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Original Article
Renal Function and Cardiac Angiography Ayumi Niboshi, Masashi Nishida, Toshiyuki Itoi, Isao Shiraishi and Kenji Hamaoka Department of Pediatric Cardiology and Nephrology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kawaramachi-Hirokoji, Kamikyo-ku Kyoto, Japan
Abstract. Objective : To study the effect of non-ionic contrast medium on renal function in children with cardiovascular disease. Methods : Analysis of renal function in 98 children with cardiovascular disease before and after the use of Iopamidol, Iohexol, and Ioversol was done for angiography. Serum creatinine (s-Cre), urinary N-acetyl-beta-D-glucosaminase (u-NAG), urinary beta 2-microglobulin (u-BMG), and urinary alpha 1-microglobulin (u-AMG) levels were evaluated. Results : Although s-Cre levels remained unchanged, u-NAG/Cre, u-AMG/Cre and u-BMG/Cre significantly increased 12 hours after angiography. Levels of u-NAG/Cre, u-BMG/Cre, and u-AMG/Cre after angiography were significantly higher in neonates and infants (age1-year, n=61), in patients with more than 5 ml/kg of contrast medium (n=25) than in those with less than 5 ml/kg (n=70) and in cyanotic patients (n=13) than in non-cyanotic (n=80) patients. Conclusion : Transient renal tubular dysfunction occurred in all of these three non-ionic contrast mediums. Although renal tubular function was intact on a long-term basis, one should be careful of contrast medium-induced nephropathy, especially in neonates and infants, in patients receiving more than 5ml/kg of contrast mediums in total, and in patients with cyanotic heart disease in using non-ionic contrast mediums. [Indian J Pediatr 2006; 73 (1) : 49-53] E-mail:
[email protected] Key words : Non-ionic contrast medium; Renal function; Children with cardiovascular disease
Cardiac angiography has been widely used for precise structural and functional diagnoses in children with cardiovascular disease, especially in those with complicated congenital heart disease. One of the major disadvantages of using iodine-based contrast mediums is a risk of renal dysfunction.1,2 In adults, some studies showed that an increase in serum creatinine (s-Cre) after angiography was seen in some patients, and the presence of renal insufficiency or diabetes mellitus was associated with an increased risk of contrast mediuminduced nephropathy.1-3 Recently, large clinical studies have indicated that the use of non-ionic low-osmolar contrast medium substantially reduced the risk of nephropathy in high-risk patients4-7, and non-ionic lowosmolar contrast medium is now widely used for cardiac angiography in children. However, the risk of contrast medium-induced nephropathy in children with cardiac disease has not been fully elucidated. 8 Thus, in this study, we analyzed renal function in children with cardiovascular disease after cardiac angiography, using three different non-ionic contrast mediums, i.e., Iopamidol, Iohexol, and Ioversol, to study
Correspondence and Reprint requests : Dr. Kenji Hamaoka , Department of Pediatric Cardiology and Nephrology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kawaramachi-Hirokoji, Kamikyo-ku, Kyoto, Japan. 6028566. Fax : +81-75-251-5833.
Indian Journal of Pediatrics, Volume 73—January, 2006
the safety of using contrast mediums in children with cardiovascular disease. MATERIALS AND METHODS 98 patients with cardiovascular disease who had undertaken cardiac catheter and angiography examinations were studied. The contrast medium for each patient was selected randomly from a choice of three different non-ionic contrast mediums: Iopamidol (Iopamiron 370 R) 370 mg iodine/ml (n=29), Iohexol (Omunipaque 350 R) 350 mg iodine/ml (n=12), and Ioversol (Optiray 350 R ) 350 mg iodine/ml (n=57). Informed consent for the research protocol was obtained from each patient or parents before cardiac catheterization. S-Cre was measured by enzymatic assays as a parameter for glomerular function. Urinary N-acetyl-beta-D-glucosaminase (u-NAG), urinary beta 2-microglobulin (u-BMG) and urinary alpha 1 microglobulin (u-AMG) were analyzed as parameters for proximal tubular function. These urinary values were standardized with urinary creatinine levels (uNAG/Cre, u-BMG/Cre ,u-AMG/Cre). U-NAG was assayed by using spectrophotometric assay 9 , and uBMG and u-AMG were measured by Latex agglutination reaction. 10,11 We measured these parameters at three different time points, i.e., 24 hours before the angiography, and 12 hours and 2 weeks after the angiography. Paired t-test (s-Cre) or Willcoxon 49
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Ayumi Niboshi et al signed-ranks test (u-NAG/Cre, u-BMG/Cre, and uAMG/Cre) were applied to compare the parameters before and after angiography. The differences of parameters between two groups were analyzed by Student’s t-test (s-Cre) or Mann-Whitney U test (u-NAG/ Cre, u-BMG/Cre, and u-AMG/Cre), and the differences among three groups were analyzed by non-parametric ANOVA. Multiple regression analysis was performed to elucidate the contributions of independent risk factors for renal dysfunction. A statistical significance was defined as p1 (n=32) age
