Nephrotoxicity from contrast media: attenuation with theophylline.
OBJECTIVE
To determine if depression of creatinine clearance after administration of contrast medium may be prevented with theophylline.


METHODS
A nonionic, low-osmolality contrast medium (iopamidol) or an ionic, high-osmolality contrast medium (sodium diatrizoate) was administered to 93 patients. Before the examination, these patients were given theophylline or a placebo orally. There were also 30 patients who received an adenosine-uptake inhibitor (dipyridamole). Creatinine clearance and urinary adenosine levels were measured before and after angiography.


RESULTS
Creatinine clearance decreased 18% +/- 4 in the placebo-iopamidol group but did not decrease in the theophylline group; urinary adenosine increased 67% +/- 7. Creatinine clearance decreased 42% +/- 5 in the placebo-sodium diatrizoate group and decreased 24% +/- 3 in the theophylline group; urinary adenosine increased 119% +/- 8. In the dipyridamole group in which iopamidol was given, urinary adenosine increased 96% +/- 7 and creatinine clearance decreased 37% +/- 5.


CONCLUSIONS
Intrarenal adenosine can be implicated in the pathogenesis of hypertonic contrast medium nephrotoxicity.
Katholi
R E
RE
Prairie Education Research Cooperative, Springfield, Ill.
Taylor
G J
GJ
McCann
W P
WP
Woods
W T
WT
Womack
K A
KA
McCoy
C D
CD
Katholi
C R
CR
Moses
H W
HW
Mishkel
G J
GJ
Lucore
C L
CL
D000241:Adenosine / Q000037:antagonists & inhibitors / Q000502:physiology* / Q000652:urine; D003404:Creatinine / Q000378:metabolism; D003973:Diatrizoate / Q000009:adverse effects*; D004176:Dipyridamole / Q000627:therapeutic use*; D006801:Humans; D007479:Iopamidol / Q000009:adverse effects*; D007668:Kidney / Q000187:drug effects* / Q000378:metabolism; D007674:Kidney Diseases / Q000139:chemically induced* / Q000517:prevention & control*; D008875:Middle Aged; D009994:Osmolar Concentration; D018047:Receptors, Purinergic P1 / Q000187:drug effects*; D013806:Theophylline / Q000627:therapeutic use*
D018047:Receptors, Purinergic P1; D003973:Diatrizoate; D004176:Dipyridamole; D003404:Creatinine; D013806:Theophylline; D007479:Iopamidol; D000241:Adenosine