Serum neutrophil-gelatinase associated lipocalin as a predictor of post-contrast acute kidney injury in children

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Alyaa A Kotby ◽  
Marwa W Nasef ◽  
Walaa A Kabiel ◽  
Yasser H Mohammad ◽  
Rana M Elmaghrabi
Keyword(s):  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Contrast Media ◽  
Cardiac Catheterization ◽  
Congenital Heart ◽  
Kidney Injury ◽  
Significant Rise ◽  
Contrast Injection ◽  
Post Contrast ◽  
Contrast Media Administration

Abstract Background Diagnosis of post-contrast acute kidney injury (PC-AKI) by serum creatinine can be delayed because of various factors. A new biomarker neutrophilgelatinase associated lipocalin (NGAL) is postulated to be more sensitive for recognizing patients prone to PC-AKI. Objective To assess serum NGAL changes as an early biomarker of PC-AKI in children with congenital heart disease undergoing cardiac catheterization. Methods This observational study included 30 children with congenital heart disease who underwent cardiac catheterization at the Pediatric Cardiac Catheterization Unit, New Children’s Hospital, Ain Shams University. They had a median age of 30 months and 63% were females. Serum NGAL was measured just before the catheterization, 6hrs and 24hrs after contrast media administration while serum creatinine was measured before and after 24hrs of contrast media administration. Results Significant rise of serum NGAL was noted within 24hrs after contrast administration (p < 0.05) while serum creatinine showed a non-significant rise (p > 0.05). Serum NGAL was positively correlated with age, weight, height, body surface area and rate of contrast injection (p < 0.01). Higher levels of serum NGAL were found among patients who underwent diagnostic cardiac catheterization and those who received Midazolam for initial sedation during induction of anesthesia (p < 0.05). Conclusions Serum NGAL was elevated as early as 6 hours post contrast injection, however its serum level is affected by many factors. It’s important to be aware of other possible risk factors of PC-AKI rather than contrast media as type of cardiac catheterization and the anaesthetic Midazolam.

scholarly journals Heart failure and contrast-induced acute kidney injury in patients with coronary artery disease

2020 ◽  
Vol 22 (10) ◽  
pp. 61-63
Author(s):  
Olga Iu. Mironova ◽  
◽  
Olga A. Sivakova ◽  
Aleksandr D. Deev ◽  
Viktor V. Fomin ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Acute Kidney Injury ◽  
Coronary Artery ◽  
Serum Creatinine ◽  
Contrast Media ◽  
Kidney Injury ◽  
Baseline Serum ◽  
Artery Disease ◽  
Contrast Media Administration

Aim. To assess the influence of heart failure on the risk of contrast-induced acute kidney injury (CI-AKI) in patients with stable coronary artery disease (CAD) with indications to diagnostic procedures requiring intra-arterial administration of contrast media. Materials and methods. 1023 patients, who were receiving optimal medical therapy and had indications to coronary angiography and possible coronary angio-plasty, with stable CAD were included in the study. We conducted an observational open prospective cohort study, which was registered in clinicaltrials.gov with ID NCT04014153. CI-AKI was defined as 25% or more increase of baseline serum creatinine, or more than 0.5 mg/dl and was assessed 48 hours after contrast media administration. The primary endpoint was the CI-AKI development according to KDIGO criteria. Most of the patients, included in the study, were males aged 66.3±10 years with arterial hypertension and overweight (BMI 29.14±5 kg/m2). Results. The study included 1023 patients, 76 suffered from heart failure. The rate of CI-AKI in this group was 13.2% (10 patients). The rate of CI-AKI using the absolute creatinine rise definition was 4% cases (3 cases). Conclusion. Female patients suffering from heart failure with higher levels of serum creatinine and low glomerular filtration rate need more attention, less amount of contrast and adequate preventive measures before contrast media administration in order to lower the risk of CI-AKI development.

Obesity as a risk factor of contrast-induced acute kidney injury in patients with arterial hypertension and stable coronary artery disease

2021 ◽  
Vol 17 (4) ◽  
pp. 63-67
Author(s):  
Olga Iu. Mironova ◽  
Olga A. Sivakova ◽  
Viktor V. Fomin
Keyword(s):  
Risk Factors ◽  
Serum Creatinine ◽  
Contrast Media ◽  
Stable Coronary Artery Disease ◽  
Kidney Injury ◽  
Before And After ◽  
The Difference ◽  
Artery Disease ◽  
Stable Cad ◽  
Contrast Media Administration

