Assessment of Renal Function, Iatrogenic Hyperkalemia and Acute Renal Dysfunction in Cardiology. Contrast-Induced Nephropathy

2011 ◽  
Vol 64 (12) ◽  
pp. 1182-1192
Author(s):  
José Luis Górriz Teruel ◽  
Sandra Beltrán Catalán
Keyword(s):  
Renal Function ◽  
Renal Dysfunction ◽  
Contrast Induced Nephropathy ◽  
Acute Renal Dysfunction

Contrast-induced nephropathy (Pharmacology of X-ray contrast agents)

2016 ◽  
Vol 7 (1) ◽  
pp. 97-105 ◽  
Author(s):  
Vladislava A Raptanova ◽  
Alexandra A Speranskaya ◽  
Sergei N Proshin
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Serum Creatinine ◽  
Renal Dysfunction ◽  
Urine Volume ◽  
Contrast Induced Nephropathy ◽  
Acute Renal Dysfunction ◽  
X Ray ◽  
Sustained Reduction ◽  
Nephrotoxic Drugs

In the last 30 years the use of X-ray contrast media (RCM) has increased significantly during urography, angiography, computed tomography, and operating procedures. Every year the world uses about 60 million doses of PKM, but, despite the use of newer and less nephrotoxic drugs, the risk of contrast-induced nephropathy (CIN) is still significant, especially among patients with prior renal impairment. Contrast induced nephropathy is a major cause of acute renal injury and is a huge problema in clinical practice. So far, con-tradictions remain in the understanding of many aspects of CIN. Contrast-induced nephropathy is acute renal failure (ARF) occurs within 48-72 hours after intravenous administration of contrast sub-stances. Toxicity PKC determined their molecular structure and its ability to dissociate in aqueous solution into ions which consist of salts which dissociate into cations and anions. The contrast-induced nephropathy is manifested in the increase of serum creatinine of 44 mmol/L (0.5 mg / dl) or more and the same rise in serum creatinine of more than 25 % compared to baseline in the absence of other possible causes. ARF is a sudden and sustained reduction in glomerular filtration rate and urine volume, or both together. Thus renal dysfunction existing even more than 1 month can be regarded as acute renal dysfunction. Usually the development of acute renal failure occurs within 1-7 days. The criteria of sustainability is a dysfunction of its registration within 24 hours or more. The aim: to consider different approaches to the pathogenesis, risk factors and achievements in the prevention of contrast-induced nephropathy.

Acute renal dysfunction during interleukin-2 treatment: suggestion of an intrinsic renal lesion.

1990 ◽  
Vol 8 (11) ◽  
pp. 1839-1846 ◽  
Author(s):  
C L Shalmi ◽  
J P Dutcher ◽  
D A Feinfeld ◽  
K J Chun ◽  
K R Saleemi ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Dysfunction ◽  
Plasma Flow ◽  
Renal Plasma Flow ◽  
Interleukin 2 ◽  
Mean Value ◽  
High Dose ◽  
Renal Lesion ◽  
Radionuclide Studies ◽  
Acute Renal Dysfunction

Adoptive immunotherapy with interleukin-2 (IL-2) and lymphokine-activated killer (LAK) cells has been effective in treating some advanced malignancies in animals and humans. One complication of this treatment is a reversible, oliguric, acute renal failure, which has been ascribed to renal hypoperfusion and resultant prerenal azotemia. We serially studied renal function in 10 patients receiving high-dose regimens of recombinant interleukin-2 (rIL-2) to attempt to delineate further the nature of the renal dysfunction caused by IL-2 treatment. Renal plasma flow was computed from iodine 131 (I-131 Hippuran; Mediphysics, Paramus, NJ) orthoiodohippurate, excretion curves, and glomerular filtration rate (GFR) was determined by creatinine clearance. Studies done prior to and on day 4 of treatment showed that GFR fell in nine of 10 patients, with a mean decrease of 43% +/- 8%, and renal plasma flow fell in five of the 10 patients with a mean decrease of 5% +/- 10%. The average pretherapy filtration fraction was calculated to be 23% +/- 1% and after 4 days of treatment, decreased to a mean value of 15 +/- 2%. The BUN to creatinine ratio also declined in all patients. These findings collectively suggest that IL-2 nephrotoxicity may result from an intrarenal defect in addition to the previously described prerenal azotemia. Additionally, radionuclide studies of renal function are a reliable and reproducible noninvasive method of assessing these changes in renal function.

