated for histological changes including protein (hyaline) droplet accumulation, immunohistochemical staining for α2u-globulin (α2u), and proliferating cell nuclear antigen (PCNA) to quantitate renal cell proliferation. The right kidney was prepared for quantitation of total protein and α2u using an ELISA. MIBK elicited an increase in protein droplets, accumulation of α2u, and renal cell proliferation in male, but not female rats, responses characteristic of α2u-mediated nephropathy. MIBK produced identical histopathological changes in the male rat kidney when compared to d-limonene, an acknowledged inducer of α2u-nephropathy except that the grade of severity tended to be slightly lower with MIBK. MIBK did not induce any effects in female rats. Therefore, renal histopathology, along with the other measures of α2u accumulation, provides additional weight of evidence to support the inclusion of MIBK in the category of chemicals exerting renal effects through a α2u-nephropathy-mediated mode-of-action

Concomitant macro and microvascular complications in diabetic nephropathy

Directory of Open Access Journals (Sweden)

Alwakeel Jamal

2009-01-01

Full Text Available To determine the prevalence of concomitant microvascular and macrovascular complica-tions of diabetic nephropathy we retrospectively reviewed the medical records of all 1,952 type 2 dia-betic patients followed-up at Security Forces Hospital, Riyadh, Saudi Arabia from January 1989 to December 2004. There were 626 (32.1% patients (294 (47% were males who developed diabetic nephropathy. Their mean age was 66.9 ± 11.4 years, mean duration of diabetes was 15.4 ± 7.5 years, mean age at the onset of nephropathy was 61.5 ± 12.4 years, and mean duration of nephropathy was 3.9 ± 3.8 years. Concomitant diabetic complications included cataract (38.2%, acute coronary syndrome (36.1%, peripheral neuropathy (24.9%, myocardial infarction (24.1%, background retinopathy (22.4%, stroke (17.6%, proliferative retinopathy (11.7%, foot infection (7.3%, limb amputation (3.7% and blindness (3%. Hypertension was documented in 577 (92.2% patients, dyslipidemia in 266 (42.5% and mortality from all causes in 86 (13.7%. There were 148 (23.6% patients with one complication, 81 (12.9% with two, 83 (13.3% with three, and 61 (9.7% with four or more. Dete-rioration of glomerular filtration rate was observed in 464 (74% patients and doubling of serum creatinine in 250 (39.9%, while 95 (15.2% developed end-stage renal disease (ESRD at the end of study and 79 (12.6% required dialysis. Complications were significantly more prevalent among males with greater number reaching ESRD level than females (P< 0.05. Relative risks of developing com-plications were significant after the onset of nephropathy; ACS (1.41, MI (1.49, stroke (1.48, diabetic foot (1.6, amputation (1.58 and death (1.93. We conclude that complications of diabetes are aggre-ssive and progressive including high prevalence of diabetic nephropathy. Careful monitoring and proper institution of management protocols should be implemented to identify diabetic patients at high risk for complications and mitigate progression

Concomitant macro and microvascular complications in diabetic nephropathy

International Nuclear Information System (INIS)

Alwakeel, Jamal S; AlSuwaida, Abdulkareem; Isnani, Arthur C; AlHarbi, Ali; Alam Awatif

2009-01-01

To determine the prevalence of concomitant microvascular and macro vascular complications of diabetic nephropathy we retrospectively reviewed the medical records of all 1,952 type 2 dia-betic patients followed-up at Security Forces Hospital, Riyadh, Saudi Arabia from January 1989 to December 2004. There were 626 (32.1%) patients (294 (47%) were males) who developed diabetic nephropathy. Their mean age was 66.9 + -11.4 years, mean duration of diabetes was 15.4 + -7.5 years, mean age at the onset of nephropathy was 61.5 + - 12.4 years, and mean duration of nephropathy was 3.9 + - 3.8 years. Concomitant diabetic complications included cataract (38.2%), acute coronary syndrome (36.1%), peripheral neuropathy (24.9%), myocardial infarction (24.1%), background retinopathy (22.4%), stroke (17.6%), proliferative retinopathy (11.7%), foot infection (7.3%), limb amputation (3.7%) and blindness (3%). Hypertension was documented in 577 (92.2%) patients, dyslipidemia in 266 (42.5%) and mortality from all causes in 86 (13.7%). There were 148 (23.6%) patients with one complication, 81 (12.9%) with two, 83 (13.3%) with three, and 61 (9.7%) with four or more. Deterioration of glomerular filtration rate was observed in 464 (74%) patients and doubling of serum creatinine in 250 (39.9%), while 95 (15.2%) developed end-stage renal disease (ESRD) at the end of study and 79 (12.6%) required dialysis. Complications were significantly more prevalent among males with greater number reaching ESRD level than females (P< 0.05). Relative risks of developing complications were significant after the onset of nephropathy; ACS (1.41), MI (1.49), stroke (1.48), diabetic foot (1.6), amputation (1.58) and death (1.93). We conclude that complications of diabetes are aggressive and progressive including high prevalence of diabetic nephropathy. Careful monitoring and proper institution of management protocols should be implemented to identify diabetic patients at high risk for complications and mitigate

