Radiocontrast-induced nephrotoxicity and urinary alpha-glutathione S-transferase levels: effect of amlodipine administration.
OBJECTIVE
The exact pathogenesis and prophylaxis concerning radiocontrast-induced nephrotoxicity (RCIN) was unclear. Short-acting calcium antagonists were used to prevent RCIN. This study was designed to evaluate the role of a long-acting calcium antagonist (amlodipine) administration by determining serum creatinine (SCre) levels and 24 hour urinary excretion rates of glutathione S-transferase alpha (GST-alpha) which has a selective localization only to proximal tubular epithelium.


METHODS
In a prospective trial, 29 outpatients (19 M, 10 F) undergoing coronary angiography were randomized and either amlodipine 10 mg/day (n = 15) or placebo (n = 14) were administered prior to angiography and continued thereafter. All patients had normal basal renal function and none of them had any risk factor for RCIN. A low osmolar, nonionic contrast media (iopamidol 76%) was administered to all patients. Creatinine clearance (CCre), SCre and 24-hour urinary GST-alpha levels were measured before, 24 hours and 7 days after angiography.


RESULTS
SCre and 24 hour urinary GST-alpha values increased on 24th hour following the angiography in both groups (p < 0.017 and 0.001, respectively). Pretreatment with amlodipine created no difference in both variables (p > 0.05).


CONCLUSIONS
A reversible tubular dysfunction occurs following radiocontrast administration which was manifested by an increase in urinary GST-alpha excretion rates. Pretreatment with a long acting calcium antagonist amlodipine has no effect on the course of enzyme excretion and alteration observed in SCre.
Arici
Mustafa
M
Department of Nephrology and Cardiology, Hacettepe University School of Medicine, Ankara, Turkey.
Usalan
Celalettin
C
Altun
Bülent
B
Erdem
Yunus
Y
Yasavul
Unal
U
Turgan
Cetin
C
Kes
Sirri
S
Cağlar
Sali
S
D017311:Amlodipine / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography; D005260:Female; D005982:Glutathione Transferase / Q000652:urine; D006801:Humans; D007527:Isoenzymes / Q000652:urine; D007674:Kidney Diseases / Q000139:chemically induced* / Q000517:prevention & control* / Q000652:urine; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors
D002121:Calcium Channel Blockers; D003287:Contrast Media; D007527:Isoenzymes; D017311:Amlodipine; D005982:Glutathione Transferase; C119995:glutathione S-transferase alpha