scholarly journals Feasibility of Using eGFR to Diagnose Contrast-Induced Nephropathy in Patients Undergoing Coronary Angiography

2020 ◽  
pp. 1-6
Author(s):  
Shuxian Zhou ◽  
Guiyi Yuan ◽  
Boshui Huang ◽  
Dengfeng Geng ◽  
Juan Lei ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Renal Function ◽  
Coronary Angiography ◽  
Renal Dysfunction ◽  
Roc Curve ◽  
Large Scale ◽  
Influence Factors ◽  
Contrast Induced Nephropathy ◽  
Total Incidence ◽  
Before And After

Background: Contrast-induced nephropathy (CIN) is one of the common complications of coronary angiography (CAG). The changes of serum creatinine (Scr) before and after angiography were used to diagnose CIN in the world. But Scr is not a sensitive index to reflect early renal dysfunction. Estimated glomerular filtration rate (eGFR) is a comprehensive indicator to evaluate renal function but does not have accepted standard to diagnose CIN till now. This study aimed to investigate the feasibility of using eGFR to diagnose CIN in patients undergoing CAG. Methods: We included 300 coronary heart disease (CHD) patients who underwent CAG. Their demographics and basal renal function were recorded. Changes of Scr and eGFR before and after CAG were compared at the same time. Logistic regression was used to find independent influence factors of CIN. Receptor operating characteristic (ROC) curve was used to find the optimum cut-off value of eGFR for diagnosing CIN. Results: Among 300 patients with CHD, 64 (41 males and 23 females) of them were affected by CIN after CAG, with a total incidence of 21.3%. Among 271 patients whose Scr were normal (< 133 μmol/L) before CAG, 109 (40.2%) of them with impaired eGFR (< 90 ml/min/1.73m²). Patients had normal eGFR before CAG were less likely to develop CIN than those with normal Scr (15.4% vs 20.7%, P < 0.05). Logistic regression analysis showed that men, diabetes, multivessel lesion and eGFR were independent factors of CIN. ROC curve showed that the optimum cut-off value for diagnosing CIN was eGFR decrease by 22.5% after CAG (sensitivity = 98.4%, specificity = 98.3%, AUC = 0.973, 95%CI: 0.942-1.000, P = 0.000). Conclusions: eGFR is an independent factor of CIN, which is more sensitive than Scr in reflecting early renal dysfunction. Using eGFR to diagnose CIN is feasible in the clinic, but the cut-off value still needs to be confirmed by large scale clinical trials.

scholarly journals Computed Tomography Angiography before Intravenous Thrombolysis Does Not Increase the Risk of Renal Dysfunction

ISRN Stroke ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-6
Author(s):  
Pilar Sobrino García ◽  
Andrés García Pastor ◽  
Juan Pablo Cuello ◽  
Silvia Gil Navarro ◽  
Gema Vicente Peracho ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Renal Function ◽  
Renal Dysfunction ◽  
Computed Tomography Angiography ◽  
Intravenous Thrombolysis ◽  
Control Group ◽  
Acute Renal Dysfunction ◽  
Before And After ◽  
Baseline Creatinine ◽  
Inflammatory Drugs

