Contrast media nephropathy: intravenous CT angiography versus intraarterial digital subtraction angiography in renal artery stenosis: a prospective randomized trial.
BACKGROUND
Spiral computed tomographic angiography (CTA) is a noninvasive method to diagnose renal artery stenosis (RAS). In digital subtraction angiography (DSA), contrast media (CM) is injected directly into the renal artery; in CTA, a greater amount of CM is injected intravenously, potentially leading to an increased incidence of CM nephropathy.


METHODS
We investigated 80 patients with suspected RAS randomized to either CTA or DSA prospectively. The following parameters were determined: serum creatinine level and single-shot inulin clearance for evaluation of renal function and urine alpha1-microglobulin and beta-N-acetyl-glucoseaminidase (beta-NAG) as markers for tubular toxicity. Data from 16 patients undergoing angioplasty in the same session were excluded.


RESULTS
In the CTA and DSA groups, 163 +/- 13 and 104 +/- 56 mL of CM (mean +/- SD; P < 0.0001) were administered, respectively. Mean serum creatinine levels increased from 1.78 +/- 1.61 to 1.92 +/-1.73 mg/dL (157 +/- 142 to 170 +/- 153 micromol/L; P = 0.00001) in the CTA group and from 1.52 +/- 1.23 to 1.60 +/- 1.28 mg/dL (134 +/- 109 to 141 +/- 113 micromol/L; P = 0.01) in the DSA group. Mean inulin clearance decreased from 63 +/- 28 to 58 +/- 23 mL/min (P = 0.01) and 65 +/- 26 to 62 +/- 26 mL/min (P < 0.01), median beta-NAG levels increased from 4.6 to 6.0 U/g creatinine (P = not significant) and 2.5 to 8.0 U/g creatinine (P < 0.001), and median alpha1-microglobulin levels increased from 13 to 17 microg/g creatinine (P < 0.025) and 11 to 21 microg/g creatinine (P = not significant) in the CTA and DSA groups, respectively. CM nephropathy occurred in 3 of 33 patients in the CTA group and 2 of 31 patients in the DSA group. The increase in creatinine level was reversible in all patients within 7 days.


CONCLUSIONS
On this study, CTA performed for the detection of RAS is not associated with an increased risk for CM nephropathy compared with intraarterial DSA despite a greater dose of CM.
Lufft
Volkmar
V
Abteilung Nephrologie, Abteilung Diagnostische Radiologie, Klinik für Abdominal- und Transplantationschirurgie, Medizinische Hochschule Hannover, Germany. vlufft@aol.com
Hoogestraat-Lufft
Linda
L
Fels
Lüder M
LM
Egbeyong-Baiyee
Daniel
D
Tusch
Günter
G
Galanski
Michael
M
Olbricht
Christoph J
CJ
D015901:Angiography, Digital Subtraction / Q000379:methods*; D003287:Contrast Media / Q000009:adverse effects*; D003928:Diabetic Nephropathies / Q000139:chemically induced / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007269:Injections, Intra-Arterial; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012077:Renal Artery; D012078:Renal Artery Obstruction / Q000150:complications / Q000000981:diagnostic imaging*; D051437:Renal Insufficiency / Q000139:chemically induced* / Q000453:epidemiology; D014057:Tomography, X-Ray Computed / Q000379:methods*
D003287:Contrast Media