Administration of iodinated contrast in patients with pre-existing renal failure: a review

Contrast-induced nephropathy (CIN) is an important and well-known cause of acute renal failure. The published literature contains numerous clinical trials describing the relative performance of various contrast agents. This review provides a comparison of different contrast agents and assesses the relative risk of clinical nephrotoxicity among them in patients with pre-existing renal insufficiency, which appear to be the patients at highest risk for CIN with all classes of these agents. Overall, the nonionic dimeric agents perform similarly to the nonionic monomeric agents in this regard.     

Renal tolerance for ioxaglate in patients with chronic renal failure

The authors sought to evaluate renal tolerance for ioxaglate sodium meglumine used as a contrast agent in patients with chronic renal failure. Eight male patients (mean age, 55 years +/- 5) with chronic renal insufficiency (glomerular filtration rate less than 60 mL/min) who underwent diagnostic cardiac catheterization were enrolled. Renal clearance of inulin and rho-aminohippuric acid and urinary enzyme excretion were studied 1 day before and 1 day after administration of 167 mL +/- 43 of ioxaglate. None of the patients experienced any adverse reactions. All the patients had markedly depressed renal clearance values before angiography. Mean serum creatinine level, glomerular filtration rate, effective renal plasma flow, and urinary beta 2-microglobulin excretion were unaltered by angiography. After the procedure, only one patient had an increase in serum creatinine level of more than 10% (from 115 to 159 mumol/L [1.3 to 1.8 mg/dL]), with a decrease in glomerular filtration rate from 34 to 27 mL/min. In this patient, serum creatinine level and glomerular filtration rate normalized within 72 hours. Using accurate and sensitive renal function tests, the authors have shown that ioxaglate may be used safely in patients with chronic renal failure.     

Predicting angiography-induced acute renal function impairment: clinical risk model

Two hundred sixty-six patients were evaluated for development of acute renal function impairment after renal angiography. Forty-five (16.9%) had a significant increase in serum level of creatinine (sCr), six developed oliguria or anuria, and one required permanent dialysis. Age, proteinuria, abnormal baseline sCr, use of Renografin 76, and preexisting renal disease were the five independent risk factors in the series. An odds-ratio analysis establishes the relative risk (i.e., likelihood) of developing acute renal insufficiency when a given risk factor is present. For example, patients with underlying renal disease were 6.6 times more likely to develop a transient increase in sCr than those with no renal disease. A clinical test model was devised to predict the likelihood that a given individual would develop acute renal insufficiency after renal angiography on the basis of the number of risk factors present. An increasing relation was demonstrated; the more factors present, the more likely it becomes that a patient will develop acute renal insufficiency.     

Acute renal failure in critically ill patients: evaluation of an ultrasound contrast agent

The purpose of the present paper was to evaluate an ultrasound contrast agent (Levovist) in patients with oliguric acute renal failure (ARF) in order to assess renal vascularity, differentiate acute tubular from cortical necrosis and predict prognosis. Ten intensive care unit (ICU) patients with oliguric ARF were prospectively investigated by ultrasound including colour, power and pulsed Doppler before and after injection of Levovist. Doppler signals were graded as absent, equivocal or present from the inner and outer portions of the renal parenchyma, and these findings were correlated with clinical parameters and outcome. Only one patient had findings in keeping with acute cortical necrosis. All patients who survived had parenchymal vascularity while only three of six (50%) who died had parenchymal vascularity after Levovist. The ultrasound contrast caused no side effects and additional information was provided which improved diagnostic confidence, enabled appropriate classification of patients as having tubular or cortical necrosis and therefore added prognostic information.     

老年急性呼吸衰竭患者治疗中无创呼吸机辅助治疗价值分析

目的探讨老年急性呼吸衰竭患者治疗中无创呼吸机辅助治疗的价值。方法选择2015年1月至2016年8月解放军总医院呼吸内科收治的老年急性呼吸衰竭患者41例为研究对象。所有患者均在常规药物治疗的基础上给予无创呼吸机辅助通气治疗,观察无创呼吸机辅助通气治疗的疗效、治疗前后患者的动脉血气指标改善情况及并发症发生情况。结果无创呼吸机辅助通气治疗后,所有患者的临床症状及体征明显改善,没有出现患者死亡情况。无创呼吸机辅助通气治疗急性呼吸衰竭的临床有效率为100%。本组9例患者发生腹胀、误吸、红肿及疼痛等并发症,并发症的发生率为21.95%,没有出现其他严重并发症。通气治疗前后患者的p H值、动脉血氧分压及血二氧化碳分压比较,差异有统计学意义(P<0.05)。结论老年急性呼吸衰竭患者在常规药物治疗的基础上给予无创呼吸机辅助通气治疗,能明显改善患者的临床症状及动脉血气指标。     

Clearance of iopamidol, a non-ionic contrast medium, by CAPD in patients with end-stage renal failure.