Background. The prevalence of obesity in patients with stable coronary artery disease (CAD) and arterial hypertension (AH) is increasing each year. As the number of percutaneous coronary interventions requiring contrast media administration is rising in this group of patients, the risk of contrast-induced acute kidney injury (CI-AKI) remains high. The most important risk factors of CI-AKI in this group of patients remain to be determined as well as their prognostic significance. Aim. The aim of the study was to assess the role of obesity as a risk factor of CI-AKI in patients with stable CAD and AH. Materials and methods. 863 patients with stable CAD and AH were included in the prospective open observational cohort study (ClinicalTrials.gov ID NCT04014153). 398 patients were obese and 465 had body mass index (BMI) below 30 kg/m2. CI-AKI was defined as the 25% rise (or 0.5 mg/dl) of serum creatinine from baseline assessed 48 hours after administration of contrast media. The primary endpoint was the development of CI-AKI. Results. The rate of CI-AKI in patients with obesity was 12.6%, without obesity 12.7%, but the difference between groups was not statistically significant (p=0.935, 95% CI -0.0430.046). The rate of CI-AKI in male patients with obesity was higher than in female ones. The logistic regression model of CI-AKI development in patients with stable CAD, AH and obesity was build (AUC 0.9928, р0,0001, 95% CI 0.98191) and included age, weight, body mass index, female gender, heart failure, diabetes mellitus, proteinuria, anemia, baseline creatinine, contrast volume and the difference between baseline serum creatinine and creatinine level after the contrast media exposure. The baseline level of creatinine and the difference between the levels of creatinine before and after contrast media administration were statistically significant risk factors in the model. Conclusion. The rate of CI-AKI in patients with stable CAD, AH and obesity was 12.6%. The main risk factors of CI-AKI development in multiple logistic regression model were the baseline level of creatinine and the difference between levels of serum creatinine before and after contrast media administration.

scholarly journals Midkine: A Novel and Early Biomarker of Contrast-Induced Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Interventions

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Jolanta Malyszko ◽  
Hanna Bachorzewska-Gajewska ◽  
Ewa Koc-Zorawska ◽  
Jacek S. Malyszko ◽  
Grazyna Kobus ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Kidney Injury ◽  
Significant Rise ◽  
Normal Serum ◽  
Contrast Nephropathy ◽  
Percutaneous Coronary ◽  
Early Biomarker ◽  
Baseline Values ◽  
Normal Serum Creatinine

We tested the hypothesis whether midkine could represent an early biomarker of contrast-induced acute kidney injury (CIAKI) in 89 patients with normal serum creatinine undergoing PCI. Midkine, serum and urinary NGAL, and cystatin C were evaluated before and 2, 4, 8, 24, and 48 hours after PCI using commercially available kits. Serum creatinine was assessed before and 24 and 48 hours after PCI. We found a significant rise in serum midkine as early as after 2 hours (P<0.001) when compared to the baseline values. It was also significantly higher 4 hours after PCI and then returned to the baseline values after 24 hours and started to decrease after 48 hours. When contrast nephropathy was defined as an increase in serum creatinine by >25% of the baseline level 48 hours after PCI, the prevalence of CIN was 10%. Patients with CIN received significantly more contrast agent (P<0.05), but durations of PCI were similar. Midkine was significantly higher 2, 4, and 8 hours after PCI in patients with CIN. Since the “window of opportunity” is narrow in CIAKI and time is limited to introduce proper treatment after initiating insult, particularly when patients are discharged within 24 hours after the procedure, midkine needs to be investigated as a potential early marker for renal ischemia and/or nephrotoxicity.

Does intravenous contrast medium administration result in altered renal biomarkers? A study in clinically stable cats with and without azotemia

2021 ◽  
pp. 1098612X2110385
Author(s):  
Maria Laura Prüllage ◽  
Ilse Schwendenwein ◽  
Eva Eberspächer-Schweda ◽  
Sibylle Kneissl
Keyword(s):  
Contrast Media ◽  
Contrast Medium ◽  
Kidney Function ◽  
Kidney Injury ◽  
Intravenous Contrast ◽  
Post Contrast ◽  
Contrast Medium Administration ◽  
Intravenous Contrast Medium ◽  
Blood And Urine Samples ◽  
Contrast Media Administration

Objectives The aim of this study was to determine the prevalence of post-contrast acute kidney injury or comparable side effects on kidney function in cats receiving the non-ionic, iodinated agent ioversol and/or paramagnetic agent gadoteric acid. Methods Fifty-two animals were divided into four groups on the basis of contrast medium administration for imaging: ioversol (n = 27), gadoteric acid (n = 12), dual contrast media (n = 4) or control, which received an infusion of isotone intravenous fluids only during anaesthesia (n = 9). Blood and urine samples were obtained three times after contrast administration and compared with values obtained prior to administration of the contrast medium. Creatinine (<1.60 mg/dl), symmetric dimethylarginine (SDMA; ⩽14 μg/dl), urine protein:creatinine ratio (UPC; <0.2) and critical differences for creatinine (<0.3 mg/dl) and SDMA (<5.98 μg/dl) were measured. Results No significant short-term effects on mean creatinine, SDMA and UPC measurements were seen. Borderline proteinuria (UPC, 0.2–0.4) was detected in 11.4% of cases after contrast media administration. A UPC of more than 0.2 in five cases indicated that contrast media may affect kidney function, leading to (transient) proteinuria. Conclusions and relevance This study found no side effect on renal function following the administration of ioversol or gadoteric acid, provided patients were adequately hydrated. However, the clinical relevance of proteinuria in some cats needs to be evaluated in future studies.