Concomitant macro and microvascular complications in diabetic nephropathy

Energy Technology Data Exchange (ETDEWEB)

Alwakeel, Jamal S; AlSuwaida, Abdulkareem [Div. of Nephrology, Dept. of Medicine, King Khalid Univ., Hospital, Riyadh (Saudi Arabia); Isnani, Arthur C [Dept. of Family and Community Medicine, King Khalid Univ. Hospital, Riyadh (Saudi Arabia); AlHarbi, Ali [Coll. of Medicine and Research Center, King Khalid Univ. Hospital, Riyadh (Saudi Arabia); Awatif, Alam [Div. of Nephrology, Dept. of Medicine, Security Forces Hospital, Riyadh (Saudi Arabia)

2009-07-01

To determine the prevalence of concomitant microvascular and macro vascular complications of diabetic nephropathy we retrospectively reviewed the medical records of all 1,952 type 2 dia-betic patients followed-up at Security Forces Hospital, Riyadh, Saudi Arabia from January 1989 to December 2004. There were 626 (32.1%) patients (294 (47%) were males) who developed diabetic nephropathy. Their mean age was 66.9 + -11.4 years, mean duration of diabetes was 15.4 + -7.5 years, mean age at the onset of nephropathy was 61.5 + - 12.4 years, and mean duration of nephropathy was 3.9 + - 3.8 years. Concomitant diabetic complications included cataract (38.2%), acute coronary syndrome (36.1%), peripheral neuropathy (24.9%), myocardial infarction (24.1%), background retinopathy (22.4%), stroke (17.6%), proliferative retinopathy (11.7%), foot infection (7.3%), limb amputation (3.7%) and blindness (3%). Hypertension was documented in 577 (92.2%) patients, dyslipidemia in 266 (42.5%) and mortality from all causes in 86 (13.7%). There were 148 (23.6%) patients with one complication, 81 (12.9%) with two, 83 (13.3%) with three, and 61 (9.7%) with four or more. Deterioration of glomerular filtration rate was observed in 464 (74%) patients and doubling of serum creatinine in 250 (39.9%), while 95 (15.2%) developed end-stage renal disease (ESRD) at the end of study and 79 (12.6%) required dialysis. Complications were significantly more prevalent among males with greater number reaching ESRD level than females (P< 0.05). Relative risks of developing complications were significant after the onset of nephropathy; ACS (1.41), MI (1.49), stroke (1.48), diabetic foot (1.6), amputation (1.58) and death (1.93). We conclude that complications of diabetes are aggressive and progressive including high prevalence of diabetic nephropathy. Careful monitoring and proper institution of management protocols should be implemented to identify diabetic patients at high risk for complications and mitigate

Do intravenous N-acetylcysteine and sodium bicarbonate prevent high osmolal contrast-induced acute kidney injury? A randomized controlled trial.

Directory of Open Access Journals (Sweden)

Antonio Jose Inda-Filho

Full Text Available N-acetylcysteine (NAC or sodium bicarbonate (NaHCO3, singly or combined, inconsistently prevent patients exposed to radiographic contrast media from developing contrast-induced acute kidney injury (CI-AKI.We asked whether intravenous isotonic saline and either NaHCO3 in 5% dextrose or else a high dose of NAC in 5% dextrose prevent CI-AKI in outpatients exposed to high-osmolal iodinated contrast medium more than does saline alone.This completed prospective, parallel, superiority, open-label, controlled, computer-randomized, single-center, Brazilian trial (NCT01612013 hydrated 500 adult outpatients (214 at high risk of developing CI-AKI exposed to ioxitalamate during elective coronary angiography and ventriculography. From 1 hour before through 6 hours after exposure, 126 patients (group 1 received a high dose of NAC and saline, 125 (group 2 received NaHCO3 and saline, 124 (group 3 received both treatments, and 125 (group 4 received only saline.Groups were similar with respect to age, gender, weight, pre-existing renal dysfunction, hypertension, medication, and baseline serum creatinine and serum cystatin C, but diabetes mellitus was significantly less prevalent in group 1. CI-AKI incidence 72 hours after exposure to contrast medium was 51.4% (257/500, measured as serum creatinine > (baseline+0.3 mg/dL and/or serum cystatin C > (1.1 · baseline, and 7.6% (38/500, measured as both serum creatinine and serum cystatin C > (baseline+0.3 mg/dL or > (1.25 · baseline. CI-AKI incidence measured less sensitively was similar among groups. Measured more sensitively, incidence in group 1 was significantly (p<0.05 lower than in groups 2 and 3 but not group 4; adjustment for confounding by infused volume equalized incidence in groups 1 and 3.We found no evidence that intravenous isotonic saline and either NaHCO3 or else a high dose of NAC prevent CI-AKI in outpatients exposed to high osmolal iodinated contrast medium more than does saline alone

Fixed drug eruption induced by an iodinated non-ionic X-ray contrast medium: a practical approach to identify the causative agent and to prevent its recurrence

Energy Technology Data Exchange (ETDEWEB)

Boehm, Ingrid; Block, Wolfgang; Schild, Hans H. [University of Bonn, Department of Radiology, Bonn (Germany); Medina, Jesus; Prieto, Pilar [JUSTESA IMAGEN SA, Biological R and D Department, Madrid (Spain)

