الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
CI-AKI is an acute kidney injury that occurs as a complication of the iodinated contrast media in the contrast based radiological studies. It is the third leading cause of acute kidney injury in hospitalized patients. CI-AKI is associated with rapid and often irreversible decline in kidney function and so it increases the morbidity, mortality, and the length of hospitalization.
The mechanism by which the contrast medium can induce CI-AKI is complex and not fully understood, but it is believed that renal ischemia is the cornerstone in the pathophysilogy of CI-AKI. The contrast medium can induce vasoconstriction at the corticomedullary junction through the release of multiple vasoconstrictive substances like adenosine and endothelin. The prolonged reduction of blood flow to the outer medulla leads to medullary ischemia. The prolonged hypoxia leads to oxidative stress with a consequent production of reactive oxygen species which play a role in the pathophysilogy of CI-AKI. High-osmolar contrast agents impair the nitric acid production, so lead to loss of the renal autoregulatory capacity. All the previous mechanisms plus contrast induced direct tubular toxicity lead to acute tubular necrosis and the syndrome of CI-AKI.
Patients at risk for CI-AKI are those with old age, pre-existing renal disease, diabetes, congestive heart failure, shock or hypotension, dehydration, anemia, acute myocardial infarction, intra-aortic balloon pump and the prior or concomitant use of nephrotoxic drugs like NSAIDs and diuretics. There are contrast related risk factors as the use of high-osmolar contrast agents, high viscosity and large volume of contrast medium.
There are several prophylactic measures against CI-AKI. The most effective measures are the pre-procedural hydration and N-acetylcysteine. Other measures are ascorbic acid, sodium bicarbonate, diuretics, Mannitol, and vasodilators. The type and volume of the contrast agent also should be taken in to consideration.
The aim of this study was to assess the effect of furosemide-forced diuresis and intravenous saline infusion matched with urine output (Furosemide Matched Hydration) in prevention of contrast induced nephropathy (CIN)
The study included 100 patients who were undergoing coronary interventions. None of them was dehydrated.
The patients were divided in to two groups:
group I: Furosemide Matched Hydration (FMH) group received an initial 250-ml intravenous bolus of normal saline over 30 min followed by an intravenous bolus (0.5 mg/kg) of furosemide. Hydration infusion rate was automatically adjusted to precisely replace the patient’s urine output. When a urine output rate of 300 ml/h was obtained, patients underwent the coronary procedure. Matched fluid replacement was maintained during the procedure and for 4 h post-treatment. (Study group).
group II: Fifty patients will receive the conventional preventive measures only (Control group).
All Subjects in the present study was subjected to the following:
- History taking and clinical examination.
- History of the cardiac disease that necessitate the need of this study.
Routine laboratory investigations including the following:
- Complete blood picture.
- Blood urea.
- Lipid profile.
- Serum creatinine, before and 48 hours after the procedure.
The results of this study showed that CI-AKI in group I developed in 3 patients (6%), while in group II CI-AKI developed in 6 patients (12%), based on CI-AKI definition which is increase in the basal serum creatinine of ≥25% 48 hours after the procedure. This difference in the incidence of CI-AKI between the two studied groups did not reach a statistical significant level and this may be attributed to the small sample size (p=0.487). On the other hand, the percentage change of serum creatinine after the study was significantly lower in the furosemide hydration group in comparison to the control group (t=2.338, p=0.019). These data may point to the beneficial effect of the furosemide matched hydration in preventing CI-AKI.
Age has significant positive correlation with percentage change in serum creatinine after the procedure in all cases (P= 0.012). This finding may denote that elderly patients are liable to CI-AKI and thus all preventive measures should be applied to those patients.
Weight has a significant positive correlation with percentage change in serum creatinine after the procedure in all cases (P= 0.000). Thus, obesity may be considered as a risk factor for the occurrence of CI-AKI.
from this study, we can conclude that hydration remains the corner stone in prevention of contrast induced nephropathy in patients undergoing coronary angiography but Furosemide matched hydration with saline may be more beneficial in preventing contrast induced AKI than standard hydration.