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Cyanotic nephropathy and use of non-ionic contrast agents during cardiac catherization in patients with cyanotic congenital heart disease

Published online by Cambridge University Press:  19 August 2008

Sven Dittrich ,
Katrin Kurschat ,
Ingo Dähnert ,
Michael Vogel ,
Christian Müller  and
Peter E. Lange
Sven Dittrich*
Affiliation:
Deutsches Herzzentrum BerlinCharité, Campus Virchow – Clinics, Humboldt University, Berlin, Germany
Katrin Kurschat
Affiliation:
Deutsches Herzzentrum BerlinCharité, Campus Virchow – Clinics, Humboldt University, Berlin, Germany
Ingo Dähnert
Affiliation:
Deutsches Herzzentrum BerlinCharité, Campus Virchow – Clinics, Humboldt University, Berlin, Germany
Michael Vogel
Affiliation:
Deutsches Herzzentrum BerlinCharité, Campus Virchow – Clinics, Humboldt University, Berlin, Germany
Christian Müller
Affiliation:
Department of Clinical Chemistry and Biochemistry, Charité, Campus Virchow – Clinics, Humboldt University, Berlin, Germany
Peter E. Lange
Affiliation:
Deutsches Herzzentrum BerlinCharité, Campus Virchow – Clinics, Humboldt University, Berlin, Germany
*
Dr. Sven Dittrich, Deutsches Herzzentrum Berlin, Abteilung Angeborene Herzfehler/Kinderkardiologie, Augustenburger Platz 1, Berlin, Germany. Tel: +49–30–4593–2800; Fax +49–30–4593–2900; E-mail: [email protected]
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Abstract

Background

Chronic cyanosis with its associated rheologic changes is a known risk factor for glomerular nephropathy. Therefore, contrast-induced nephrotoxicity should be an important consideration for angiographers comparable to diabetics. On the other hand, progressions in diagnostic and interventional techniques have led to expanded indications and a more widespread use of x-ray contrast agents. The aim of this study was to investigate the risk of contrast-induced nephropathy in the small group of patients with cyanotic heart disease prior to surgical repair.

Methods

We investigated 23 cyanotic patients with an oxygen saturation of 82 (50–92)%, age 25 (5–63) years, and 13 control subjects with atrial septal defect, age 37 (20–66) years. Blood viscosity was measured before and after cardiac catherization. Renal damage was evaluatated by selective analysis of urinary proteins and enzymes.

Results

Before cardiac catheterization, 48% of the cyanotic patients had a moderate glomerulopathy. Cardiac catherization was performed with 3.0 (1.2 – 6.8) mls/kg non ionic contrast medium. Only one of the 23 patients (4.3%) with normal urinary analysis before cardiac catheterization showed renal damage, which involved tubular and glomerular function. Elevated blood viscosity in cyanotic patients was slightly reduced by the contrast. None of the acyanotic controls had contrast-induced nephropathy.

Conclusions

The use of non-ionic contrast medium does not worsen cyanotic glomerulopathy. This finding may be due to the reduction of blood viscosity by the application of the contrast medium. The finding of contrast-induced nephropathy in one patient underlines the importance of monitoring renal function after cardiac catheterization.

Keywords

cardiac catheterizationcyanotic congenital heart diseaserenal failureblood viscositycontrast-induced nephrotoxicity
Type
Original Articles
Information
Cardiology in the Young , Volume 10 , Issue 1 , January 2000 , pp. 8 - 14
Copyright
Copyright © Cambridge University Press 2000

