150.00 rub.
Buy article

Contrast-induced nephropathy in patients with myocardial infarction who had undergone interventions using radiocontrast agents: A diagnostic role of serum NGAL

Karetnikova V. N.1, Kalaeva V. V.2, Evseeva M. V.1, Gruzdeva O. V.2, Zykov M. V.2, Kashtalap V. V.2, Barbarash O. L.2
1 – Federal State Budget Educational Institution of Higher Education "Kemerovo State Medical Academy" the Ministry of Health of the Russian Federation, Voroshilova 22a, Kemerovo 650029
2 – Federal State Budgetary Science Institution "Research Institute for Complex Issues of Cardiovascular Diseases", Sosnovy Bulvar 6, Kemerovo 650002

Keywords: nephropathy, NGAL, myocardial infarction

DOI: 10.18087/rhj.2017.3.2344

Background. Traditional diagnostic criteria for acute kidney injury (AKI), including AKI induced by radiocontrast agents, take into consideration deviations of serum creatinine concentrations and volume of excreted urine. However, these indexes are quite “late” and do not provide effective diagnostics of developing contrast-induced nephropathy (CIN). Aim. To evaluate the significance of serum neutrophil gelatinase-associated lipocalin (NGAL) for early detection of CIN in patients with ST segment elevation MI (STEMI) who had undergone interventions using radiocontrast agents (IRA). Materials and methods. The study included 954 patients with STEMI; 696 of them (73%) had undergone procedures using radiocontrast agents (coronary angiography and/or transcutaneous coronary intervention) within 24 hours prior to the onset of symptoms. CIN was diagnosed by an increase in serum creatinine by more than 25 % or 0.5 mg/dl (44 μmol/l) from baseline within 48–72 h of intravascular administration of a contrast agent in the absence of an alternative cause. Serum NGAL was measured in 107 patients at days 1 and 12–14 of MI. The endpoints of cardiovascular events were evaluated during the hospital stay. Results. CIN was diagnosed in 61 (8.8%) patients exposed to IRA. Incidence of unfavor-able, both fatal and nonfatal, outcomes was considerably increased in patients with CIN (19.7 vs 7.4%, р<0.001 and 50.8 vs 23.8%, р<0.001, respectively). In the CIN group, both at admission and at the end of hospital stay, median NGAL concentrations were 1.9 [1.8–2.4] ng/ml and 3.4 [2.9–3.6] ng/ml, respectively. These values were significantly higher than those for patients without signs of CIN (1.28 [0.3–1.9] and 1.61 [1.25–2.36] ng/ml). A history of chronic kidney disease (CKD) increased the risk of CIN 1.7 times (p=0.013); a CFR decrease below 60 ml/min/1.73 m2 at admission – 3.7 times (p=0.039), and the level of NGAL ≥1.33 ng/ml measured at one day following IRA increased the risk of CIN 5.5 times (p=0.041). Conclusion. CIN was detected in 8.8% of patients with acute STEMI exposed to IRA and was associated with an unfavorable outcome of the hospital treatment period. Independent risk factors of CIN included a history of CHD, reduced GFR <60 ml/min/1.73 m2 at admission, and an increased serum concentration of NGAL ≥1.33 ng/ml at day 1 of IRA.
  1. Bavry AA, Kumbhani DJ, Rassi AN, Bhatt DL, Askari AT. Benefit of Early Invasive Therapy in Acute Coronary Syndromes. Journal of the American College of Cardiology. 2006;48(7):1319–25. DOI:10.1016/j.jacc.2006.06.050.
  2. Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE et al. ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction): Developed in Collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons: Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. Circulation. 2007;116(7):e148–304. DOI:10.1161/CIRCULATIONAHA.107.181940.