Our aim is to determine whether computed tomography angiography (CTA) before intravenous thrombolysis (IVT) affects renal function in acute ischemic stroke (AIS) patients. We performed an observational analysis of AIS patients treated with IVT for three years. Patients were classified into 2 groups: those who underwent CTA (CTA-group) and those who did not (control-group). Differences in creatinine levels between baseline and 24–72 hours after IVT were calculated. Acute renal dysfunction (ARD) was defined as an increase in serum creatinine level of ≥0.5 mg/dL and/or ≥25% above baseline within 24–72 hours after IVT. 190 patients were treated with IVT. Renal function (before and after IVT) was assessed in 162 (115 in control-group; 47 in CTA-group). Nine patients (5.5%) developed ARD (2 (4.2%) in CTA-group and 7 (6.1%) in control-group; P=0.6). CTA was not associated with a higher risk of ARD and did not affect the efficacy or safety of IVT. Previous chronic renal insufficiency, baseline creatinine levels, and previous use of nonsteroidal anti-inflammatory drugs were associated with a significant increase in creatinine levels, independently of contrast use. In conclusion, CTA does not seem to increase the risk of renal dysfunction. This technique may be used safely without knowledge of baseline creatinine levels.

scholarly journals Cardiorenal syndrome: pathogenesis, clinical picture

2016 ◽  
Vol 97 (2) ◽  
pp. 274-278
Author(s):  
N A Tsibul’kin ◽  
A A Novozhilova ◽  
D M Khakimova
Keyword(s):  
Renal Function ◽  
Cardiovascular System ◽  
Renal Dysfunction ◽  
Mutual Influence ◽  
Circulatory System ◽  
Cardiorenal Syndrome ◽  
Left Ventricular ◽  
Renal Diseases ◽  
Clinical Value ◽  
Acute Renal Dysfunction

Owing to the commonality of a number of pathogenetic mechanisms, cardiovascular system and kidneys diseases often occur together, mutually exacerbating the severity. The circulatory system and the circulating plasma amount are in many respects regulated by the kidneys functional activity. The parameters of systemic hemodynamics and left ventricular function influence on renal function. The discovery of the mechanisms of renal function impairment influence on the heart state and activity contribute to a fuller understanding of the two systems mutual influence. Currently it is recognized that the frequent combination of cardiovascular and renal diseases based primarily on common pathogenic mechanisms of both forms of pathology and their mutually aggravating influence. In accordance with the modern classification there are five types of cardiorenal syndrome: (1) acute renal dysfunction amid acute-onset cardiac dysfunctions; (2) chronic renal dysfunction due to chronic cardiac pathology; (3) acute cardiac dysfunctions due to acute renal impairment; (4) long-term cardiac and cardiovascular system disorders in patients with chronic renal dysfunction; (5) combined cardiorenal pathology due to other organs and systems dysfunction. The clinical significance of this disease is that doctors of various specialties might face it in their practice: physicians, cardiologists, endocrinologists, resuscitators. Cardiorenal syndrome diagnosis is based on patient constant monitoring in several ways, including laboratory and instrumental indicators, allowing timely suspect the initial stages of this pathology development. This increases the research relevance in this field and clinical value of obtained through them practical conclusions and recommendations, reflected in a number of international documents.

scholarly journals Radiocontrast increases plasma and urinary endothelin.

1991 ◽  
Vol 2 (5) ◽  
pp. 1041-1045
Author(s):  
K B Margulies ◽  
F L Hildebrand ◽  
D M Heublein ◽  
J C Burnett
Keyword(s):  
Heart Failure ◽  
Animal Model ◽  
Renal Function ◽  
Renal Dysfunction ◽  
Atrial Natriuretic Factor ◽  
Hemodynamic Responses ◽  
Acute Renal Dysfunction ◽  
Natriuretic Factor ◽  
Baseline Levels ◽  
Vasoconstrictor Peptide

Recent studies indicate that endothelin (ET), a potent endogenous systemic and renal vasoconstrictor peptide, may mediate decreases in GFR in models of acute renal dysfunction. Moreover, in an animal model of radiocontrast-induced nephropathy (RCIN), it was recently demonstrated that early renal hemodynamic responses to radiocontrast are attenuated by intra-arterial atrial natriuretic factor (ANF), which prevents subsequent RCIN. The studies presented here were therefore designed to determine whether i.v. infusion of radiocontrast produces increases in endogenous plasma and urinary ET and whether these responses are modulated by intra-arterial ANF in an animal model of RCIN. In these studies, dogs with pacing-induced heart failure received i.v. radiocontrast in the presence and absence of an intra-aortic infusion of ANF. Significant increases in both plasma and urinary ET were observed during and after radiocontrast. Although coadministration of ANF did not prevent increases in plasma and urinary ET, ANF preserved renal function acutely in this model of RCIN by increasing GFR above baseline levels.

