Abstract
Background and Aims
Determination of markers of kidney damage in patients with coronary artery disease after coronary angiography. HYPERLINK “https://www.healthline.com/health/coronary-angiography”
Method
The study included 303 patients with coronary artery disease who were planned coronary angiography. The initial examination of patients included an assessment of the structural and functional state of the kidneys, metabolic profile and the functional state of the cardiovascular system. Renal filtration function was assessed by the clearance of creatinine and cystatin C with the calculation of glomerular filtration rate (eGFRcr and eGFRcis) All coronary artery disease patients included in the study underwent coronary angiography using a contrast drug unigexole. If there is necessity, stenting of the coronary arteries was performed. On the 2nd day after coronary angiography, a serum creatinine concentration was determined to isolate patients in whom coronary angiography was complicated by CIN. Contrast induced nephropathy was defined as an increase in serum creatinine concentration by 25% 24 hours after coronarography. According to the study, patients were divided into 2 groups - 67.99% of patients with an uncomplicated postoperative period of caranoroangiography; CIN (-) group and CIN (+) group 32.01% of patients who developed contrast-induced nephropathy. Subsequently, the CIN + and CIN- groups were retrospectively compared according to the initial hemodynamic parameters, structural and functional state of the kidneys, and metabolic characteristics.
Results
The results of the study showed that eGFRcr did not significantly differ in the CIN(+) and CIN(-) groups, although it turned out to be lower in both groups. (p <0.05). While eGFRcis in the CIN(+) group was significantly lower than in patients with uncomplicated coronary angiography. Correlation analysis showed a reliable positive average relationship between the values of eGFRcr and eGFRcis in the CIN(+) group (r = 0.32, p <0.001). Correlation revealed a reliable average negative relationship between eGFRcis and the relative density of urine (r = -0.46, p <0.001), indicating a combined violation of the glomerular and canalicular function of the kidneys, which indicates that in these patients, despite the preserved eGFRcr, pathogenetic markers of impaired renal function are detected. The Resistance Index (RI), which characterizes the resistance of the microvasculature of the kidneys in all patients with coronary artery disease significantly exceeded the control values. The selected groups according to the value of RI were arranged as follows: the minimum value of RI is in the CIN(–) without diabetes mellites group, and the maximum value is in patients with СIN(+) and diabetes mellitus.
Conclusion
In patients with coronary artery disease undergoing endovascular procedures, eGFRcis is a more accurate indicator of latent impaired renal filtration function than eGFRcr. Decrease in eGFRcis below 89ml / min in patients with coronary artery disease at risk of developing contrast-induced nephropathy during caranoroangiography. An increase in RI of segmental arteries of the kidneys is associated with a decrease in the filtration function of the kidneys and patients with maximum RI have the greatest risk of developing glomerular dysfunction under conditions of exposure to contrast.
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