OBJECTIVETo lessen the occurrence of contrast-induced nephropathy (CIN), the preventive measures of CIN were reviewed.

DATA SOURCESThe data used in this review were from PubMed with relevant English articles and from Chinese Knowledge Information (CNKI) published from 1989 to 2009. The search terms were "contrast medium", "contrast-induced nephropathy" and "prevention". Articles involved in prevention of CIN were selected.

STUDY SELECTIONCIN is the third most common cause of acute kidney injury and is associated with an unfavorable prognosis. The best treatment is prophylaxis because CIN can not be reversed or ameliorated.

RESULTSThirty articles were included. Among various preventive measures, pericatheterization hydration is almost universally accepted as an appropriate and safe measure to prevent CIN, although there is no agreement as to composition, amount, and timing of hydration. Based on the use of concomitant nephrotoxic agents or high doses of contrast medium (CM) is one of risk factors for CIN, discontinuation of potentially nephrotoxic drugs 2 - 3 days before and after the procedure until renal function recover, and using the lowest possible dose of CM can decrease the risk of CIN. It is promising that removing the majority of CM from the coronary sinus, before it enters the systemic circulation, during coronary angiography can reduce the risk for CIN in animal studies and in limited clinical trials. Inconsistent data exist with respect to application of some vasodilators (endothelin antagonists and adenosine antagonists) and antioxidants (N-acetylcysteine and statins) in preventing CIN in high-risk patients, and new vasodilators and antioxidants continue to be tested.

CONCLUSIONSPericatheterization hydration, discontinuation of nephrotoxic drugs, and using the lowest possible dose of CM are effective measures to lessen the risk for CIN. Other prophylactic strategies and some drugs are promising, but further confirmation is required.

Contrast Media ; adverse effects ; Humans ; Iodine ; adverse effects ; Kidney Diseases ; chemically induced ; prevention & control

OBJECTIVETo compare the efficacy of high and low dose atorvastatin on preventing contrast induced nephropathy (CIN) in patients underwent diagnostic and therapeutic coronary intervention.

METHODSAll patients received atorvastatin 10 mg/d on the basis of hydrated therapy (n = 100) and high dose group received additional atorvastatin 80 mg at 12 to 24 hours before procedure (n = 50). Scr, Ccr, blood beta(2)-M, urine NAG/Cr, and urine osmolality before and after the procedure were compared between the groups.

RESULTSBaseline demographic characteristics and nephropathy risk factors were similar between groups. Ccr was significantly reduced while blood beta(2)-M and uric NAG/Cr were significantly increased in low dose group (all P < 0.05). Blood beta(2)-M in the high dose group was significantly lower than that in the low dose group at day 1 [(2.35 +/- 0.52) mg/L vs. (2.67 +/- 0.64) mg/L, P = 0.008], day 3 [(2.49 +/- 0.55) mg/L vs. (2.80 +/- 0.64) mg/L, P = 0.011] and day 5 [(2.29 +/- 0.53) mg/L vs. (2.56 +/- 0.66) mg/L, P = 0.026] post-procedure respectively;urine NAG/Cr in the high dose group was also significantly lower than that in the low dose group at day 1 [(1.19 +/- 0.30) U/mmol vs. (1.46 +/- 0.34) U/mmol, P < 0.001], day 3 [(1.30 +/- 0.30) U/mmol vs. (1.59 +/- 0.33) U/mmol, P < 0.001], and day 5 [(1.10 +/- 0.30) U/mmol vs. (1.34 +/- 0.35) U/mmol, P = 0.001] post-procedure respectively;Ccr in the high dose group was significantly higher than that in the low dose group at day 1 [(73.69 +/- 20.99) ml/min vs. (65.19 +/- 18.72) ml/min, P = 0.035], day 3 [(64.04 +/- 15.82) ml/min vs. (56.79 +/- 14.50) ml/min, P = 0.019]post-procedure respectively.

