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Contrast induced acute kidney injury

Tse-Min Lu, Chiao-Po Hsu, Chao-Fu Chang, Chih-Ching Lin, Tzong-Shyuan Lee, Shing-Jong Lin, Wan-Leong Chan
BACKGROUND AND AIMS: Decreased nitric oxide (NO) bioavailability and increased oxidative stress may be involved in the pathogenesis of contrast-induced acute kidney injury (CI-AKI). The relationship between asymmetric dimethylarginine (ADMA), an endogenous NO synthase inhibitor, and CI-AKI is unknown. METHODS: We measured plasma ADMA levels in 664 consecutive subjects undergoing cardiac catheterization. Mehran score for predicting the risk of CI-AKI was calculated...
October 6, 2016: Atherosclerosis
Gillian Balbir Singh, Soe Hee Ann, Jongha Park, Hyun Chul Chung, Jong Soo Lee, Eun-Sook Kim, Jung Il Choi, Jiho Lee, Shin-Jae Kim, Eun-Seok Shin
OBJECTIVE: Remote ischemic preconditioning (RIPC) induces transient episodes of ischemia by the occlusion of blood flow in non-target tissue, before a subsequent ischemia-reperfusion injury. When RIPC is applied before percutaneous coronary intervention (PCI), the kidneys may be protected against ischemia-reperfusion injury and subsequently contrast-induced acute kidney injury (CI-AKI). The aim of this study was to evaluate the efficacy of RIPC for the prevention of CI-AKI in patients with diabetes with pre-existing chronic kidney disease (CKD) undergoing elective PCI...
2016: PloS One
Jianxiao Shen, Ling Wang, Na Jiang, Shan Mou, Minfang Zhang, Leyi Gu, Xinghua Shao, Qin Wang, Chaojun Qi, Shu Li, Wanpeng Wang, Xiajing Che, Zhaohui Ni
Iodinated contrast media serves as a direct causative factor of acute kidney injury (AKI) and is involved in the progression of cellular dysfunction and apoptosis. Emerging evidence indicates that NLRP3 inflammasome triggers inflammation, apoptosis and tissue injury during AKI. Nevertheless, the underlying renoprotection mechanism of NLRP3 inflammasome against contrast-induced AKI (CI-AKI) was still uncertain. This study investigated the role of NLRP3 inflammasome in CI-AKI both in vitro and in vivo. In HK-2 cells and unilateral nephrectomy model, NLRP3 and NLRP3 inflammasome member ASC were significantly augmented with the treatment of contrast media...
October 10, 2016: Scientific Reports
Erik W Holy, Alexander Akhmedov, Thimoteus Speer, Giovanni G Camici, Stephen Zewinger, Nicole Bonetti, Jürg H Beer, Thomas F Lüscher, Felix C Tanner
BACKGROUND: Carbamylation alters low-density lipoprotein (LDL) structure and is thought to promote vascular inflammation and dysfunction in patients with chronic kidney disease (CKD). OBJECTIVES: This study sought to determine whether carbamylated LDL (cLDL) exerts prothrombotic effects in vascular cells and platelets and whether cLDL enhances arterial thrombus formation in vivo. METHODS: LDL was isolated from healthy subjects or patients with CKD by sequential ultracentrifugation...
October 11, 2016: Journal of the American College of Cardiology
Xiaole Su, Xinfang Xie, Lijun Liu, Jicheng Lv, Fujian Song, Vlado Perkovic, Hong Zhang
BACKGROUND: To simultaneously evaluate the relative efficacy of multiple pharmacologic strategies for preventing contrast-induced acute kidney injury (AKI). STUDY DESIGN: Systematic review containing a Bayesian network meta-analysis of randomized controlled trials. SETTING & POPULATION: Participants undergoing diagnostic and/or interventional procedures with contrast media. SELECTION CRITERIA FOR STUDIES: Randomized controlled trials comparing the active drug treatments with each other or with hydration alone...
October 1, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Michele Andreucci, Teresa Faga, Eleonora Riccio, Massimo Sabbatini, Antonio Pisani, Ashour Michael
Contrast-induced acute kidney injury (CI-AKI) is a problem associated with the use of iodinated contrast media, causing kidney dysfunction in patients with preexisting renal failure. It accounts for 12% of all hospital-acquired kidney failure and increases the length of hospitalization, a situation that is worsening with increasing numbers of patients with comorbidities, including those requiring cardiovascular interventional procedures. So far, its diagnosis has relied upon the rise in creatinine levels, which is a late marker of kidney damage and is believed to be inadequate...