2007-02-15

We describe the case of a 61-year-old physician who developed a fixed drug eruption (FDE) after i.v. administration of a non-ionic monomeric iodinated X-ray contrast medium (CM) (iopromide). During CM injection, a sensation of heat occurred, which was most intense in the right inguinal region. Four hours later, the FDE arose with a red macule of approximately 2 cm in diameter covering a dermal infiltration in the right inguinal region, and enlarged up to a final size of 15 x 8 cm, accompanied by a burning sensation. The patient's history revealed a similar reaction in the same localization and of the same clinical appearance after CM injection 1 year before. Patch testing 4 months later revealed positive reactions to iomeprol and iohexol. Iopamidol injection for another CT examination 23 months later was well tolerated. Based on these results, we suggest patch testing after CM-induced FDE, which could help to select a CM for future CT examinations. Late onset of adverse CM reactions may manifest as FDE. Patch testing within the previous skin reaction area is the diagnostic tool that should be used to confirm the suspected agent, possible cross-reacting agents and well-tolerated agents. (orig.)

Fixed drug eruption induced by an iodinated non-ionic X-ray contrast medium: a practical approach to identify the causative agent and to prevent its recurrence

International Nuclear Information System (INIS)

Boehm, Ingrid; Block, Wolfgang; Schild, Hans H.; Medina, Jesus; Prieto, Pilar

2007-01-01

We describe the case of a 61-year-old physician who developed a fixed drug eruption (FDE) after i.v. administration of a non-ionic monomeric iodinated X-ray contrast medium (CM) (iopromide). During CM injection, a sensation of heat occurred, which was most intense in the right inguinal region. Four hours later, the FDE arose with a red macule of approximately 2 cm in diameter covering a dermal infiltration in the right inguinal region, and enlarged up to a final size of 15 x 8 cm, accompanied by a burning sensation. The patient's history revealed a similar reaction in the same localization and of the same clinical appearance after CM injection 1 year before. Patch testing 4 months later revealed positive reactions to iomeprol and iohexol. Iopamidol injection for another CT examination 23 months later was well tolerated. Based on these results, we suggest patch testing after CM-induced FDE, which could help to select a CM for future CT examinations. Late onset of adverse CM reactions may manifest as FDE. Patch testing within the previous skin reaction area is the diagnostic tool that should be used to confirm the suspected agent, possible cross-reacting agents and well-tolerated agents. (orig.)

Multi-detector CT urography: effect of oral hydration and contrast medium volume on renal parenchymal enhancement and urinary tract opacification - a quantitative and qualitative analysis

International Nuclear Information System (INIS)

Szolar, Dieter H.; Tillich, Manfred; Preidler, Klaus W.

2010-01-01

To assess the effect of oral hydration and contrast-medium volume on renal enhancement and urinary tract opacification in multi-detector CT urography. A total of 192 patients were assigned to different protocols with varying doses of contrast agent with and without oral hydration. The attenuation was measured in the renal parenchyma in the unenhanced, nephrographic and excretory phase, and in the urinary tract in excretory phase imaging, respectively. Opacification of the urinary tract was graded on volume rendered images. Oral hydration did not significantly alter renal parenchymal enhancement in both the nephrographic and the excretory phase (p > 0.001), but significantly decreased mean attenuation of the urinary tract in the excretory phase (p ≤ 0.001), and improved continuous opacification of all ureter segments (p < 0.01). Higher volumes of contrast medium improved renal parenchymal enhancement (p ≤ 0.001) and continuous opacification of the urinary tract (p ≤ 0.01). Oral hydration leads to lower attenuation values in the urinary tract but improves the continuous opacification of the tract. Increase in contrast medium volume leads to higher renal parenchymal enhancement as well as to an increased continuous opacification of the urinary tract. Decrease in contrast medium volume cannot be compensated for by oral hydration in terms of parenchymal enhancement. (orig.)

The protective effect of ebselen on radiocontrast-induced nephrotoxicity.

Science.gov (United States)

Ozgur, Tumay; Tutanc, Murat; Zararsiz, Ismail; Motor, Sedat; Ozturk, Oktay Hasan; Yaldiz, Mehmet; Kurtgoz, Ozgur Yildirim

2012-01-01

Radiocontrast-induced nephropathy has become one of the most important causes of renal acute failure. The most effective management of reducing the incidence of contrast nephropathy is to understand and prevent its causes. We aimed to investigate the protective role of ebselen against radiocontrast-induced nephrotoxicity in terms of tissue oxidant/antioxidant parameters and light microscopy in rats. Albino Wistar rats were randomly separated into four groups. The Group 1 rats were treated with sodium chloride as the control group, Group 2 with radiocontrast, Group 3 with radiocontrast plus ebselen, and Group 4 with ebselen alone. After 24 h, the animals over the experimental period were euthanized and blood samples were analyzed for blood urea nitrogen (BUN) and serum creatinine (Cr) levels. Kidney sections were analyzed for malondialdehyde (MDA) levels and superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GSH-Px) activities, as well as histopathological changes. In the radiocontrast group, BUN, MDA, and GSH-Px levels increased while SOD activity decreased compared with the control group. These decays were improved by ebselen administration in the radiocontrast group. Significant histological deteriorations were observed in the radiocontrast group. We noted improvement in the histologic findings with ebselen administration. These results indicate that ebselen might produce a protective mechanism against radiocontrast-induced nephrotoxicity.