MO419THE ROLE OF SHORT-TERM, HIGH-DOSE ATORVASTATIN FOR PREVENTION OF CONTRAST-INDUCED ACUTE KIDNEY INJURY (CI-AKI) IN PATIENTS WITH CARDIOVASCULAR DISEASES UNDERGOING COMPUTED TOMOGRAPHY WITH INTRAVENOUS CONTRAST ADMINISTRATION

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Andrey Vasin ◽  
Olga Mironova ◽  
Viktor Fomin
Keyword(s):  
Computed Tomography ◽  
Acute Kidney Injury ◽  
Cardiovascular Diseases ◽  
Contrast Media ◽  
Kidney Injury ◽  
Ct Scans ◽  
Intravenous Contrast ◽  
Dosing Regimens ◽  
Intravenous Contrast Media ◽  
Contrast Media Administration

Abstract Background and Aims Computed tomography with intravenous contrast media is widely used in hospitals. The incidence of CI-AKI due to intravenous contrast media administration in high-risk patients remains not studied as well as CI-AKI after intraarterial contrast media administration is. According to other researchers, the use of statins in the prevention of AKI after intra-arterial administration of a contrast agent is currently considered an efficient preventive measure. The aim of our study is to assess the incidence of contrast-induced acute kidney injury in patients with cardiovascular diseases during CT scan with intravenous contrast media and analyze the efficacy and safety of various statin dosing regimens for prevention of CI-AKI. Method A randomized controlled open prospective study is planned. Statin naive patients with cardiovascular diseases will be divided into 3 groups. Patients in the first group will receive atorvastatin 80mg 24 hours and 40mg 2 hours before CT scans and 40 mg after. The second group – 40 mg 2 hours before CT scans and 40 mg after. A third group is a control group. Exclusion criteria were current or previous statin treatment, contraindications to statins, severe renal failure, acute coronary syndrome, administration of nephrotoxic drugs. The primary endpoint will the development of CI-AKI, defined as an increase in serum Cr concentration 0.5 mg/dl (44.2 mmol/l) or 25% above baseline at 72 h after exposure to the contrast media. Results We assume a higher incidence of contrast-induced acute kidney injury in the group of patients not receiving statin therapy (about 5-10%). At the same time, it is unlikely to get a significant difference between statin dosing regimens. Risk factors such as age over 75 years, the presence of chronic kidney disease, diabetes mellitus, and chronic heart failure increase the risk of contrast-induced acute kidney injury. Conclusion Despite the significantly lower incidence of CI-AKI with intravenous contrast compared to intra-arterial, patients with CVD have a greater risk of this complication even with intravenous contrast. Therefore, the development of prevention methods and scales for assessing the likelihood of CI-AKI is an important problem. As a result of the study, we expect to conclude the benefits of statins in CI-AKI prevention and the optimal dosage regimen. This information will help us to reduce the burden of CI-AKI after CT scanning in statin naive patients with cardiovascular diseases in everyday clinical practice. ClinicalTrials.gov ID: NCT04666389

scholarly journals Variation in clinical usefulness of biomarkers of acute kidney injury in young children undergoing cardiac surgery

2020 ◽  
Vol 63 (4) ◽  
pp. 151-156
Author(s):  
Hee Sun Baek ◽  
Youngok Lee ◽  
Hea Min Jang ◽  
Joonyong Cho ◽  
Myung Chul Hyun ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Young Children ◽  
Serum Creatinine ◽  
Congenital Heart ◽  
Heart Diseases ◽  
Kidney Injury ◽  
Clinical Usefulness ◽  
Congenital Heart Diseases ◽  
Significant Difference

Background: Acute kidney injury (AKI) is one of the most significant postoperative complications of pediatric cardiac surgery. Because serum creatinine has limitations as a diagnostic marker of AKI, new biomarkers including neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and interleukin-18 (IL-18) are being evaluated to overcome these limitations and detect AKI at an early stage after cardiac surgery.Purpose: This study aimed to investigate the clinical usefulness of these biomarkers in young children.Methods: Thirty patients with congenital heart diseases who underwent cardiac surgery using cardiopulmonary bypass (CPB) were selected, and their urine and blood samples were collected at baseline and 6, 24, and 48 hours after surgery. Serum creatinine and blood urea nitrogen levels as well as NGAL, KIM-1, and IL-18 levels in urine samples were measured, and clinical parameters were evaluated.Results: Of the 30 patients, 12 developed AKI within 48 hours after cardiac surgery. In the AKI group, 8 of 12 (66.6%) met AKI criteria after 24 hours, and urine KIM-1/creatinine (Cr) level (with adjustment of urine creatinine) peaked at 24 hours with significant difference from baseline level. Additionally, urine KIM-1/Cr level in the AKI group was significantly higher than in the non-AKI group at 6 hours. However, urine NGAL/Cr and IL-18/Cr levels showed no specific trend with time for 48 hours after cardiac surgery.Conclusion: It is suggested that urine KIM-1/Cr concentration could be considered a good biomarker for early AKI prediction after open cardiac surgery using CPB in young children with congenital heart diseases.

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