Nephrotoxicity of high- and low-osmolality contrast media.
Nephrotoxicity of radio-opaque contrast media (CM) is generally believed to involve toxic injury of proximal tubular cells. Measurement of urinary tubular enzyme excretion has been advocated as a sensitive marker of such toxic injury. It has been claimed that the new low-osmolality or nonionic CM reduce the incidence of nephrotoxicity but this remains uncertain. We studied 23 patients with normal renal function undergoing coronary angiography; patients were randomized into three groups receiving either diatrizoate (1,800 mmol/kg H2O), ioxaglate (600 mmol/kg H2O) or iohexol (850 mmol/kg H2O). Urinary excretion of a panel of enzymes increased significantly in all groups by 20 h (p less than 0.05 to less than 0.005). Alanine aminopeptidase excretion at 20 h was greater after the administration of high osmolality ionic CM than with the others but all three CM produced a similar pattern of enzyme excretion. No significant change in glomerular filtration rate was found in any group so the significance of the enzymuria remains uncertain.
Jevnikar
A M
AM
Department of Medicine, Victoria Hospital, London, Ont., Canada.
Finnie
K J
KJ
Dennis
B
B
Plummer
D T
DT
Avila
A
A
Linton
A L
AL
D000328:Adult; D000368:Aged; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography; D003973:Diatrizoate / Q000009:adverse effects; D005260:Female; D006801:Humans; D007472:Iohexol / Q000009:adverse effects; D007485:Ioxaglic Acid / Q000009:adverse effects; D007674:Kidney Diseases / Q000139:chemically induced* / Q000201:enzymology; D007684:Kidney Tubules / Q000187:drug effects / Q000201:enzymology; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D011446:Prospective Studies; D011897:Random Allocation
D003287:Contrast Media; D003973:Diatrizoate; D007472:Iohexol; D007485:Ioxaglic Acid