  3. Wi J, Ko Y-G, Kim J-S, Kim B-K, Choi D, Ha J-W et al. Impact of contrast-induced acute kidney injury with transient or persistent renal dysfunction on long-term outcomes of patients with acute myocardial infarction undergoing percutaneous coronary intervention. Heart. 2011;97(21):1753–7. DOI:10.1136/hrt.2010.218677.
  4. Marenzi G, Cabiati A, Bertoli SV, Assanelli E, Marana I, De Metrio M et al. Incidence and Relevance of Acute Kidney Injury in Patients Hospitalized With Acute Coronary Syndromes. The American Journal of Cardiology. 2013;111(6):816–22. DOI:10.1016/j.amjcard.2012.11.046.
  5. Marenzi G, Assanelli E, Campodonico J, De Metrio M, Lauri G, Marana I et al. Acute kidney injury in ST-segment elevation acute myocardial infarction complicated by cardiogenic shock at admission. Critical Care Medicine. 2010;38(2):438–44. DOI:10.1097/CCM.0b013e3181b9eb3b.
  6. Haase-Fielitz A, Haase M, Bellomo R . Instability of Urinary NGAL During Long-Term Storage. American Journal of Kidney Diseases. 2009;53(3):564–5. DOI:10.1053/j.ajkd.2009.01.009.
  7. Nickolas TL. Sensitivity and Specificity of a Single Emergency Department Measurement of Urinary Neutrophil Gelatinase–Associated Lipocalin for Diagnosing Acute Kidney Injury. Annals of Internal Medicine. 2008;148(11):810. DOI:10.7326/0003-4819-148-11-200806030-00003.
  8. Morcos SK, Thomsen HS, Webb JA. Contrast-media-induced nephrotoxicity: a consensus report. Contrast Media Safety Committee, European Society of Urogenital Radiology (ESUR). Eur Radiol. 1999;9(8):1602–13.
  9. Bartholomew BA, Harjai KJ, Dukkipati S, Boura JA, Yerkey MW, Glazier S et al. Impact of nephropathy after percutaneous coronary intervention and a method for risk stratification. Am J Cardiol. 2004;93(12):1515–9. DOI:10.1016/j.amjcard.2004.03.008.
  10. Palevsky PM. Epidemiology of Acute Renal Failure: The Tip of the Iceberg. Clinical Journal of the American Society of Nephrology. 2005;1(1):6–7. DOI:10.2215/CJN.01521005.
  11. McCullough PA. Contrast-Induced Acute Kidney Injury. Journal of the American College of Cardiology. 2008;51(15):1419–28. DOI:10.1016/j.jacc.2007.12.035.
  12. Weisbord SD, Palevsky PM. Contrast-Induced Acute Kidney Injury: Short- and Long-Term Implications. Seminars in Nephrology. 2011;31(3):300–9. DOI:10.1016/j.semnephrol.2011.05.009.
  13. Bartorelli AL, Marenzi G. Contrast-Induced Nephropathy. Journal of Interventional Cardiology. 2008;21(1):74–85. DOI:10.1111/j.1540-8183.2007.00318.x.
  14. Alpert MA. Do Statins Reduce the Risk of Contrast-Induced Acute Kidney Injury in Patients Undergoing Coronary Angiography or Percutaneous Coronary Interventions? Journal of the American College of Cardiology. 2014;63(1):80–2. DOI:10.1016/j.jacc.2013.07.097.
  15. Кобалава Ж. Д., Виллевальде С. В., Ефремовцева М. А. Основы кардиоренальной медицины/ под ред. Кобалава Ж. Д., Моисеева В. С. –М.: ГЭОТАР-Медиа; 2014. 256с [Kobalava Zh. D., Villeval`de S. V., Efremovczeva M. A. Osnovy` kardiorenal`noj medicziny`/ pod red. Kobalava Zh. D., Moiseeva V. S. –M.: GE`OTAR-Media; 2014. 256s].
  16. Ronco C. NGAL: an emerging biomarker of acute kidney injury. Int J Artif Organs. 2008;31(3):199–200.
  17. Glassford NJ, Schneider AG, Xu S, Eastwood GM, Young H, Peck L et al. The nature and discriminatory value of urinary neutrophil gelatinase-associated lipocalin in critically ill patients at risk of acute kidney injury. Intensive Care Medicine. 2013;39(10):1714–24. DOI:10.1007/s00134-013-3040-7.
Karetnikova V. N., Kalaeva V. V., Evseeva M. V., Gruzdeva O. V., Zykov M. V., Kashtalap V. V. et al. Contrast-induced nephropathy in patients with myocardial infarction who had undergone interventions using radiocontrast agents: A diagnostic role of serum NGAL. Russian Heart Journal. 2017;16 (3):177–184

To access this material please log in or register

Register Authorize
Ru En