Evaluation of the acute adverse reaction of contrast medium with high and moderate iodine concentration in patients undergoing computed tomography

International Nuclear Information System (INIS)

Nagamoto, Masashi; Gomi, Tatsuya; Terada, Hitoshi; Terada, Shigehiko; Kohda, Eiichi

2006-01-01

The aim of this prospective study was to evaluate and compare acute adverse reactions between contrast medium containing moderate and high concentrations of iodine in patients undergoing computed tomography (CT). A total of 945 patients undergoing enhanced CT were randomly assigned to receive one of two doses of contrast medium. We then prospectively investigated the incidence of adverse reactions. Iopamidol was used as the contrast medium, with a high concentration of 370 mgI/ml and a moderate concentration of 300 mgI/ml. The frequency of adverse reactions, such as pain at the injection site and heat sensation, were determined. Acute adverse reactions were observed in 2.4% (11/458) of the moderate-concentration group compared to 3.11% (15/482) of the high-concentration group; there was no significant difference in incidence between the two groups. Most adverse reactions were mild, and there was no significant difference in severity. One patient in the high-concentration group was seen to have a moderate adverse reaction. No correlation existed between the incidence of adverse reactions and patient characteristics such as sex, age, weight, flow amount, and flow rate. The incidence of pain was not significantly different between the two groups. In contrast, the incidence of heat sensation was significantly higher in the high-concentration group. The incidence and severity of acute adverse reactions were not significantly different between the two groups, and there were no severe adverse reactions in either group. (author)

Clustering of risk factors in parents of patients with type 1 diabetes and nephropathy.

Science.gov (United States)

Thorn, Lena M; Forsblom, Carol; Fagerudd, Johan; Pettersson-Fernholm, Kim; Kilpikari, Riika; Groop, Per-Henrik

2007-05-01

To assess the impact of parental risk factors for diabetic nephropathy. This cross-sectional study included 2,355 type 1 diabetic patients from the FinnDiane (Finnish Diabetic Nephropathy) study. Diabetic nephropathy was defined as macroalbuminuria (urinary albumin excretion rate >200 microg/min or >300 mg/24 h) or end-stage renal disease. Information was available from 4,676 parents. Parental scores were calculated based on the number of various traits in the parents. Patients with diabetic nephropathy, compared with those without diabetic nephropathy, had a higher prevalence of maternal (41 vs. 35%, P = 0.046) and parental (62 vs. 55%, P = 0.044) hypertension, maternal stroke (7.6 vs. 5.1%, P = 0.044), and maternal (1.4 vs. 0.7%, P = 0.058) and parental (4.3 vs. 2.9%, P = 0.030) type 1 diabetes. If both, compared with none, of the parents had hypertension, the adjusted odds ratio (OR) for diabetic nephropathy in offspring was 1.56 (95% CI 1.13-2.15). The adjusted OR for diabetic nephropathy was 2.13 (1.36-3.33) for the parental hypertension-diabetes score (3-4 vs. 0 points) and 2.13 (1.37-3.33) for the parental hypertension-cardiovascular disease (CVD)-diabetes score (4-6 vs. 0 points). Fathers of patients with diabetic nephropathy, compared with those without diabetic nephropathy, had reduced overall survival (log-rank P = 0.04) and reduced cardiovascular survival (log-rank P = 0.03). A cluster of parental hypertension, CVD, and diabetes is associated with diabetic nephropathy in type 1 diabetes, as is paternal mortality.

Predictors of Atrasentan-Associated Fluid Retention and Change in Albuminuria in Patients with Diabetic Nephropathy

DEFF Research Database (Denmark)

Kohan, Donald E; Lambers Heerspink, Hiddo J; Coll, Blai

2015-01-01

. CONCLUSIONS: In the Reducing Residual Albuminuria in Subjects With Diabetes and Nephropathy With Atrasentan/JAPAN trials, atrasentan-associated fluid retention was more likely in patients with diabetes and nephropathy who had lower eGFR or received a higher dose of atrasentan. Finding that albuminuria......BACKGROUND AND OBJECTIVES: Endothelin A receptor antagonists (ERAs) decrease residual albuminuria in patients with diabetic kidney disease; however, their clinical utility may be limited by fluid retention. Consequently, the primary objective of this study was to identify predictors for ERA......-induced fluid retention among patients with type 2 diabetes and CKD. A secondary objective was to determine if the degree of fluid retention necessarily correlated with the magnitude of albuminuria reduction in those patients receiving ERAs. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A post hoc analysis...

