Abstract
Background: Contrast-induced nephropathy (CI-AKI) is a complication of
diagnostic/therapeutic hemodynamic procedures in cardiology, which may
also cause renal cholesterolinic atheroembolism. Despite the severe
clinical impact of these complications, there is no optimal therapy for
preventing and treating them. We suggest a short course of high-dose
steroids as an effective preventive measure.
Methods: Patients at risk of CI-AKI (n = 38) undergoing cardiovascular
procedures were assigned 1:1 to 1 of 2 experimental arms
(prednisone+hydration vs. hydration alone). Oral prednisone 1 mg/kg was
administered 12 hours before, at 6 Am on the same day, and 24 hours
following the procedure. Serum creatinine was tested immediately before
and again 24-48 hours after the procedure; neutrophil
gelatinase-associated lipocalin (NGAL), kidney injury molecule-1
(KIM-1), protein and albumin were assayed in spot urine before and 6
hours after the procedure.
Results: NGAL and KIM-1 tended to rise after the procedure, but to a
lesser degree in the prednisone group (delta NGAL: hydration = +128\%,
prednisone = +46\%; p = 0.26; delta KIM-1: hydration = +99\%, prednisone
= +11\%; p = 0.02). Proteinuria and albuminuria decreased significantly
in the prednisone group. In 5 patients developing CI-AKI, their delta
NGAL and delta KIM-1 did not differ from the values seen in patients
without CI-AKI. Hypertension, peripheral arteriopathy and use of
low-dose aspirin or diuretics were positive predictors of baseline NGAL,
while treatment with calcium channel blockers and statins were negative
predictors. Statins were negative predictors of baseline KIM-1.
Conclusions: A short course of prednisone reduces the procedure-induced
changes in biomarkers of renal tubular damage. This study suggests that
steroids had a tubule-protecting effect.
Lingua originale | English |
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pagine (da-a) | 586-593 |
Numero di pagine | 8 |
Rivista | JN. JOURNAL OF NEPHROLOGY |
Volume | 26 |
DOI | |
Stato di pubblicazione | Pubblicato - 2013 |
Keywords
- Acute kidney injury
- Contrast-induced nephropathy
- Interventional cardiology
- Steroids