In normal healthy subjects radiographic contrast media are cleared by the kidneys with a half-life of approximately 2 h and a total body clearance of 8 l/h. The mechanism of contrast clearance has not been previously investigated in chronic renal failure patients undergoing continuous ambulatory peritoneal dialysis (CAPD). A study was undertaken to investigate the pharmacokinetics of a non-ionic water soluble radiographic contrast medium (iopamidol) in 10 patients stabilized on CAPD. All patients (eight male, two female) aged 22-68 years (median 53 years) had injection of 30 ml of iopamidol 300 via a forearm vein to investigate subclavian vein patency following previous cannulation for haemodialysis. Venous blood samples, CAPD dialysate and urine were collected for seven days post injection. The mean plasma half-life was 37.9 h (SD 10.6) (range 24.1-57.2 h) for the CAPD patients and was greatly prolonged in comparison to healthy subjects. The total body clearance of iopamidol was also greatly reduced (0.377 l/h). CAPD removed an average of 53.6% of the administered dose (range 36.3-80.8%) whilst an average of 26.9% was excreted in the urine (range 1.3-56.3%). The combined renal and dialysate clearance was up to 93% of the administered dose over the period of the study. There is therefore some evidence for a small extra renal clearance of iopamidol in end-stage renal failure patients. This study has shown for the first time that patients with end-stage renal failure undergoing CAPD have significantly delayed elimination of contrast medium. This should be taken into consideration when extensive or prolonged investigations using contrast medium are proposed.     

多排螺旋CT扫描对急性肾功能衰竭肾脏血流灌注研究

目的 :通过CT扫描测量肾脏组织血流灌注值 ,探讨螺旋CT对急性肾功能衰竭肾脏血流灌注变化的反映能力。方法 :实验动物分为急性肾功能衰竭组和对照组 ,用核医学肾脏动态显像作为参考指标。利用多排螺旋CT扫描机 ,获得肾皮质、肾外髓质和全肾血流灌注值。结果 :肾功能衰竭组单位体积肾脏、肾皮质血流灌注量明显低于对照组 ,差异非常显著 (P<0 .0 1) ,肾脏外髓质的血流量仅有轻微下降 ,但两组之间无显著性差异 (P>0 .0 5 )。结论 :螺旋CT能够反映急性肾脏功能衰竭肾脏血流量的变化。急性肾脏功能衰竭肾脏血流量的下降出现在肾脏皮质 ,而肾脏外髓质血流量无改变。     

Salivary function in patients with chronic renal failure undergoing hemodialysis

PURPOSE: The aim of this study was to evaluate the changes in salivary gland function in patients with chronic renal failure (CRF) undergoing hemodialysis. METHODS: The group consisted of 23 patients with CRF (13 female, 10 male; mean age: 40 +/- 13 yr) and 14 healthy control subjects (mean age: 40 +/- 13 yr). All underwent dynamic salivary gland scintigraphy with gustatory stimulation. After intravenous administration of 99mTc pertechnetate, first, perfusion images at 2 seconds per frame were acquired for 1 minute, then dynamic images at 1 minute per frame were acquired for 45 minutes. At 30 minutes after injection, 10 ml lemon juice was given for 15 minutes as a gustatory stimulus. We obtained time-activity curves derived from regions of interest centered over the four major salivary glands. The following functional indices were calculated for each gland: the time of maximum radioactivity (Tmax) for the prestimulated period, the time of minimum radioactivity (Tmin), as an indicator of velocity of secretion after stimulation, and the Lem E5% value as an indicator of the secretion function. RESULTS: When the patients with CRF undergoing hemodialysis were compared to the controls, there were statistically significant differences in Tmax, Tmin and Lem E5% values for bilateral parotid glands, and Tmin values for bilateral submandibular glands (p < 0.05), there were no statistically significant differences in Tmax and Lem E5% values for bilateral submandibular glands. There were also significant differences in Tmax and Lem E5% values for bilateral parotid glands between mild oral problems and severe oral problems in patients with CRF (undergoing hemodialysis). CONCLUSION: In this study, prolonged Tmax and Tmin values, and decreased Lem E5% values for parotid glands and prolonged Tmin values for submandibular glands on salivary scintigraphy pointed out decreased parenchymatous and excretory function in patients with CRF undergoing hemodialysis.     

