Prevention of contrast induced nephropathy

Kontrastom inducirana nefropatija (KIN) je reververzibilni akutni poremećaj bubrežne funkcije definiran porastom serumskog kreatinina za 44 μmol/L ili 25% od njegove početne vrijednosti koja nastaje nakon primjene jodiranih kontrastnih sredstava (KS).(1) Posebno rizičnu skupinu za razvoj KIN-a čine pacijenti s šećernom bolesti i KBB-om. Rizični čimbenici pacijenta imaju značajnu ulogu u porastu prevalencije KIN-a; kod visokorizičnih bolesnika prevalencija doseže 15%, dok u običnih bolesnika ne prelazi 1%. Provedenim istraživanjem željeli smo utvrditi razvoj KIN-a kroz period praćenja od godinu dana kod bolesnika kod kojih je bila indicirana neka vrsta radiološke pretrage uz primjenu KS u Kliničkom bolničkom centru Rijeka. U razdoblju od siječnja 2017. godine do prosinca 2018. godine zbog KIN-a metodom hidracije liječeno je 17 bolesnika (šest žena i 11 muškaraca). Prosječna dob je 73,17 ± 7,35 (59-84) godina. Najčešće bolesti od kojih su pacijenti bolovali bile su: KBB 82,35% (14 bolesnika), druga je bila šećerna bolest 23,52% (četiri bolesnika), dok su dva bolesnika (5,88%) imala transplantirani bubreg. Najčešća ptretraga koja je dovela do uzimanja kontrasta bila je MSCT periferna angiografija 41% (sedam ispitanika). Svi analizirani bolesnici primili su otopinu natrijevog klorida 9 mg/ml (0,9%) prije i nakon primanja kontrastnog sredstva u ukupnoj količini od 1500 ml. Prosječna vrijednost kreatinina prije uzimanja KS bila je 211,35 ± 82,61 (98-372) μmol/L, dok je 24 sata nakon uzimanja KS prosječna vrijednost kreatinina bila 243,93 ± 92,06 (123-401) μmol/L. Analiza podataka dobivene vrijednosti kreatinina prije uzimanja KS-a u usporedbi s vrijednostima serumskog kreatinina nakon uzimanja KS-a pokazala je da njegov porast nije statistički značajan, čime smo potvrdili uspješnost hidracije kao izbor metode prevencije.Contrast-induced nephropathy (CIN) is a reversible acute renal function disorder defined by serum creatinine increase by 44 μmol /L or 25% of the initial creatinine value that occurs after iodinated contrast media(CM) is given. A particular risk group for the development of CIN are diabetic patients and chronic kidney disease (CBB) patients. Patient risk factors play a significant role in the prevalence of CIN; in high-risk patients the prevalence rate is 15%, while in ordinary patients it does not exceed 1%. In the course of the research we wanted to establish the development of CIN during the one-year follow-up period in patients with some type of radiological examination in Clinical Hospital Center Rijeka. In the period from January 2017 to December 2018, 17 patients (6 women and 11 males) were treated for CIN. The average age is 73.17 ± 7.35 (59-84) years. The most common illnesses the patients suffered from were: CBB 82.35% (14 patients), the second one is diabetes 23.52% (4 patients) and we had two patients with transplanted kidney 5.88%. The most common radiological imaging was MSCT peripheral angiography 41% (7 patients). All analyzed patients received 9 mg/ml (0.9%) sodium chloride solution before and after receiving the CM in a total amount of 1500 ml. The average creatinine value before taking CM was 211.35 ± 82.61 (98-372) μmol/L. 24 hours after taking CM average value of creatinine was 243.93 ± 92.06 (123-401) μmol/L. Analyzing the values of creatinin before taking CM and 24 hours later we found that the increase of serum creatinine was not statistically significant, confirming that hydration is a succesfull prevention method