2016: International Journal of Nephrology and Renovascular Disease
Tian Zuo, Lu Jiang, Shuai Mao, Xuehui Liu, Xin Yin, Liheng Guo
BACKGROUND: Hyperuricemia may be associated with an increased risk of contrast-induced acute kidney injury (CI-AKI). In recent years, studies about the relationship between them gradually appeared. We performed a systematic review and meta-analysis to investigate whether hyperuricemia is an independent risk factor for CI-AKI. METHODS: Relevant studies were searched in PubMed, Embase, Cochrane Library, and CBM (Chinese Biomedical Literature database) databases until April 18, 2016, without language restriction...
September 18, 2016: International Journal of Cardiology
Roberto Filomia, Sergio Maimone, Gaia Caccamo, Carlo Saitta, Luca Visconti, Angela Alibrandi, Simona Caloggero, Antonio Bottari, Maria Stella Franzè, Carmine Gabriele Gambino, Tindaro Lembo, Giovanni Oliva, Irene Cacciola, Giovanni Raimondo, Giovanni Squadrito
Contrast medium administration is one of the leading causes of acute kidney injury (AKI) in different clinical settings. The aim of the study was to investigate occurrence and predisposing factors of AKI in cirrhotic patients undergoing contrast-enhanced computed tomography (CECT).Datasets of 1279 consecutively hospitalized cirrhotic patients were retrospectively analyzed. Two hundred forty-nine of 1279 patients (mean age 64 ± 11 years, 165 male) who had undergone CECT were selected on the basis of the availability of serum creatinine (sCr) values evaluated before and after CECT (CECT group)...
September 2016: Medicine (Baltimore)
Peter A McCullough, James P Choi, Georges A Feghali, Jeffrey M Schussler, Robert M Stoler, Ravi C Vallabahn, Ankit Mehta
Coronary angiography and percutaneous intervention rely on the use of iodinated intravascular contrast for vessel and chamber imaging. Despite advancements in imaging and interventional techniques, iodinated contrast continues to pose a risk of contrast-induced acute kidney injury (CI-AKI) for a subgroup of patients at risk for this complication. There has been a consistent and graded signal of risk for associated outcomes including need for renal replacement therapy, rehospitalization, and death, according to the incidence and severity of CI-AKI...
September 27, 2016: Journal of the American College of Cardiology
Kosmas I Paraskevas, Dimitri P Mikhailidis
Carotid artery stenting (CAS) is increasingly offered to patients with carotid artery stenosis. Although CAS is a less invasive (and thus more attractive) alternative compared with carotid endarterectomy, it requires the use of contrast material. A possible side effect from the use of contrast material during CAS is the development of contrast-induced acute kidney injury (CI-AKI). This review discusses the incidence/prevalence and clinical significance of CI-AKI developing after CAS. We also discuss possible measures to reduce the incidence of CI-AKI after CAS...
September 19, 2016: Angiology
Jun Zhang, Peter A McCullough
Hypoxia, reactive oxygen species (ROS) and oxidative stress contribute to contrast-induced acute kidney injury (CI-AKI) and ischemic reperfusion injury (IRI) in the kidney and heart. Imbalance between the increased formation of ROS by hypoxia in the cardiac and renal tissue and the low availability of endogenous antioxidants is a common cause of cellular and tissue damage. Therefore, a strategy to inhibit ROS generation or to scavenger free radicals becomes an important intervention to prevent CI-AKI and myocardial IRI...
September 8, 2016: Nephron
David E Leaf, Sushrut S Waikar
Acute kidney injury (AKI) is an increasingly common and feared complication in hospitalized patients. The selection of appropriate primary and secondary end points is critical to the design and eventual success of clinical trials aimed at preventing and treating AKI. In this article, we provide an overview of AKI definitions and suggestions on the rational selection of end points for clinical trials in various settings, including the prevention of contrast-induced AKI, prevention of cardiac surgery-associated AKI, treatment of established AKI, and treatment of dialysis-requiring AKI...
September 3, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Haranatha Reddy Potteti, Chandramohan Reddy Tamatam, Rakesh Marreddy, Narsa M Reddy, Sanjeev Noel, Hamid Rabb, Sekhar P Reddy
Ischemia-reperfusion (IR)-induced kidney injury is a major clinical problem, but the underlying mechanisms remain unclear. The transcription factor Nuclear Factor, Erythroid 2-like 2 (NFE2L2 or Nrf2) is crucial for protection against oxidative stress generated by pro-oxidant insults. We have previously shown that Nrf2 deficiency enhances susceptibility to IR-induced kidney injury in mice and its upregulation is protective. Here, we examined Nrf2 target antioxidant gene expression and the mechanisms of its activation in both human and murine kidney epithelia following acute (2 h) and chronic (12 h) hypoxia and re-oxygenation conditions...