CONCLUSIONHigh dose atorvastatin use before angiography is superior than low dose atorvastatin on attenuating contrast induced renal dysfunction.

Aged ; Atorvastatin Calcium ; Contrast Media ; adverse effects ; Coronary Angiography ; methods ; Female ; Heptanoic Acids ; administration & dosage ; therapeutic use ; Humans ; Kidney Diseases ; chemically induced ; prevention & control ; Kidney Failure, Chronic ; chemically induced ; prevention & control ; Male ; Middle Aged ; Pyrroles ; administration & dosage ; therapeutic use

OBJECTIVETo compare the effects of different contrast media on the renal function in children, and to investigate the prophylactic efficacy of hydration.

METHODSSixty patients on whom either intravenous pyelography (IVP) or enhanced CT scan was required were divided into high osmolality contrast media (HOCM) group (n = 27) and low osmolality contrast media (LOCM) group (n = 33), and each group was randomly subdivided into hydration group (HG) and non-hydration group (NHG). In HOCM group, HG had 14 cases and NHG had 13 cases; while in LOCM group, HG had 18 cases and NHG had 15 cases. A 1/5-tonic solution at a dose of 20 ml/kg was intravenously given immediately after the exposure to a contrast medium within 3 hours in the HG, while the NHG cases were not given any infusion.

RESULTSThere were no significant difference between HG and NHG in baseline serum creatinin (SCr) and creatinin clearance (Ccr). After exposure, in HOCM group, SCr of NHG (59.71 +/- 12.49) micromol/L significantly increased as compared with baseline (49.91 +/- 6.09) micromol/L (P < 0.05), while Ccr (97.81 +/- 15.10)ml/(min x 1.73 m(2)) decreased compared with baseline (71.33 +/- 7.51) ml/(min x 1.73 m(2)) (P < 0.05). No significant changes of SCr and Ccr were observed in the HG before (48.37 +/- 7.11) micromol/L, (99.81 +/- 15.41) ml/(min x 1.73 m(2)) and after (49.63 +/- 6.84) micromol/L, (88.29 +/- 12.75) ml/(min x 1.73 m(2)) (P > 0.05) the exposure to contrast medium. Contrast medium-associated nephropathy (CAN) was found in 3 cases in NHG (23.1%, 3/13) but none in HG (P > 0.05). In the LOCM group, there was no significant difference in SCr and Ccr before and after the exposure to the contrast media. The incidence of CAN was 6.7% (1/15) in the NHG and 11.1% (2/18) in the HG (P > 0.05). The average increase of SCr in HOCM group was significantly higher than that in LOCM group (Z = -2.42, P < 0.05). The average decrease of Ccr in HOCM group was significantly higher than that in LOCM group (Z = -2.83, P < 0.05). The SCr and Ccr of the 6 CAN cases in both HOCM and LOCM groups returned to baseline level within 2 weeks.

CONCLUSIONS(1) Children can develop reversible CAN after the exposure to high or low osmolality contrast medium. (2) The high osmolality contrast medium seemed to have more serious toxicity in renal function than low osmolality contrast medium. (3) The prophylactic use of hydration can effectively prevent CAN in patients who will expose to high osmolality contrast medium. (4) Children can develop reversible CAN after the exposure to low osmolality contrast medium even after hydration.

Child ; Contrast Media ; adverse effects ; Creatinine ; blood ; Fluid Therapy ; Humans ; Infusions, Intravenous ; Kidney Diseases ; chemically induced ; prevention & control ; Kidney Function Tests ; Osmolar Concentration

OBJECTIVETo explore the effect of curcumin (CMN) on contrast-induced nephropathy (CIN) in rats and explore the potential mechanisms focusing on heme oxygenase-1 (HO-1) expression.