经皮肾穿刺活检术在急性肾衰竭患者诊治中的作用

目的探讨经皮肾穿刺活检术(PRB)对急性肾功能衰竭(ARF)病因诊断及治疗方案的影响,进一步提高ARF的诊疗水平。方法收集南方医院1992年11月至2007年12月的176例ARF患者,均符合48h内血肌酐(SCr)上升≥26·5μmol/L;SCr增长≥50%;尿量<0·5ml/(kg·h)持续6h的临床ARF诊断标准。回顾性分析行PRB前后的病因诊断及治疗方案修订情况。结果PRB术后病因诊断率由术前的64·2%(113/176)提高至96·6%(170/176)。PRB前后病因诊断符合率95·6%(108/113),病因诊断错误率4·4%(5/113)。170例患者经PRB后确诊为ARF,6例临床误诊为ARF的患者经PRB后修正诊断为慢性肾功能不全(CRI)。术后有47·2%(83/176)的患者治疗方案得到了补充,5·6%(10/176)的患者更改了治疗方案,治疗方案修正率合计52·8%(93/176)。PRB后确诊了8例IgA肾病患者,其中1例明确为由IgA肾病慢性迁延为CRI,6例为ARF合并IgA肾病,1例为IgA肾病引发新月体形成从而导致ARF,占ARF发病率的0·6%(1/170)。结论PRB对明确ARF病因诊断,及时明确治疗方案和判断预后有重要意义。     

Renal tolerance of gadolinium-DTPA/dimeglumine in patients with chronic renal failure.

Safety data for renal tolerance of gadolinium-DTPA(Gd-DTPA)/dimeglumine were evaluated in 21 patients (age: mean +/- standard deviation [SD], 58 +/- 12 years) with impaired renal function. The mean +/- SD serum creatinine level at baseline was 213 +/- 101 mumol/L (range, 89.2-551 mumol/L). Creatinine clearance at baseline averaged 34.5 +/- 19.2 mL/minute (range, 7.2-70 mL/minute). Gd-DTPA was injected at a dose of 0.1 mmol/kg body weight. Serum parameters (creatinine, sodium, and potassium) were determined before and 6, 24, 48, and 120 hours after administration of Gd-DTPA. Urinary parameters (N-acetyl-beta-D-glucosaminidase [beta-NAG], protein, and albumin) were determined before (spot urine sample) and after treatment for collection periods 0 to 3, 3 to 6, 6 to 12, 12 to 24, and 24 to 48 hours. A final spot urine sample was taken at 120 hours. There was no significant statistical change of serum creatinine level within the observation period, and there was no single patient matching the criteria of acute renal failure (increase of serum creatinine level of 88.4 mumol/L [1 mg/dL] or more within 48 hours after injection). Serum values of sodium and potassium levels remained unchanged. Beta-NAG was slightly increased 0 to 3 hours after injection, but returned to baseline values during the collection periods up to 120 hours. There was no increase of protein or albumin excretion. These preliminary results suggest Gd-DTPA has good renal tolerance in patients with pre-existing chronic renal failure.     

Effects of contrast media on myocardial function during acute left ventricular failure in the dog

We studied the hemodynamic side effects of intracoronary injection of contrast media during acute ischemic heart failure by using anesthetized dogs. Induction of failure was performed by microembolization of the area supplied by the left main coronary artery. Six ml of iohexol (Omnipaque) increased contractility during the normal state, while this contrast medium induced no alterations in any of the recorded hemodynamic variables during left ventricular failure. Ioxaglate (Hexabrix) was also well tolerated during the normal state, while sodium-meglumine diatrizoate (Renografin) markedly decreased systolic variables. However, in the failing heart both ioxaglate and diatrizoate resulted in greater reduction in all systolic variables than in the normal heart. We conclude that both ionic contrast media may be harmful in acute ischemic heart failure. Non-ionic iohexol appears safer in this condition.     