August 31, 2016: American Journal of Physiology. Renal Physiology
Bertrand N Mukete, Russell A Riehl, Alvaro Alonso, Rohan Samson, Abhishek Jaiswal, Thierry H Le Jemtel
BACKGROUND: Recent studies and meta-analysis have shown that complete revascularization (CR) compared with infarct-related artery revascularization (IRA) during percutaneous coronary intervention for ST-segment elevation myocardial infarction (STEMI) is associated with decreased mortality. However, it is unclear if CR versus IRA in STEMI during indexed hospitalization is associated with risk of contrast-induced acute kidney injury (CI-AKI). METHODS: A database search was conducted for all randomized controlled trials that enrolled STEMI patients and compared CR versus IRA and reported CI-AKI...
August 31, 2016: American Journal of Cardiovascular Drugs: Drugs, Devices, and Other Interventions
Dhaval Kolte, Nathan Spence, Mohamedtauqir Puthawala, Omar Hyder, Christopher P Tuohy, Carolyn B Davidson, Mark W Sheldon, Warren K Laskey, J Dawn Abbott
BACKGROUND: Patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) are at an increased risk of developing contrast-induced acute kidney injury (CI-AKI). Data on the association between transradial (TRA) vs. transfemoral (TFA) access and the risk of CI-AKI in this setting are limited. METHODS: We analyzed data on 1162 patients undergoing primary PCI for STEMI at two tertiary care centers between 2010 and 2014...
July 21, 2016: Cardiovascular Revascularization Medicine: Including Molecular Interventions
G T C Wong, E Y P Lee, M G Irwin
Contrast induced nephropathy (CIN) is traditionally associated with outpatient imaging studies. More recently, patients afflicted with vascular pathologies are increasingly undergoing endovascular treatments that require the use of iodinated contrast media (CM) agents, thus placing them as risk of developing CIN. As perioperative physicians, anaesthetists should be aware of the risk factors and measures that might minimize acute kidney injury caused by CM. This review evaluates recent data regarding preventive measures against CIN and where possible, places the evidence in the context of the patient receiving endovascular surgical treatment...
September 2016: British Journal of Anaesthesia
Osamu Kurihara, Yoshihiko Seino, Yusaku Shibata, Masato Matsushita, Hidenori Komiyama, Katsuhito Kato, Daisuke Murakami, Ryo Munakata, Masamichi Takano, Yasushi Miyauchi, Noritake Hata, Wataru Shimizu
Contrast media are considered to cause acute kidney injury by activating various factors that induce renal vasoconstriction. We analysed the renal microvascular haemodynamic response using the Doppler flow wire method. Then changes in urinary liver-type fatty acid-binding protein levels following contrast medium administration were compared between groups with or without a micro-injury of the kidney. In the group without renal micro-injury, the average peak velocity (APV) decreased significantly, whereas the renal artery resistance index (RI) increased significantly following contrast medium administration...
August 25, 2016: Clinical and Experimental Pharmacology & Physiology
A J George, N E Manghat, M C K Hamilton
AIM: To compare a fixed-dose intravenous iodinated contrast medium protocol with weight-based dosing protocols for abdominal computed tomography (CT). MATERIALS AND METHODS: Fifty patients were scanned using a fixed-dose protocol, 50 patients were scanned using a full-dose weight-based contrast dosing protocol, and 13 patients were scanned using a reduced dose weight-based protocol. Radiodensity was measured at the portal vein, aorta, spleen, and liver. These values were plotted against contrast medium dose per unit weight...
August 21, 2016: Clinical Radiology
Martine Ann Harris, Beverly Snaith, Ruth Clarke
OBJECTIVES: To identify current UK screening practices prior to contrast-enhanced computerised tomography (CT). To determine the patient management strategies to minimise the risk of contrast induced acute kidney injury risk (CI-AKI) in outpatients. METHODS: An invitation to complete an electronic survey was distributed to the CT managers of 174 UK adult NHS hospital trusts. The survey included questions related to local protocols and national guidance on which these are based...
August 25, 2016: British Journal of Radiology
Maria Picken, Jianrui Long, Geoffrey A Williamson, Aaron J Polichnowski
The relative contribution of self-perpetuating versus hemodynamic-induced fibrosis to the progression of chronic kidney disease (CKD) after acute kidney injury (AKI) is unclear. In the present study, male Sprague-Dawley rats underwent right uninephrectomy and were instrumented with a blood pressure radiotelemeter. Two weeks later, separate groups of rats were subjected to 40 minutes renal ischemia-reperfusion or sham surgery and followed up for 4 or 16 weeks to determine the extent to which glomerulosclerosis and tubulointerstitial fibrosis as a result of the AKI-CKD transition (ie, at 4 weeks post AKI) change over time during the progression of CKD (ie, at 16 weeks post AKI)...
October 2016: Hypertension
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