METHODSMale SD rats (n = 24) were randomly divided into four groups (n = 6 each): control group (group A), diatrizoate group (DTZ, group B), DTZ + CMN group (group C), DTZ + CMN + zinc protoporphyrin IX group (group D). All rats were fed with normal chow for 1 week, right kidney was excised under anesthesia and rats were fed with normal chow for another 4 weeks. Afterwards, rats in group A was fed with normal chow, and rats in group B to D were fed with low-salt diet. All rats were injected furosemide 2 mg×kg(-1)×d(-1) for 7 days intramuscularly. At the beginning of the 7(th) day, rats in group C were injected intramuscularly with CMN 20 mg/kg, rats in group D were injected with CMN (20 mg/kg) + zinc protoporphyrin IX (7.5 mg/kg) while rats in group A and B were injected with equal volume of physiological saline. At the end of the 7(th) day, indometacin (10 mg/kg) was injected into tail vein of all rats. One hour later, 60% DTZ (8 ml/kg) was injected to rats in the group B, C and D while equal volume saline was injected to rats in group A through common carotid artery. After 48 hours, blood was drawn from the hearts of deeply anesthetized rats and kidney tissue was obtained for histology, HO-1, Bax, Bcl-2 expression and the apoptotic index measurements.

RESULTSThe serum creatinine of group B, C and D [(83.67 ± 4.50) µmol/L, (63.67 ± 4.76) µmol/L, (104.17 ± 4.58) µmol/L] was significantly higher than that of group A [(41.50 ± 5.58) µmol/L, all P < 0.05], the serum creatinine was significantly higher in group B than in group C and lower than in group D (all P < 0.05). HO-1 expression of group B, C and D was significantly higher than that of group A (all P < 0.05), significantly higher in group C than in group B and D (all P < 0.05). HO-1 activity of group A, B and C was significantly higher than that of group D(all P < 0.05), HO-1 activity was significantly higher in group B than in group A and significantly lower in group B than in group C (all P < 0.05). Bax, Bcl-2 expression and apoptosis index of group B, C and D were significantly higher than that of group A (all P < 0.05), while Bcl-2/Bax of group B, C and D were significantly lower than that of group A (all P < 0.05). Bcl-2 and Bcl-2/Bax were significantly higher while apoptosis index was significantly lower in group C than in group B (all P < 0.05). Bax and apoptosis index were significantly higher and Bcl-2, Bcl-2/Bax were significantly lower in group D than in group B (all P < 0.05).

CONCLUSIONCMN could protect against contrast-induced nephropathy through reducing renal cell apoptosis via upregulating HO-1 expression and activating HO-1 activity in rats.

Animals ; Contrast Media ; administration & dosage ; Curcumin ; pharmacology ; Disease Models, Animal ; Heme Oxygenase (Decyclizing) ; metabolism ; Kidney ; metabolism ; Kidney Diseases ; chemically induced ; prevention & control ; Male ; Rats ; Rats, Sprague-Dawley

We investigated the effect of urinary alkalinization accomplished by intraperitoneal injection of sodium bicarbonate and acetazolamide on gentamicin nephrotoxicity in male Fisher 344rats. Forty rats (body weight 200-300g) were divided into four groups: control (gentamicin 20mg/kg, bid), high sodium load (gentamicin 20mg/kg, 25cc of saline, bid), low bicarbonate (gentamicin 20mg/kg, 25cc of sodium bicarbonate 100mEq/L, 2.5mg of Diamox, bid) and high bicarbonate (gentamicin 20mg/kg, 10cc of sodium bicarbonate 250mEq/L, 2.5mg of Diamox, bid) groups. All drugs and electrolyte solutions as mentioned above were administered intraperitoneally twice a day for seven days and changes in renal functions were studied. While salt loading failed to influence the severity of gentamicin nephrotoxicity, urinary alkalinization induced by bicarbonate and acetazolamide injection showed remarkable ameliorating effects on gentamicin nephrotoxicity. The high bicarbonate group exhibited more beneficial effects than the low bicarbonate group on gentamicin nephrotoxicity. So, urinary alkalinization seems to be an effective method for the prevention of gentamicin nephrotoxicity in rats.
Animal ; Bicarbonates/*administration and dosage ; Carbon Dioxide/urine ; Gentamicins/*toxicity ; Kidney Diseases/chemically induced/*prevention and control ; Male ; Random Allocation ; Rats ; Rats, Inbred F344