Early Renal Dysfunction in Obese Patients with Insulin Resistance

2019 ◽  
Vol 26 (3) ◽  
pp. 261-265
Author(s):  
Natalia Pertseva ◽  
Mariia Rokutova
Keyword(s):  
Insulin Resistance ◽  
Renal Function ◽  
Renal Dysfunction ◽  
Filtration Rate ◽  
Diagnostic Value ◽  
Glomerular Hyperfiltration ◽  
Model Assessment ◽  
Homa Index ◽  
Obese Patients ◽  
Homeostasis Model Assessment

Abstract Background and aims. Obese individuals have insulin resistance status assessed in the present study by the HOMA index (“Homeostasis model assessment”). This prospective study assessed renal disorders in the insulin resistance in obese patients. Material and Methods. The study included 73 young obese patients. The assessment included the HOMA index before meal and parameters of renal function (glomerular filtration rate, albuminuria, β2-microglobulinuria). Results. In young obese, insulin-resistance patients, glomerular hyperfiltration and β2-microglobulinuria are found in 77.0 and 93.4% of cases respectively. The albuminuria is noted in some cases, which reduces diagnostic value. Conclusions. In young obese patients with insulin resistance, glomerular hyperfiltration and β2-microglobulinuria are main diagnostic markers of renal dysfunction.

scholarly journals POS1120 PRESENCE OF TOPHI IS ASSOCIATED WITH A RAPID DECLINE IN THE RENAL FUNCTION IN PATIENTS WITH GOUT

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 839.1-839
Author(s):  
Y. J. Oh ◽  
K. W. Moon
Keyword(s):  
Renal Function ◽  
Renal Dysfunction ◽  
Clinical Characteristics ◽  
Multivariate Logistic Regression Analysis ◽  
Joint Involvement ◽  
Rapid Decline ◽  
Symptom Duration ◽  
Tophaceous Gout ◽  
Duration Of Symptoms ◽  
Increased Risk

Background:Gout is the most common inflammatory arthritis resulting from a chronic deposition of MSU crystals in the joints and other soft tissues. After the process of repeated tissue damage and repair due to gout, tophi could be formed around the affected joints. Intra-articular tophi may sometimes result in bone destruction, joint deformities, and dysfunction which can adversely affect the patient’s quality of life. Furthermore, early-onset tophaceous gout patients are more likely to develop renal dysfunction, however, few studies have investigated if the presence of tophi is related with the progression of renal dysfunction in gout patients.Objectives:We aimed to compare clinical characteristics of patients with and without tophi at the time of the diagnosis of gout and investigate the effect of tophi on the renal function in gout patients.Methods:Data of 257 patients who were first diagnosed with gout at the Kangwon National University Hospital from January 2012 to December 2018 were retrospectively studied. Patients were divided into 2 groups according to the presence of tophi at the diagnosis. We compared clinical characteristics and the progression of renal dysfunction between the two groups.Results:Of all patients, 66 (25.5%) initially presented with tophi. Patients with tophi were older, had a longer duration of symptoms, and had a higher prevalence of multiple joint involvement than those without tophi. The decline in the eGFR was more prominent in patients with tophi than in those without (-4.8±14.5 ml/min/1.73m2vs. -0.7±11.9 ml/min/1.73m2, respectively; P=0.039). In multivariate logistic regression analysis, a prolonged symptom duration (odds ratio [OR], 1.010; 95% confidence interval [CI], 1.004–1.017; P=0.001) and multiple joint involvement (OR, 3.027; 95% CI, 1.831–5.004; P<0.001) were significantly associated with increased risk of formation of tophi. The presence of tophi was significantly associated with a rapid decline in the eGFR (β=-0.141; P=0.035).Conclusion:A prolonged symptom duration and multiple joint involvement were independent risk factors for tophi as the presenting symptom in gout patients. The presence of tophi was associated with a declining renal function. Therefore, an early diagnosis and active treatment are important in tophaceous gout.References:[1]Bardin T, Richette P. Definition of hyperuricemia and gouty conditions. Curr Opin Rheumatol 2014;26:186-91.[2]Liu F, Du GL, Song N, Ma YT, Li XM, Gao XM, et al. Hyperuricemia and its association with adiposity and dyslipidemia in Northwest China: results from cardiovascular risk survey in Xinjiang (CRS 2008-2012). Lipids Health Dis 2020;19:58.[3]Dalbeth N, Merriman TR, Stamp LK. Gout. Lancet 2016;388:2039-52.[4]Ruoff G, Edwards NL. Overview of Serum Uric Acid Treatment Targets in Gout: Why Less Than 6 mg/dL? Postgrad Med 2016;128:706-15.[5]Bieber A, Schlesinger N, Fawaz A, Mader R. Chronic tophaceous gout as the first manifestation of gout in two cases and a review of the literature. Semin Arthritis Rheum 2018;47:843-8.Disclosure of Interests:None declared.