Angiotensinogen gene polymorphisms in IDDM patients with diabetic nephropathy

DEFF Research Database (Denmark)

Tarnow, L; Cambien, Francois; Rossing, P

1996-01-01

Genotypic abnormalities of the renin-ANG system have been suggested as a risk factor for the development of diabetic nephropathy. Cleavage of angiotensinogen is the rate-limiting step in the activation of the renin-ANG system. The TT genotype of a polymorphism encoding threonine instead of methio......Genotypic abnormalities of the renin-ANG system have been suggested as a risk factor for the development of diabetic nephropathy. Cleavage of angiotensinogen is the rate-limiting step in the activation of the renin-ANG system. The TT genotype of a polymorphism encoding threonine instead...... of methionine (M235T) has been associated not only with increased plasma angiotensinogen concentration but also with essential hypertension. In addition, a polymorphism in the angiotensinogen gene substituting methionine for threonine (T174M) has been associated with hypertension in nondiabetic populations. We...... studied the relationship between these polymorphisms in the angiotensinogen gene in IDDM patients with diabetic nephropathy (121 men, 74 women, age 40.9 +/- 10 years, diabetes duration 27 +/- 8 years). There was no difference in M235T genotype distribution between IDDM patients with diabetic nephropathy...

Grave′s disease associated with immunoglobulin A nephropathy: A rare association

OpenAIRE

I Khan; R A Bhat; I Khan; I Hameed

2015-01-01

Immunoglobulin A (Ig A) nephropathy is the most common form of primary glomerulonephritis. The association of Ig A nephropathy with Grave's disease has not been reported so far. We report a case of 20-year-old female with Grave's disease who presented with edema, facial puffiness, and decreased urine output. She was found to be hypertensive with renal failure and nephrotic range proteinuria. Renal biopsy revealed features of Ig A nephropathy. The patient was treated with oral corticosteroids ...

IgA nephropathy enigma

Czech Academy of Sciences Publication Activity Database

Městecký, Jiří; Novák, J.; Moldoveanu, Z.; Raška, M.

2016-01-01

Roč. 172, NOV 2016 SI (2016), s. 72-77 ISSN 1521-6616 R&D Projects: GA MZd(CZ) NV15-33686A Institutional support: RVO:61388971 Keywords : IgA nephropathy * IgA subclasses * Autoimmunity Subject RIV: EE - Microbiology, Virology Impact factor: 3.990, year: 2016

Nonpharmacological Strategies to Prevent Contrast-Induced Acute Kidney Injury

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Paweena Susantitaphong

2014-01-01

Full Text Available Contrast-induced AKI (CI-AKI has been one of the leading causes for hospital-acquired AKI and is associated with independent risk for adverse clinical outcomes including morbidity and mortality. The aim of this review is to provide a brief summary of the studies that focus on nonpharmacological strategies to prevent CI-AKI, including routine identification of at-risk patients, use of appropriate hydration regimens, withdrawal of nephrotoxic drugs, selection of low-osmolar contrast media or isoosmolar contrast media, and using the minimum volume of contrast media as possible. There is no need to schedule dialysis in relation to injection of contrast media or injection of contrast agent in relation to dialysis program. Hemodialysis cannot protect the poorly functioning kidney against CI-AKI.

Endothelial nitric oxide synthase gene haplotypes and diabetic nephropathy among Asian Indians

DEFF Research Database (Denmark)

Ahluwalia, Tarun Veer Singh; Ahuja, Monica; Rai, Taranjit Singh

2008-01-01

of the constitutive endothelial nitric oxide synthase gene (eNOS) polymorphisms with type 2 diabetic nephropathy. We genotyped three polymorphisms of eNOS (Two SNPs: -786T > C, 894G > T and one 27-bp repeat polymorphism in Intron 4 (27VNTR)) in type 2 diabetic nephropathy patients (cases: n = 195) and type 2 diabetic...... without nephropathy (controls: n = 255), using validated PCR-RFLP assays. We measured serum NO levels in these subjects and examined its correlation with diabetic nephropathy and eNOS genotypes. The frequency of CC (-786T > C), TT (894G > T) and aa genotypes (27VNTR) were significantly higher in diabetic...

Herba Artemisiae Capillaris Extract Prevents the Development of Streptozotocin-Induced Diabetic Nephropathy of Rat

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Jianan Geng

2018-01-01

Full Text Available Diabetic nephropathy (DN is a major cause of end-stage renal disease throughout the world; until now there is no specific drug available. In this work, we use herba artemisiae capillaris extract (HACE to alleviate renal fibrosis characterized by the excessive accumulation of extracellular matrix (ECM in rats, aiming to investigate the protective effect of the HACE on DN. We found that the intragastric treatment of high-dose HACE could reverse the effect of streptozotocin not only to decrease the level of blood glucose and blood lipid in different degree but also further to improve renal functions. It is worth mentioning that the effect of HACE treatment was comparable to the positive drug benazepril. Moreover, we found that HACE treatment could on one hand inhibit oxidative stress in DN rats through regulating enzymatic activity for scavenging reactive oxygen species and on the other hand increase the ECM degradation through regulating the activity of metalloproteinase-2 (MMP-2 and the expression of tissue transglutaminase (tTG, which explained why HACE treatment inhibited ECM accumulation. On the basis of above experimental results, we conclude that HACE prevents DN development in a streptozotocin-induced DN rat model, and HACE is a promising candidate to cure DN in clinic.

