title: Increased pre-procedural urinary microalbumin is associated with a risk for renal functional deterioration after coronary computed tomography angiography.
abstract: BACKGROUND
  Urinary microalbumin is a marker for preclinical nephropathy. A percentage change in cystatin C (%CyC) of ≥10% for 24h after tests with contrast media is reportedly an independent predictor for developing contrast-induced nephropathy. We investigated the relationship between the presence of urinary microalbumin and changes in CyC after coronary computed tomography angiography (CCTA).
  
  
  METHODS
  Three hundred and thirty-three patients with known or suspected coronary artery disease who scheduled for CCTA using a 70mL of Iopamidol were enrolled. Serum creatinine and CyC levels were measured at baseline and 24 h post-procedure. The %CyC, absolute changes in estimated glomerular filtration rate (ΔeGFR), and oral fluid volume from pre- to post-procedure were calculated. The patients were dichotomized into 2 groups as follows: group A comprised 83 patients showing a %CyC of ≥10%; and group B comprised 250 patients showing a %CyC of <10%.
  
  
  RESULTS
  The ΔeGFR, fasting plasma glucose levels, HbA1c, and pre-procedural urinary microalbumin levels were significantly greater in group A than in group B. Oral fluid intake volume was significantly less in group A than in group B. The urinary microalbumin significantly correlated with %CyC (r=0.504, P<0.0001). Multivariate logistic regression analysis revealed that pre-procedural urinary microalbumin and oral fluid volume were independent predictors for %CyC≥10%. The optimal cut-off value of a pre-procedural urinary microalbumin level was 58mg/g·creatinine for predicting a %CyC≥10% using receiver-operating-characteristic analysis.
  
  
  CONCLUSIONS
  Renal functional changes should be carefully paid attention to after CCTA, particularly in patients exhibiting increased pre-procedural urinary microablumin levels.
authors.affiliation: Department of Cardiology, Isobe Naika Clinic, Nagoya, Japan. Electronic address: sisobe@med.nagoya-u.ac.jp.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Isobe
authors.affiliation: Department of Cardiology, Isobe Naika Clinic, Nagoya, Japan.
authors.forename: Miyuki
authors.initials: M
authors.lastname: Yuba
authors.affiliation: Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Mori
authors.affiliation: Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Suzuki
authors.affiliation: Division of Radiology, Kami-iida Dai-ichi General Hospital, Nagoya, Japan.
authors.forename: Kimihide
authors.initials: K
authors.lastname: Sato
authors.affiliation: Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Ishii
authors.affiliation: Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Murohara
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced / Q000150:complications / Q000453:epidemiology*; D000368:Aged; D000419:Albuminuria / Q000453:epidemiology* / Q000209:etiology; D015415:Biomarkers / Q000097:blood; D000072226:Computed Tomography Angiography / Q000009:adverse effects*; D003287:Contrast Media / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000175:diagnosis; D055316:Cystatin C / Q000378:metabolism; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D007479:Iopamidol / Q000009:adverse effects*; D007564:Japan / Q000453:epidemiology; D008297:Male; D012372:ROC Curve; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D003287:Contrast Media; D055316:Cystatin C; D007479:Iopamidol
keywords: Coronary computed tomography angiography; Cystatin C; Oral fluid volume; Renal function; Urinary microalbumin