scholarly journals 1692. Retrospective Review on the Safety and Efficacy of Nitrofurantoin for the Treatment of Cystitis in the Veteran Population With or Without Renal Insufficiency

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S829-S830
Author(s):  
Elwyn W Welch ◽  
Shaila Sheth ◽  
Chester Ashong ◽  
Caroline Pham
Keyword(s):  
Renal Function ◽  
Renal Dysfunction ◽  
Clinical Cure ◽  
Clinical Cure Rate ◽  
Retrospective Chart Review ◽  
Outpatient Setting ◽  
Secondary Outcome ◽  
Cure Rate ◽  
Acute Cystitis ◽  
Significant Difference

Abstract Background Nitrofurantoin has been used to treat cystitis in women; however, data supporting its use in men is lacking. In addition, recent retrospective studies have challenged the manufacturer’s recommendation to avoid nitrofurantoin with creatinine clearances (CrCl) less than 60 mL/min. The purpose of this study is to compare the efficacy and safety of nitrofurantoin for the treatment of acute cystitis in male and female veterans with variable degrees of renal dysfunction. Methods A retrospective chart review was conducted in adult patients who received nitrofurantoin for acute cystitis in the outpatient setting between May 1, 2018 and May 1, 2019. The primary outcomes were rates of clinical cure as compared between males and females, and across various renal function groups (CrCl greater than 60 mL/min, 30 to 60 mL/min, and less than 30 mL/min) following treatment with nitrofurantoin. The secondary outcome was adverse event rates. Results A total of 446 patients were included with 278 females and 168 males. Overall clinical cure rate was 86.5% (n=386). Clinical cure rate did not vary between genders (p=0.0851) or CrCl ranges (p=1.0) as shown in the tables. Benign prostatic hyperplasia (BPH) was associated with decreased odds of clinical cure (OR 0.50 [95% CI 0.26-0.97], p=0.0404) in addition to cirrhosis (OR 0.22 [95% CI 0.06-0.91], p=0.0357). Adverse events occurred in 2% of patients and did not vary based on gender or renal function. RATES OF CLINICAL CURE Conclusion There was no statistically significant difference in clinical cure with nitrofurantoin between genders and various renal impairments. However, history of BPH and cirrhosis were associated with decreased efficacy. Subgroup analysis also revealed lower efficacy in males with CrCl greater than 60 mL/min versus females with similar renal function. This study adds to the growing body of literature suggesting that renal dysfunction with CrCl of 30 to 60 mL/min may not carry the risk of treatment failure and adverse effects previously associated with nitrofurantoin, but large randomized trials are needed to confirm these results. Disclosures All Authors: No reported disclosures

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