الفهرس 
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Abstract
Contrast-induced nephropathy (CIN) is a common complication following coronary angiography with or without percutaneous coronary intervention (PCI) Contrast induced nephropathy (CIN) is generally defined as an increase in serum creatinine concentration of > 0.5 mg/dl or 25% above baseline within 48 hours after contrast administration. It occurs within 24-48 hours of exposure, with creatinine level typically peaking 3-5 days after procedure and returning to baseline or near baseline in 1-3 weeks. Hyperglycemia is defined as random blood glucose > 200 mg/dl irrelevant to history of established diagnosis of DM according to American Diabetes Association. Our study is a prospective cohort study which was delivered in cardiovascular department at Specialized Medical Hospital, Mansoura University and Dar elshifa hospital – Cairo and included 200 patients who are candidate for either elective or emergent coronary angiography with or without PCI including diabetic and non diabetic patients to study the effect of hyperglycemia on the incidence of CIN after coronary angiography. Patients were divided into two main groups group 1 : (study group) 100 patients with preprocedural hyperglycemia ( random blood glucose > 200 mg/dl) group 2 : (control group) 100 patients with preprocedural normoglycemia ( random blood gluose < 140 mg/dl). • All patients were subjected to complete history taking, thorough physical examination and routine biochemical investigations. Moreover, ECG and echocardiography were ordered for all the included patients. • Pre and post procedural random blood glucose was measured to all included patients. • Baseline serum creatinine and 48 hours post procedure was measured to detect and diagnose CIN. The results of this study showed that: • No significant difference was found between the two study groups in the mean age, sex distribution, smoking history and dyslipidemia. • Mean age in group 1 is 57.80±9.33 while in group 2 is 56.88±8.51. • Sex distribution was equal in these study, 66 males and 34 females for each group. • No significant difference was found between the two study groups in the clinical examination. • No significant difference was found between the two study groups in the mode of presentation and echocardiographic findings. • There was a statistically significant difference between the two groups in pre procedural random blood glucose (p<0.001), post procedural random blood glucose (p<0.001) and 6 hours after the procedure random blood glucose (p<0.001). • There was significant statistical difference in the incidence of CIN in the two study group (P value =0.021) where the incidence of CIN in hyperglycemia group was 22 while only 10 in normoglycemia group According to the incidence of CIN there were 32 patients with CIN among all studied patients , here we compared multiple variants between two groups according to the incidence of CIN . group 1 (CIN group n=32) : patients with increase in serum creatinine 48 hours postprocedure by 0.5 mg/dl or increase from baseline creatinine with 25% or more. group 2 (No CIN group n=168) : patients who didn’t meet the criteria of incidence of CIN. • No significant difference was found between the two study groups in the amount of contrast agent used in the procedure ( P value 0.264). • There was a statistically significant difference between the two groups in pre procedural random blood glucose (p=0.04), post procedural random blood glucose (p<0.001). • There was a statistically significant difference between the two groups in HbA1c level (P value =0.003). • There was significant statistical difference in the incidence of CIN in patients with elevated HbA1c > 7 % and patients with normal HbA1c<7 % (P value = 0.003) . The incidence of CIN was 27.3 % and 10.4 % respectively. • On univariate analysis, sex distrubution, Histoy of IHD, Dyslipidemia,CCS as a mode of presentation , number of stents used as well as HbA1c , pre and post procedural random blood glucose were risk factors of CIN (p < 0.05). However, on multivariate analysis, HbA1c, pre and post procedural random blood glucose were significant predictors of CIN after coronary angiography (p < 0.05).