Cyclosporine (CsA) has improved patient and graft survival rates following solid-organ transplantation and has been increasingly applied with significant clinical benefits in the management of autoimmune diseases. However, the clinical use of CsA is often limited by acute and chronic nephrotoxicity, which remains a major problem. Acute nephrotoxicity depends on the dosage of CsA and seems to be caused by a reduction in renal blood flow related to afferent arteriolar vasoconstriction. However, the mechanisms underlying chronic CsA nephrotoxicity are not fully understood. Activation of the intrarenal renin-angiotensin system, increased release of endothelin-1, dysregulation of nitric oxide (NO) and NO synthase, upregulation of transforming growth factor-beta1, inappropriate apoptosis, stimulation of inflammatory mediators, and enhanced immunogenecity have all been implicated in the pathogenesis of chronic CsA nephrotoxicity. Reducing the CsA dose or withdrawing it and using combined nephroprotective drugs (mycophenolate mofetil, losartan, and pravastatin) may ameliorate chronic CsA-induced renal injury. This review discusses new insights and preventive strategies for this clinical dilemma.
Animals ; Chronic Disease ; Cyclosporine/*poisoning/therapeutic use ; Humans ; Immunosuppressive Agents/*poisoning/therapeutic use ; Kidney Diseases/*chemically induced/*prevention & control ; *Organ Transplantation ; Research Support, Non-U.S. Gov't

To systemically evaluate the efficacy and safety of salvianolate intravenous drip in combination with hydration against contrast-induced nephropathy( CIN),and guide clinical medication. Chinese and English databases( PubMed,EMbase,the Cochrane Library,CBM,VIP,Wan Fang database,CNKI) were retrieved to collect the randomized controlled trials( RCTs) about the efficacy of salvianolate intravenous drip in combination with hydration( trial group) vs routine hydration( control group) in the prevention of contrastinduced nephropathy. The methodological quality of the RCTs was evaluated by using the Cochrane 5. 1. 0 Bias Risks Assessment Tool.The data were extracted and Meta-analysis was conducted by Reviewer Manager 5. 3. Egger's test and non-parametric clipping method were used to evaluate publication bias. A total of 9 RCTs with 2 186 participants were included. RESULTS:: of Meta-analysis showed that the incidence of contrast-induced nephropathy of trial group was significantly higher than that of control group( RR = 0. 46,95% CI[0. 35,0. 59],P<0. 001). Subgroup analysis showed that the incidences of CIN in patients with acute coronary syndrome( ACS) undergoing PCI,in patients with the average age≥65 years,in patients who received mean contrast volume ≥200 m L,in patients with serum creatinine( Scr) ≥ 80 μmol,or in patients who received intraoperative administration of salvianolate or PCI were higher than those in control group,with statistically significant differences( P<0. 05). The experimental group was superior to the control group in improving the indexes of renal function after operation,and the difference was statistically significant( P<0. 05). No study reported the incidence of adverse reactions( ADRs). The funnel plots of the incidence of CIN showed potential publication bias. The results of Egger's linear regression showed that there was certain publication bias. Sensitivity analysis,funnel plot,and " trim and fill" showed that the results of this study were stable and reliable. Salvianolate combined with routine hydration showed definite clinical efficacy in the prevention of contrast-induced nephropathy. However,exact conclusion should be further verified by additional high-quality,multi-centre,and large-scale RCT studies.
Contrast Media ; adverse effects ; Humans ; Kidney Diseases ; chemically induced ; prevention & control ; Percutaneous Coronary Intervention ; Plant Extracts ; therapeutic use ; Randomized Controlled Trials as Topic

