2017

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2017/№3

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.
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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

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