title: Tubular nephrotoxicity after intravenous urography with ionic high-osmolal and nonionic low-osmolal contrast media in patients with chronic renal insufficiency.
abstract: Nephrotoxicity of intravenous contrast media is more frequent and striking in patients with risk factors, the major one being preexisting chronic renal insufficiency. New nonionic low-osmolal contrast media allegedly have less nephrotoxicity than the traditional ionic high-osmolal ones. This was tested for two contrast media in a group of 18 patients with stable chronic renal insufficiency. The urinary excretion of two brush-border enzymes (alanine aminopeptidase, AAP, and gamma-glutamyl transpeptidase, gamma-GT) and of a lysosomal enzyme (N-acetyl-beta glucosaminidase, NAG), functional markers of tubular injury, were measured before and after intravenous urography with an ionic high-osmolal radiocontrast medium, meglumine sodium diatrizoate, or with a non ionic low-osmolal one, iopamidol. Urinary NAG excretion did not change significantly after administration of either contrast media. Urinary AAP and gamma-GT excretion increased significantly (p less than 0.01) after diatrizoate. After iopamidol, only gamma-GT excretion increased significantly (p less than 0.05). Our data suggest that the nonionic low-osmolal radiocontrast medium iopamidol is less toxic to tubules than the ionic high-osmolal medium diatrizoate and that the brush-border enzymes AAP and gamma-GT are sensitive markers for this toxicity.
mesh_terms: D000118:Acetylglucosaminidase / Q000652:urine; D000328:Adult; D000368:Aged; D000626:Aminopeptidases / Q000652:urine; D018826:CD13 Antigens; D003287:Contrast Media / Q000009:adverse effects*; D003973:Diatrizoate / Q000009:adverse effects; D005260:Female; D006801:Humans; D007479:Iopamidol / Q000009:adverse effects; D007676:Kidney Failure, Chronic / Q000000981:diagnostic imaging*; D007684:Kidney Tubules / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D014567:Urography; D005723:gamma-Glutamyltransferase / Q000652:urine
chemical_list: D003287:Contrast Media; D003973:Diatrizoate; D005723:gamma-Glutamyltransferase; D000118:Acetylglucosaminidase; D000626:Aminopeptidases; D018826:CD13 Antigens; D007479:Iopamidol