Evolution of IgA nephropathy into anaphylactoid purpura in six cases--further evidence that IgA nephropathy and Henoch-Schonlein purpura nephritis share common pathogenesis.

Science.gov (United States)

Kamei, Koichi; Ogura, Masao; Sato, Mai; Ito, Shuichi; Ishikura, Kenji

2016-05-01

As the morphological and immunohistochemical manifestations of immunoglobulin A (IgA) nephropathy and Henoch-Schonlein purpura nephritis (HSPN) are very similar, they are considered to share a common pathogenesis. Although HSPN usually develops after the appearance of anaphylactoid purpura, we have encountered patients whose renal symptoms preceded purpura. We reviewed the clinical courses of patients who were first diagnosed with IgA nephropathy, but developed purpura later, at the National Center for Child Health and Development in Tokyo, Japan. Of the 53 patients who were diagnosed with primary IgA nephropathy at our institute during the study period (March 2002 to July 2015), six (11 %) developed anaphylactoid purpura after the diagnosis of primary IgA nephropathy and therefore met the inclusion criteria. Duration between the onset of nephritis and subsequent appearance of purpura ranged from 5 months to 14 years. One patient reached end-stage renal failure due to IgA nephropathy and developed purpura after renal transplantation. All renal biopsies performed before the appearance of purpura showed mesangial proliferation with predominant IgA deposits. Urinary findings deteriorated in three patients after the appearance of purpura, including one patient who developed rapidly progressive glomerulonephritis. Renal biopsy findings worsened in two patients. At the last observation, two patients showed mild renal insufficiency. Our clinical experience and previous reports support the argument that IgA nephropathy and HSPN are different manifestations of a single disease. Hence, it is acceptable to consider that they are variants of a single disease.

Dioxins, furans and dioxin-like PCBs in human blood: causes or consequences of diabetic nephropathy?

Science.gov (United States)

Everett, Charles J; Thompson, Olivia M

2014-07-01

Nephropathy, or kidney disease, is a major, potential complication of diabetes. We assessed the association of 6 chlorinated dibenzo-p-dioxins, 9 chlorinated dibenzofurans and 8 polychlorinated biphenyls (PCBs) in blood with diabetic nephropathy in the 1999-2004 National Health and Nutrition Examination Survey (unweighted N=2588, population estimate=117,658,357). Diabetes was defined as diagnosed or undiagnosed (glycohemoglobin ≥ 6.5%) and nephropathy defined as urinary albumin to creatinine ratio >30 mg/g, representing microalbuminuria or macroalbuminuria. For the 8 chemicals analyzed separately, values above the 75th percentile were considered elevated, whereas for the other 15 compounds values above the maximum limit of detection were considered elevated. Seven of 8 dioxins and dioxin-like compounds, analyzed separately, were found to be associated with diabetic nephropathy. The chemicals associated with diabetic nephropathy were: 1,2,3,6,7,8-Hexachlorodibenzo-p-dioxin; 1,2,3,4,6,7,8,9-Octachlorodibenzo-p-dioxin; 2,3,4,7,8-Pentachlorodibenzofuran; PCB 126; PCB 169; PCB 118; and PCB 156. Three of the 8 dioxins and dioxin-like compounds; 1,2,3,4,6,7,8,9-Octachlorodibenzo-p-dioxin; 2,3,4,7,8-Pentachlorodibenzofuran and PCB 118; expressed as log-transformed continuous variables; were associated with diabetes without nephropathy. When 4 or more of the 23 chemicals were elevated the odds ratios were 7.00 (95% CI=1.80-27.20) for diabetic nephropathy and 2.13 (95% CI=0.95-4.78) for diabetes without nephropathy. Log-transformed toxic equivalency (TEQ) was associated with both diabetic nephropathy, and diabetes without nephropathy, the odds ratios were 2.35 (95% CI=1.57-3.52) for diabetic nephropathy, and 1.44 (95% CI=1.11-1.87) for diabetes without nephropathy. As the kidneys function to remove waste products from the blood, diabetic nephropathy could be either the cause or the consequence (or both) of exposure to dioxins, furans and dioxin-like PCBs. Copyright © 2014

Mycotoxic nephropathy in Bulgarian pigs and chickens: complex aetiology and similarity to Balkan endemic nephropathy

CSIR Research Space (South Africa)

Stoev, SD

2009-01-01

Full Text Available picture of this nephropathy. A heavy contamination with Gibberella fujikuroi var. moniliformis (Fusarium verticillioides) and Penicillium aurantiogriseum complex (mainly Penicillium polonicum) was observed in almost all examined feed samples coming from...

Multiple metabolic hits converge on CD36 as novel mediator of tubular epithelial apoptosis in diabetic nephropathy.

