title: Effects of prednisone on biomarkers of tubular damage induced by radiocontrast in interventional cardiology.
abstract: BACKGROUND
  Contrast-induced nephropathy (CI-AKI) is a complication of diagnostic/therapeutic hemodynamic procedures in cardiology, which may also cause renal cholesterolinic atheroembolism. Despite the  severe clinical impact of these complications, there is no optimal therapy for preventing and treating them. We suggest a short course of high-dose steroids as an effective preventive measure.
  
  
  METHODS
  Patients at risk of CI-AKI (n = 38) undergoing cardiovascular procedures were assigned 1:1 to 1 of 2 experimental arms (prednisone+hydration vs. hydration alone). Oral prednisone 1 mg/kg was administered 12 hours before, at 6 am on the same day, and 24 hours following the procedure. Serum creatinine was tested immediately before and again 24-48 hours after the procedure; neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), protein and albumin were assayed in spot urine before and 6 hours after the procedure.
  
  
  RESULTS
  NGAL and KIM-1 tended to rise after the procedure, but to a lesser degree in the prednisone group (delta NGAL: hydration = +128%, prednisone = +46%;  p = 0.26; delta KIM-1: hydration = +99%, prednisone = +11%; p = 0.02). Proteinuria and albuminuria decreased significantly in the prednisone group. In 5 patients developing CI-AKI, their delta NGAL and delta KIM-1 did not differ from the values seen in patients without  CI-AKI. Hypertension, peripheral arteriopathy and use of low-dose aspirin or diuretics were positive predictors of baseline NGAL, while treatment with calcium channel blockers and statins were negative predictors. Statins were negative predictors of baseline KIM-1.
  
  
  CONCLUSIONS
  A short course of prednisone reduces the procedure-induced changes in biomarkers of renal tubular damage. This study suggests that steroids had a tubule-protecting effect.
authors.affiliation: Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy.
authors.forename: Flavio
authors.initials: F
authors.lastname: Ribichini
authors.forename: Alessia
authors.initials: A
authors.lastname: Gambaro
authors.forename: Michele
authors.initials: M
authors.lastname: Pighi
authors.forename: Gabriele
authors.initials: G
authors.lastname: Pesarini
authors.forename: Pietro Manuel
authors.initials: PM
authors.lastname: Ferraro
authors.forename: Cecilia
authors.initials: C
authors.lastname: Zuppi
authors.forename: Silvia
authors.initials: S
authors.lastname: Baroni
authors.forename: Romina
authors.initials: R
authors.lastname: Penitente
authors.forename: Valeria
authors.initials: V
authors.lastname: Ferrero
authors.forename: Corrado
authors.initials: C
authors.lastname: Vassanelli
mesh_terms: D000368:Aged; D000792:Angiography; D015415:Biomarkers / Q000032:analysis; D057791:Cardiac Imaging Techniques / Q000379:methods*; D003287:Contrast Media / Q000009:adverse effects*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007674:Kidney Diseases / Q000097:blood / Q000139:chemically induced* / Q000517:prevention & control* / Q000652:urine; D007684:Kidney Tubules / Q000187:drug effects*; D008297:Male; D010865:Pilot Projects; D011241:Prednisone / Q000627:therapeutic use*
chemical_list: D015415:Biomarkers; D003287:Contrast Media; D005938:Glucocorticoids; D011241:Prednisone