Aged ; Animals ; Cyclosporine ; adverse effects ; therapeutic use ; Drugs, Chinese Herbal ; therapeutic use ; Graft Rejection ; drug therapy ; prevention & control ; Humans ; Immunosuppressive Agents ; therapeutic use ; Kidney Diseases ; chemically induced ; prevention & control ; Kidney Transplantation ; Phytotherapy

Cyclosporine (CsA) has improved patient and graft survival rates following solid-organ transplantation and has shown significant clinical benefits in the management of autoimmune diseases. However, the clinical use of CsA is often limited by acute or chronic nephropathy, which remains a major problem. Acute nephropathy depends on the dosage of CsA and appears to be caused by a reduction in renal blood flow related to afferent arteriolar vasoconstriction. However, the mechanisms underlying chronic CsA nephropathy are not completely understood. Activation of the intrarenal renin-angiotensin system (RAS), increased release of endothelin-1, dysregulation of nitric oxide (NO) and NO synthase, up-regulation of transforming growth factor-beta1 (TGF-beta1), inappropriate apoptosis, stimulation of inflammatory mediators, enhanced innate immunity, endoplasmic reticulum stress, and autophagy have all been implicated in the pathogenesis of chronic CsA nephropathy. Reducing the CsA dosage or using other renoprotective drugs (angiotensin II receptor antagonist, mycophenolate mofetil, and statins, etc.) may ameliorate chronic CsA-induced renal injury. This review discusses old and new concepts in CsA nephropathy and preventive strategies for this clinical dilemma
Animals ; Chronic Disease ; Cyclosporine/*adverse effects ; Humans ; Immunosuppressive Agents/*adverse effects ; Kidney/*drug effects/immunology/metabolism/pathology ; Kidney Diseases/*chemically induced/immunology/metabolism/pathology/prevention & control ; Risk Factors ; Signal Transduction/*drug effects

OBJECTIVETo study the prevention effect of salidroside on contrast-induced-nephropathy (CIN) and its underlying mechanism.

METHODSA total of 24 Wistar rats were randomly divided into 4 groups with 6 in each group. Rats were firstly administrated with normal saline (control and model groups), N-acetylcysteine (NAC, NAC group) and salidroside (salidroside group) for 7 days before model establishment in each group, respectively. Histopathological analysis was performed by periodic acid-Schiff (PAS) staining. Oxidative stress related parameters including superoxide dismutase (SOD) and methane dicarboxylic aldehyde (MDA), nitric oxide (NO), angiotensin II (Ang II), 8-hydroxy-2'-deoxyguanosine (8-OHdG), mRNA and protein levels of endothelial nitric oxide synthase (eNOS), and nitric oxide synthase (NOS) activity were measured.

RESULTSCompared with the control group, the levels of MDA, Ang II and 8-OHdG were all significantly increased and levels of SOD, NO, and eNOS mRNA and protein were decreased significantly in the model group (P<0.05). Meanwhile, the NOS activity was also significantly decreased in the model group (P<0.05). In addition, the levels of these parameters were all improved in the NAC (P<0.05) and salidroside groups and no significant different was found between these two groups (P>0.05).

CONCLUSIONSalidroside can be the potential substitute of NAC to prevent CIN. The underlying mechanism may be associated with oxidative stress damage caused by contrast agents.

Acetylcysteine ; pharmacology ; Animals ; Contrast Media ; adverse effects ; Cytoprotection ; drug effects ; Glucosides ; pharmacology ; Kidney ; drug effects ; pathology ; Kidney Diseases ; chemically induced ; prevention & control ; Oxidative Stress ; drug effects ; Phenols ; pharmacology ; Rats ; Rats, Wistar ; Signal Transduction ; drug effects