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Katalin Susztak

2005-02-01

Full Text Available Diabetic nephropathy (DNP is a common complication of type 1 and type 2 diabetes mellitus and the most common cause of kidney failure. While DNP manifests with albuminuria and diabetic glomerulopathy, its progression correlates best with tubular epithelial degeneration (TED and interstitial fibrosis. However, mechanisms leading to TED in DNP remain poorly understood.We found that expression of scavenger receptor CD36 coincided with proximal tubular epithelial cell (PTEC apoptosis and TED specifically in human DNP. High glucose stimulated cell surface expression of CD36 in PTECs. CD36 expression was necessary and sufficient to mediate PTEC apoptosis induced by glycated albumins (AGE-BSA and CML-BSA and free fatty acid palmitate through sequential activation of src kinase, and proapoptotic p38 MAPK and caspase 3. In contrast, paucity of expression of CD36 in PTECs in diabetic mice with diabetic glomerulopathy was associated with normal tubular epithelium and the absence of tubular apoptosis. Mouse PTECs lacked CD36 and were resistant to AGE-BSA-induced apoptosis. Recombinant expression of CD36 in mouse PTECs conferred susceptibility to AGE-BSA-induced apoptosis.Our findings suggest a novel role for CD36 as an essential mediator of proximal tubular apoptosis in human DNP. Because CD36 expression was induced by glucose in PTECs, and because increased CD36 mediated AGE-BSA-, CML-BSA-, and palmitate-induced PTEC apoptosis, we propose a two-step metabolic hit model for TED, a hallmark of progression in DNP.

Effective antihypertensive treatment postpones renal insufficiency in diabetic nephropathy

DEFF Research Database (Denmark)

Parving, H H; Smidt, U M; Hommel, E

1993-01-01

The effect of long-term, aggressive, antihypertensive treatment on kidney function in diabetic nephropathy was studied prospectively in 11 insulin-dependent diabetic patients (mean age, 30 years). Renal function was assessed every 4 months by measurement of glomerular filtration rate (GFR) (single...... infarction (GFR, 46 mL/min/1.73 m2). Effective antihypertensive treatment postpones renal insufficiency in diabetic nephropathy....

Dual therapy of vildagliptin and telmisartan on diabetic nephropathy in experimentally induced type 2 diabetes mellitus rats.

Science.gov (United States)

Sharma, Ashish Kumar; Kanawat, Devendra Singh; Mishra, Akanksha; Dhakad, Prashant Kumar; Sharma, Prashant; Srivastava, Varnika; Joshi, Sneha; Joshi, Megha; Raikwar, Sachin Kumar; Kurmi, Muneem Kumar; Srinivasan, Bharthu Parthsarthi

2014-12-01

The objective of this article is to investigate the combination of telmisartan with vildagliptin therapy versus monotherapy of vildagliptin and telmisartan on diabetic nephropathy in type 2 diabetes mellitus rats. In adult rats streptozotocin (65 mg/kg) and nicotinamide (110 mg/kg) were injected intraperitoneally to produce diabetic nephropathy. Rats of either sex allotted to the following groups: (i) triple therapy: metformin (120 mg/kg, o.d.) + pioglitazone (1.25 mg/kg, o.d.) + glimepiride (0.7 mg/kg, o.d.); (ii) dual therapy: vildagliptin (8.76 mg/kg, o.d.) + telmisartan (6.48 mg/kg, o.d.); (iii) vildagliptin (8.76 mg/kg, o.d.); and (iv) telmisartan (6.48 mg/kg, o.d.); therapy was carried out for 35 days orally. Weekly at days 7, 14, 21, 28 and 35, blood pressure, blood glucose level, body weight, blood serum creatinine level, protein albumin level in urine, and blood urea nitrogen (BUN) were estimated. Renal structural changes were observed. Blood pressure, blood glucose level, blood serum creatinine level, protein albumin level in urine, BUN and renal deterioration increased significantly in diabetic rats compared with normal control rats. The vildagliptin + telmisartan treatment group showed no weight gain and controlled blood pressure, renovascular structural and biochemical parameters in diabetic neuropathy rats. The addition of telmisartan to vildagliptin demonstrated the best control over blood pressure, glycemia and diabetic nephropathy markers, renal structural changes and improvement of renal function as opposed to monotherapy with either drug, possibly because of the dual inhibitory effect on the renin-angiotensin system. © The Author(s) 2013.

Intracavitary application of contrast medium in the follow-up of complicated tube-drained pleural empyema: Conventional radiography vs CT

International Nuclear Information System (INIS)

Duex, M.; Bischoff, H.; Schmaehl, A.; Tuengerthal, S.

1997-01-01

Purpose: To define the value of conventional radiography compared with CT in the follow-up of complicated, long-term tube drained pleural empyema after intracavitary application of contrast medium. Methods: 28 patients with complicated pleural empyema (stage III) and longterm tube drainage were submitted to fluoroscopy of the pleural cavity and a CT of the thorax after contrast medium had been instilled into the pleural space. Both examinations were judged by the following criteria: Number and morphology of pleural cavities, quality of drainage and accompanying thoracic disease. Results: 49 pleural cavities were diagnosed. Judgement of drainage corresponded in 79% of cases and differed 21% with proof of further not drained cavities only on CT. 4 bronchopleural fistulas were diagnosed by fluoroscopy, of which only 2 were evident on CT. Accompanying thoracic disease was reliably detected by CT only. Conclusions: Diagnosis of bronchopleural fistulas and judgement of the pleural drainage is best possible using fluoroscopy after application of contrast medium into the pleural space. CT is most accurate to detect further cavities that have not been drained, to look for concomitant thoracic disease, and to judge the morphology of the pleural cavity. Conventional radiography of the pleural space is effective and recommended to be used as a first line investigation for the follow-up of stage III empyemas. Patients in poor general condition (fever, elevated blood markers indicating inflammation) should be examined by both fluoroscopy and CT. (orig.) [de

Transcatheter aortic-valve implantation with one single minimal contrast media injection.

