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Abstract
Nephrotoxicity is a major complication associated with the administration of radiographic contrast agents. Despite efforts to prevent contrast-media-induced nephrotoxicity, it remains a significant cause of iatrogenic renal dysfunction, contributing to morbidity, prolonged hospitalizations, mortality, increased cost of health care, and chronic end-stage renal disease.
The risk factors for contrast-media-induced reductions in renal function include preexisting renal dysfunction (such as diabetic nephropathy), increased age, reduced arterial volume, heart failure, increased volume of contrast agent administered, type of contrast dye used (high versus low osmolarity, ionic versus non ionic), repeat exposure to contrast media within 72 hours, and concomitant administration of drugs that interfere with renal perfusion, such as angiotensin - converting - enzyme (ACE) inhibitors.
Several prophylactic methods have been studied in an attempt to prevent nephrotoxicity associated with contrast media, including i.v. saline, dopamine, atrial natriuretic peptide, mannitol, calcium channel blockers (CCBs), furosemide, theophylline, and most recently, acetylcystiene.
Greater contrast exposure and concomitant peripheral atherosclerosis, including renovascular disease, precludes extrapolation of these results into cardiology practice. Several studies have shown conflicting results with prolonged regimes of prehydration and acetylcystiene therapy.
Patients and methods
This study included 64 patients who undergone diagnostic coronary angiography or percutanous coronary intervention (PCI).
Group I :
Includes 20 patients with renal impairment as defined by serum creatinine ? 1.5 mg/dl. Group I patients took acetylcystiene 600 mg twice before angiography (at four hours interval) and thrice after coronary angiography (at twelve hours interval).
Group II :
It included 24 patients who have renal impairment as defined by serum creatinine ? 1.5 mg/dl. Group II patients were not given acetylcystiene.
Group III (Control group) :
It included 20 patients who have no renal impairment as defined by serum creatinine < 1.5 mg/dl. Group III patients were not given acetylcystiene
All patients were hydrated by 0.9% saline at a rate of 1ml/kg/hour, for twelve hours before coronary angiography, and for twelve hours after the procedure.
All patients were subjected to :
1- Careful history taking and clinical examination, with special referance to risk factors of contrast induced nephropathy as preexisting renal impairment, age, nephrotoxic drugs.
2- ECG
3- Echocardiography
4- Blood urea and serum creatinine immediately before, and daily after the procedure, for three days.
5- Creatinine clearance the day before, and the day after angiography.
Result
The incidence of contrast induced nephropathy was 5% in group I, 30% in group II and 0% in group.