Valuable markers for contrast-induced nephropathy in patients undergoing cardiac catheterization.
BACKGROUND
Contrast-induced nephropathy (CIN) frequently complicates cardiac catheterization, so the objectives of present study were to investigate the usefulness of cystatin C before catheterization and establish a cut-off level for CIN, and to examine the changes in cystatin C and several other markers in patients with and without CIN.


RESULTS
Prospective study of consecutive 87 patients who underwent elective catheterization: moderate renal disease defined as glomerular filtration rate 30-59 ml . min(-1) .1.73 mm(-2); cystatin C and creatinine (Cr), urinary liver-type fatty acid-binding protein (L-FABP), alpha1, beta2 microglobulins, N-acetyl-beta-D-glucosaminidase, and microalbumin were measured immediately before, and 1, 2, and 3 days after catheterization. CIN occurred in 18 patients and receiver-operating characteristic analysis showed a higher area-under-the-curve for cystatin C compared with serum Cr (0.933 vs 0.832 p=0.012). At a cut-off level of >1.2 mg/L, cystatin C before catheterization exhibited 94.7% (95% confidence interval: 0.851-1.015) sensitivity and 84.8% specificity for detecting CIN. Cystatin C levels were higher in CIN patients than in those without CIN, even before catheterization (cystatin C: 1.08+/-0.22 vs 1.36+/-0.28 mg/L, p=0.007). Urinary L-FABP was increased on days 1 and 2 in patients with moderate renal disease.


CONCLUSIONS
Cystatin C was useful for predicting the occurrence of CIN. Urinary L-FABP was the only marker of transient renotubular damage.
Kato
Koji
K
Intensive and Cardiac Care Unit, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan. katokoji@nms.ac.jp
Sato
Naoki
N
Yamamoto
Takeshi
T
Iwasaki
Yu-Ki
YK
Tanaka
Keiji
K
Mizuno
Kyoichi
K
D000117:Acetylglucosamine / Q000097:blood; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000510:Alpha-Globulins / Q000032:analysis; D015415:Biomarkers / Q000097:blood / Q000652:urine; D006328:Cardiac Catheterization; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D055316:Cystatin C / Q000097:blood*; D050556:Fatty Acid-Binding Proteins / Q000652:urine*; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D007674:Kidney Diseases / Q000097:blood* / Q000139:chemically induced* / Q000652:urine*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D001613:beta 2-Microglobulin / Q000097:blood
D000510:Alpha-Globulins; D015415:Biomarkers; C525030:CST3 protein, human; D003287:Contrast Media; D055316:Cystatin C; C493319:FABP1 protein, human; D050556:Fatty Acid-Binding Proteins; C016001:alpha-1-microglobulin; D001613:beta 2-Microglobulin; D000117:Acetylglucosamine