Effect of N-acetyl cysteine in prevention of contrast nephropathy on patients under intravenous pyelography and contrast CT

Momeni, Ali; Mirhoseini, Mahmood; Mohamadali Beigi, Faramarz; Rajaei Esfahani, Mohamad; Kheiri, Soleiman; Amiri, Masoud; Seidain, Zahra

Effect of N-acetyl cysteine in prevention of contrast nephropathy on patients under intravenous pyelography and contrast CT

Authors

¹ Shahrekord University of Medical Sciences, Shahrekord, Iran

² Isfahan University of Medical Sciences, Shahrekord, Iran

Abstract

Background: Contrast nephropathy is a common and often reversible cause of acute renal failure (ARF). About 10% of ARF in admitted patients might be due to it and may also lead to dialysis. Some methods could prevent it such as fluid therapy with half or normal saline, Na bicarbonate, N-acetyl cysteine (NAC), and so on. The aim of this study was to evaluate the efficacy of NAC to prevent contrast nephropathy.
Materials and Methods: In a cross-sectional study, 110 patients who were candidate for intravenous pyelography (IVP) or CT scan enrolled in two groups: Case and control. In patients of case group, meglumine compound and in control group, placebo was prescribed before procedure. Before study and after 48 h, blood urea nitrogen (BUN) and creatinine (Cr) was checked, and glomerular filtration rate (GFR) was measured with Cockcroft-Gault formula.
Results: There were no difference between age and gender of two groups. There was also no significant difference between mean Cr before and after study; however, GFR of patients in case group was significantly higher than the control group after 48 h of procedure.
Conclusion: Because GFR was higher in case group and there were no drug side-effects in patients, we recommend the use of NAC before administration of intravenous contrast especially in high-risk population such as diabetic patients.

Keywords

References

1.	Massry SG, Glassock RJ. Textbook of nephrology. 4th ed. USA: Lippincott Williams and Wilkins; 2001. p. 950-3.
2.	Bailey SR. Past and present attempts to prevention radio contrast nephropathy. Rev Cardiovasc Med 2001;2 Suppl:1.
3.	Porter GA. Contrast-associated Nephropathy. Am Cardiol 1989;64:22E-6E. [PUBMED]
4.	Barrett BJ, Parfrey PS. Clinical practice. Preventing nephropathy induced by contrast medium. N Engl J Med 2006;354:379-86. [PUBMED] [FULLTEXT]
5.	Pannu N, Wiebe N, Tonelli M. Prophylaxis strategies for contrast-induced nephropathy. JAMA 2006;295:2765-79. [PUBMED] [FULLTEXT]
6.	Sinert R, Doty CI. Evidence-based emergency medicine review. Prevention of contrast-induced nephropathy in the emergency department. Ann Emerg Med 2007;50:335-45, 345.e1-2. [PUBMED] [FULLTEXT]
7.	McCullough PA, Wolyn R, Rocher LL, Levin RN, O'Neill WW. Acute renal failure after coronary intervention: Incidence, risk factors, and relationship to mortality. Am J Med 1997;103:368-75. [PUBMED] [FULLTEXT]
8.	Scanlon PJ, Faxon DP, Audet AM, Carabello B, Dehmer GJ, Eagle KA, et al. ACC/AHA guidelines for coronary angiography. J Am Coll Cardiol 1999;33:1756-824. [PUBMED] [FULLTEXT]
9.	Agmon Y, Peleg H, Greenfeld Z, Rosen S, Brezis M. Nitric oxide and prostanoids protect the renal outer medulla from radiocontrast toxicity in the rat. J Clin Invest 1994;94:1069-75. [PUBMED] [FULLTEXT]
10.	Parfrey PS. Contrast material induced renal failure in patients with diabetes mellitus, renal insufficiency or both a prospective controlled study. N Engl J Med 1989;320:143-9.
11.	Lloberas N, Torras J, Herrero-Fresneda I, Cruzado JM, Riera M, Hurtado I, et al. Postischemic renal oxidative stress induces inflammatory response through PAF and oxidized phospholipids. Prevention by antioxidant treatment. FASEB J 2002;16:908-10. [PUBMED] [FULLTEXT]
12.	Briguori C, Airoldi F, D'Andrea D, Bonizzoni E, Morici N, Focaccio A, et al. Renal Insufficiency Following Contrast Media Administration Trial (REMEDIAL) Multimodality Prevention of Contrast-Induced Acute Kidney Injury: A randomized comparison of 3 preventive strategies. Circulation 2007;115:1211-7. [PUBMED] [FULLTEXT]
13.	McLennan S, Yue DK, Fisher E, Capogreco C, Heffernan S, Ross GR, et al. Deficiency of ascorbic acid in experimental diabetes relationship with collagen and polyol pathway abnormalities. Diabetes 1988;37:359-61. [PUBMED]
14.	Millea PJ. N-Acetylcysteine: Multiple Clinical Applications. Am Fam Physician 2009;80:265-9. [PUBMED] [FULLTEXT]
15.	Diaz-Sandoval LJ, Kosowky BD. Losordo DW. Acetylcysteine prevent angiography related renal tissue injury. AM J Cardiol 2002;89:356-8.
16.	Shyu KG, Cheng JJ, Kuan P. Acetyl cysteine protects against acute renal damage in patients with abnormal renal function undergoing a coronary procedure. J Am Cardiol 2002;40:1383-8. [PUBMED]
17.	Ramesh N, Pkpill AI, Raham AT, Padmaja NP. Shmeed, Gvijayarghavan. Renoprotective effect of N-acetylcystein in patient with impaired renal intervention. JAPI 2006 June;54: 449-52.
18.	Hoffman U, Kruger B, Drobnik W, Fischereder M, Bernhard K, Krumer. Acetylcysteine Induced significant Increase in GFR in patient with normalrenal function. Inter Med J 2003;w374:2938.
19.	Marenzi G, Assanelli E, Marana I, Lauri G, Campodonico J, Grazi M, et al. N - acetylcysteine and contrast -Induced nephropathy in primary Angioplasty. N Engl J Med 2006;26:2773-82.
20.	Agrawol M, Anna M, Wodlinger, Chand E, Gail E, Tudor, et al. Effect of N-acetyl cysteine on serum Creatinin concentration in patient with chronic RenalInsufficiency who are undergoing coronary Angiography. Heart Drug 2004;4:87-91.
21.	Alla S, Mohseni A, Tabibian S, Ghezelbash Z, Hendooei N. The study of the efficacy of N-Acetylcystein in prevention of contrast nephropathy in patients with normal kidney function. J Mazandaran Med Sci 2007;17:102-7.
22.	Tepel M, van der Giet M, Schwarzfeld C, Laufer U, Liermann D, Zidek W. Prevention of radio- graphic-contrast-agent-induced reductions in renal function by acetylcysteine. N Engl J Med 2000;343:180-4. [PUBMED] [FULLTEXT]
23.	Durham JD. A randomized controlled trial of NAC to prevent contrast nephropathy in cardiac angiography. Kidney Int 2002; 62:2202-7.

Advanced Biomedical Research