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References

1.Spear, GThe glomerulus in cyanotic congenital heart disease and primary pulmonary hypertension. Nephron 1964; 1: 238–248.CrossRefGoogle ScholarPubMed
2.Dittrich, S, Haas, NA, Bührer, C, Müller, C, Dähnert, I, Lange, PERenal impairment in patients with long-standing cyanotic congenital heart disease. Acta Paediatr 1998; 87: 949–954.CrossRefGoogle ScholarPubMed
3.Krull, F, Ehrich, JH, Wurster, UToel, U, Rothganger, S, Luhmer, IRenal involvement in patients with congenital cyanotic heart disease. Acta Paediatr Scand 1991; 80: 1214–1219.CrossRefGoogle ScholarPubMed
4.Akita, H, Matsuoka, S, Kuroda, YNephropathy in patients with cyanotic congenital heart disease. Tokushima J Exp Med 1993; 40: 47–53.Google ScholarPubMed
5.Tommaso, CLContrast-induced nephrotoxicity in patients undergoing cardiac catheterization. Cathet Cardiovasc Diagn 1994; 31: 316–321.CrossRefGoogle ScholarPubMed
6.Carraro, M, Malalan, F, Antonione, R, Stacul, F, Cova, M, Petz, S, Assante, M, Grynne, B, Haider, T, Palma, LD, Faccini, LEffects of a dimeric vs a monomeric nonionic contrast medium on renal function in patients with mild to moderate renal insufficiency: a double-blind, randomized clinical trial. Eur Radiol 1998; 8: 144–147.CrossRefGoogle Scholar
7.Barrett, BJ, Carlisle, EJMetaanalysis of the relative nephrotoxicity of high- and low-osmolality iodinated contrast media. Radiology 1993; 188: 171–178.CrossRefGoogle ScholarPubMed
8.Spinler, SAGoldfarb, SNephrotoxicity of contrast media following cardiac angiography: pathogenesis, clinical course, and preventive measures, including the role of low-osmolality contrast media. Ann Pharmacother 1992; 26: 56–64.CrossRefGoogle ScholarPubMed
9.Stacul, F, Cova, M, Assante, M, Hougens Grynne, B, Haider, T. Comparison between the efficacy of dimeric and monomeric non-ionic contrast media (iodixanol vs iopromide) in urography in patients with mild to moderate renal insufficiency. Br J Radiol 1998; 71: 918–922.CrossRefGoogle ScholarPubMed
10.Rudnick, MR, Goldfarb, S, Wexler, L, Ludbrook, PA, Murphy, MJ, Halpern, EF, Hill, JA, Winniford, M, Cohen, MB, VanFossen, DBNephrotoxicity of ionic and nonionic contrast media in 1196 patients: a randomized trial. The lohexol Cooperative Study. Kidney Int 1995; 47: 254–261.CrossRefGoogle Scholar
11.Schwab, SJ, Hlatky, MA, Pieper, KS, Davidson, CJ, Morris, KG, Skelton, TN, Bashore, TMContrast nephrotoxicity: a randomized controlled trial of a nonionic and an ionic radi ographic contrast agent. N Engl J Med 1989; 320: 149–153.CrossRefGoogle Scholar
12.Almen, TThe etiology of contrast medium reactions. Invest Radiol 1994; 29 Suppl 1:S37–45.CrossRefGoogle ScholarPubMed
13.Solomon, RRadiocontrast-induced nephropathy. Semin Nephrol 1998; 18: 551–557.Google ScholarPubMed
14.Weisberg, LS, Kurnik, PB, Kurnik, BR.Radiocontrast-induced nephropathy in humans: role of renal vasoconstriction. Kidney Inc 1992; 41: 1408–1415.CrossRefGoogle ScholarPubMed
15.Simpson, LOA hypothesis proposing increased blood viscosity as a cause of proteinuria and increased vascular permeability. Nephron 1982; 31: 89–93.CrossRefGoogle ScholarPubMed
16.Simpson, LOBlood viscosity induced proteinuria. Nephron 1984; 36: 280–281.CrossRefGoogle ScholarPubMed
17.Laranja, SM, Ajzen, H, Schor, N. Nephrotoxicity of low-osmolality contrast media. Ren Fail 1997; 19: 307–314.CrossRefGoogle ScholarPubMed
18.Rudnick, MR, Berns, JS, Cohen, RM, Goldfarb, SContrast media- associated nephrotoxicity. Semin Nephrol 1997; 17: 15–26.Google ScholarPubMed
19.Parfrey, PS, Barrett, BJHigh-osmolality and low-osmolality contrast agents. N Engl J Med 1992; 327: 204–205.Google ScholarPubMed
20.Nunez, BD, Allon, MEffect of cardiac catheterization on renal function. Clin Nephrol 1990; 34: 263–266.Google ScholarPubMed
21.Stevens, MAMcCullough, PA, Tobin, KJ, Speck, JP, Westveer, DC, Guido-Allen, DA, Timmis, GC, OòÀNeill, WW. A prospective randomized trial of prevention measures in patients at high risk for contrast nephropathy: results of the P.R.I.N.C.E. Study. Prevention of Radiocontrast Induced Nephropathy Clinical Evaluation.J Am Coll Cardiol 1999; 33: 403–411.CrossRefGoogle ScholarPubMed
22.Solomon, R, Werner, C, Mann, D, D'Elia, J, Silva, PEffects of saline, mannitol, and furosemide to prevent acute decreases in renal function induced by radiocontrast agents. N Engl J Med 1994; 331: 1416–1420.CrossRefGoogle ScholarPubMed
23.Cigarroa, RG, Lange, BA, Williams, RH, Hillis, LDDosing of contrast material to prevent contrast nephropathy in patients with renal disease. Am J Med 1989; 86: 649–652.CrossRefGoogle ScholarPubMed
24.Lautin, EM, Freeman, NJ, Schoenfeld, AH, Bakal, CWHaramati, N, Friedman, AC, Lautin, JL, Braha, S, Kadish, EG, Haramiti, NRadiocontrast-associated renal dysfunction: a comparison of lower- osmolality and conventional high-osmolality contrast media. AJR Am J Roentgenol 1991; 157: 59–65.CrossRefGoogle ScholarPubMed
25.Leonardi, MContrast medium dose and renal failure. Radiology 1998; 207: 832–833.CrossRefGoogle ScholarPubMed