Intravascular contrast media: effect of dose on renal function

Effect of contrast material dose on clinically evident change in renal function was studied prospectively in 200 examinations requiring intravenous or intraarterial administration of contrast material. All patients were adequately hydrated. Blood urea nitrogen and serum creatinine were measured before and after the procedure. Ionic and nonionic contrast agents were used. Total dose of contrast material ranged from 30 to 530 mL (mean, 237 mL). There was no tendency to give smaller doses to patients with preexisting renal impairment and no relationship between total dose and patient age. No consistent clinical effect on renal function was demonstrated with increasing dose, regardless of whether ionic or nonionic agents were used. In adequately hydrated low-risk patients with predominantly normal initial renal function and within the dose range studied, there does not appear to be any consistent clinical change in renal function with increasing contrast material dose.     

阿托伐他汀对介入手术患者对比剂应用后肾功能的影响

 目的 观察阿托伐他汀对介入手术患者对比剂应用后肾功能的影响.方法 196例脑动脉弹簧圈介入手术患者随机分为2组,阿托伐他汀组98例,术前3 d给予阿托伐他汀80 mg/d;对照组98例,术前3 d给予安慰剂.观察血清肌酐(SCr)、尿N-乙酰β氨基葡萄糖苷酶(NAG)和尿渗透浓度水平.结果 术后第2天阿托伐他汀组血清SCr显著低于对照组,尿NAG水平显著低于对照组(P＜0.05).结论 阿托伐他汀能够预防脑动脉介入手术患者对比剂应用后肾功能恶化.     

Allergic reactions to iodinated contrast media: premedication considerations for patients at risk

The objectives of this article are to review allergy-type reactions to iodinated contrast media and the protocols utilized to prevent or reduce the occurrence of these adverse reactions in high-risk patients. We will begin by discussing the types or classifications of the adverse reactions to iodinated contrast media. We will then discuss reaction mechanisms, identify the patients at highest risk for adverse reactions, and clarify common misperceptions about the risk. Finally, we will discuss the actions of the medications used to help reduce or prevent allergy-type reactions to iodinated contrast media, the protocols used to help reduce or prevent contrast reactions in high-risk patients, and the potential side effects of these medications. We will also discuss the high-risk patient who has received premedication due to a prior index reaction and discuss the risk of having a subsequent reaction, termed “breakthrough reaction.” Identifying patient at high risk for an “allergy-type” reaction to contrast media is an essential task of the radiologist. Prevention of or reduction of the risk of an adverse reaction is critical to patient safety. If an examination can be performed without contrast in a patient at high risk for an allergy-type reaction, it may be appropriate to avoid contrast. However, there are situations where contrast media is necessary, and the radiologist plays a vital role in preventing or mitigating an allergy-type reaction.     

一种非离子型等渗对比剂对丙种球蛋白血症病人肾功能的影响

目的评价丙种球蛋白血症病人在CT检查时使用非离子型等渗对比剂碘克沙醇对肾功能的安全性。方法研究碘克沙醇对30例丙种球蛋白血症与20例电泳情况正常     

Opacification of the gallbladder following intravenous contrast injection in patients with normal renal function

Gallbladder opacification from vicarious excretion of urographic contrast agents may indicate decreased renal function. Doses of contrast material greater than 12.5 g, however, provide enough iodine for visualization of the gallbladder in patients whose renal function is normal. Gallbladder opacification following the administration of urographic contrast material when renal function is normal has no pathologic significance.     

慢性心力衰竭不同阶段的肾功能损害比较

目的观察慢性心力衰竭不同阶段的肾功能情况。方法将87例我院心内科住院患者分为心衰A~D阶段,A阶段为A组（18例）,B阶段为B组（30例）,C、D阶段为C组（39例）,检测各组肾小球滤过率及24h尿白蛋白含量。结果 B、C组肾小球滤过率较A组低,分别为80.2±4.3,76.0±3.8vs105.2±5.0ml·min-1·1.73m-2,均P〈0.05。B、C组24h尿白蛋白含量较A组高,分别为10.9±13.5,24.1±24.2和4.2±2.5μg/ml,各组间比较均P〈0.05。结论慢性心力衰竭早期阶段已有肾功能损害。     

Effect on renal function of an iso-osmolar contrast agent in patients with monoclonal gammopathies

Objective  

To assess the safety of the non-ionic iso-osmolar contrast agent iodixanol on renal function in patients with monoclonal gammopathies undergoing CT.     

利用CT血管成像对肾脏进行测量:与活体肾移植供者肾功能的相关性研究

摘要目的探讨CT血管成像(CTA)影像上测量供体肾脏大小的哪个参数与肾移植术前和术后的肾功能关系最密切。材料与方法伦理审查委员会批准了此项符合HIPAA的回顾性研究,且无需获得病人知情同意。在CTA影像上对111例进行活体肾移植术肾脏的长度、