Science.gov (United States)

Arrigo, Mattia; Maisano, Francesco; Haueis, Sabine; Binder, Ronald K; Taramasso, Maurizio; Nietlispach, Fabian

2015-06-01

Performing transcatheter aortic valve implantation (TAVI) with the use of minimal contrast in patients at high-risk for acute kidney injury (AKI). Contrast-induced nephropathy (CIN) is a major cause of AKI following TAVI and is associated with increased morbidity and mortality. The amount of contrast media used increases the risk for CIN. Computed tomography was omitted during the screening process. For the procedure transfemoral access was default. The self-expanding CoreValve prosthesis was chosen in all patients to minimize the risk of annular rupture in case of oversizing. Valve sizing was based on echocardiography, aortography, calcification on fluoroscopy, as well as weight and height of the patient. A single contrast injection was performed to confirm correct position of the pigtail catheter at the level of the annulus. The pigtail then served as the marker for the device landing zone. Intraprocedural assessment of the implantation result relied on echocardiography and hemodynamics. Five patients with severe aortic stenosis and at high risk for developing CIN were included. Device success was achieved in all patients and no major complications occurred. The median dose of injected contrast media was 8 ml (4-9). All but one patient had improved renal function after the intervention compared to baseline. Our study shows feasibility of performing TAVI with a single minimal contrast media injection, using a self-expandable valve. This technique has the potential to reduce the incidence of CIN. © 2015 Wiley Periodicals, Inc.

Attenuation changes of the normal and ischemic canine kidney. Dynamic CT scanning after intravenous contrast medium bolus

Energy Technology Data Exchange (ETDEWEB)

Jaschke, W.; Lipton, M.J.; Boyd, D.P.; Cann, C.; Strauss, L.; Sievers, R.S.

The potential of CT scanning to explore total and regional renal blood flow was evaluated in a dog model with unilateral renal artery stenosis (n=7, reduction of renal blood flow: 32-75% of base line flow). Attenuation versus time curves were generated for the renal cortex and medulla, as well as for the aorta and renal vein. A fast CT scanner was used which allowed for up to 24 scans/minute at the same level (slice thickness: 10 mm). A total of 10 ml contrast medim was injected into a peripheral vein for each scan series taken. During baseline conditions, the curve of the renal cortex and medulla demonstrated 2 peaks. The first peak was mainly related to early vascular enhancement, whereas the second peak corresponded mainly to the appearance of contrast medium in the distal convolutes and collecting ducts. Ischemia of the kidney resulted in a reduction of the first peak and a flattening of the leading edge slope. Transport of contrast medium through the extravascular compartments of the kidney was delayed during ischemia. Relative renal blood flow was obtained from the CT data by dividing peak enhancement by rise-time as assessed from the cortical curve. All measurements were related to baseline flow and validated by flow measurements using radioactive labeled microspheres (n=5). Correlation was found to be r=0.97. (orig.).

Nanoparticles generated by laser in liquids as contrast medium and radiotherapy intensifiers

Science.gov (United States)

Restuccia, Nancy; Torrisi, Lorenzo

2018-01-01

The synthesis of Au and Ag nanoparticles (NP) though laser ablation in liquids as a function the laser parameters is presented. Spherical NPs with diameter distribution within 1 and 100 nm were prepared by laser ablation in water. The nanoparticles characterization was performed using optical spectroscopy and electronic microscopy (SEM and TEM) measurements. Studies of the possible use of metallic nanoparticles as intensifier of diagnostics imaging contrast medium and absorbing dose from ionizing radiations in traditional radiotherapy and protontherapy are presented. Examples of in vitro (in tissue equivalent materials) and in vivo (in mice), were conducted thank to simulation programs permitting to evaluate the enhancement of efficiency in imaging and therapy as a function of the NPs concentrations and irradiation conditions.

Nanoparticles generated by laser in liquids as contrast medium and radiotherapy intensifiers

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Restuccia Nancy

2018-01-01

Full Text Available The synthesis of Au and Ag nanoparticles (NP though laser ablation in liquids as a function the laser parameters is presented. Spherical NPs with diameter distribution within 1 and 100 nm were prepared by laser ablation in water. The nanoparticles characterization was performed using optical spectroscopy and electronic microscopy (SEM and TEM measurements. Studies of the possible use of metallic nanoparticles as intensifier of diagnostics imaging contrast medium and absorbing dose from ionizing radiations in traditional radiotherapy and protontherapy are presented. Examples of in vitro (in tissue equivalent materials and in vivo (in mice, were conducted thank to simulation programs permitting to evaluate the enhancement of efficiency in imaging and therapy as a function of the NPs concentrations and irradiation conditions.

Fractalkine in type 2 Egyptian diabetics with and without nephropathy

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