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1.
Life Sci ; 259: 118379, 2020 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-32890604

RESUMO

With the increasing application of medical imaging contrast materials, contrast-induced nephropathy has become one of the leading causes of iatrogenic renal insufficiency. The underlying mechanism is associated with renal medullary hypoxia, direct toxicity of contrast agents, oxidative stress, apoptosis, immune/inflammation and epigenetic regulation in contrast-induced nephropathy. Up to date, there is no effective therapy for contrast-induced nephropathy, and thus risk predication and effective preventive strategies are keys to reduce the occurrence of contrast-induced nephropathy. It was found that the proper use of contrast medium, personalized hydration, and high-dose statins may reduce the occurrence of contrast-induced nephropathy, while antioxidants have not shown significant therapeutic benefits. Additionally, the role of remote ischemia preconditioning and vasodilators in the prevention of contrast-induced nephropathy needs further study. This review aims to discuss the incidence, pathogenesis, risk prediction, and preventive strategies for contrast-induced nephropathy.


Assuntos
Meios de Contraste/efeitos adversos , Nefropatias/induzido quimicamente , Humanos , Rim/efeitos dos fármacos , Nefropatias/prevenção & controle , Estresse Oxidativo/efeitos dos fármacos
2.
Medicine (Baltimore) ; 99(37): e21386, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925711

RESUMO

Serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) are standard biomarkers of contrast-induced nephropathy (CIN). However, recent studies suggest that serum neutrophil gelatinase-associated lipocalin (sNGAL) and urine neutrophil gelatinase-associated lipocalin (uNGAL) may be better predictors, particularly within 24 hours of contrast medium exposure.We conducted a prospective, observational cohort study of 107 consecutive patients diagnosed with arteriosclerosis obliterans between February 2016 and October 2018. We divided the patients into 2 groups: CIN (n = 22) and non-CIN (n = 85). We assessed the correlation between sNGAL and uNGAL concentrations and standard renal markers at baseline, 6, 24, and 48 hours post-procedure. We constructed conventional receiver operating characteristic (ROC) curves and calculated the area under the curve to assess the performance of SCr, eGFR, sNGAL, and uNGAL. We derived biomarker cutoff levels from ROC analysis to maximize sensitivity and specificity.The incidence of CIN within our cohort was 20.6%. sNGAL levels correlated significantly with SCr and eGFR at baseline, 6, 24, and 48 hours post-contrast medium exposure. Similarly, uNGAL levels correlated with SCr and eGFR at baseline, 24, and 48 hours post-exposure. sNGAL and uNGAL were significantly elevated as early as 6 hours post-catheterization in the CIN group, whereas only minor changes were observed in the non-CIN group. SCr was also significantly elevated in the CIN group, but not until 24 hours post-catheterization.Both sNGAL and uNGAL may be superior to SCr and eGFR as early biomarkers of CIN in patients with peripheral vascular disease undergoing endovascular therapy.


Assuntos
Lesão Renal Aguda/diagnóstico , Meios de Contraste/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Lipocalina-2/análise , Complicações Pós-Operatórias/diagnóstico , Lesão Renal Aguda/induzido quimicamente , Idoso , Área Sob a Curva , Arteriosclerose Obliterante/cirurgia , Biomarcadores/sangue , Biomarcadores/urina , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/induzido quimicamente , Estudos Prospectivos , Curva ROC , Sensibilidade e Especificidade
3.
Radiol Clin North Am ; 58(5): 841-850, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32792118

RESUMO

Moderate and severe contrast reactions are rare but can be life threatening. Appropriate contrast reaction management is necessary for the best patient outcome. This review summarizes the types and incidences of adverse events to contrast media, treatment algorithms, and equipment needed to treat common contrast reactions, the current status of contrast reaction management training, and preventative strategies to help mitigate adverse contrast events.


Assuntos
Meios de Contraste/efeitos adversos , Hipersensibilidade a Drogas/diagnóstico , Extravasamento de Materiais Terapêuticos e Diagnósticos/prevenção & controle , Gadolínio/efeitos adversos , Iodo/efeitos adversos , Radiologia/educação , Humanos , Erros de Medicação/prevenção & controle , Fatores de Risco
4.
PLoS One ; 15(7): e0237092, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32735633

RESUMO

Cerebral computed tomography angiography is a widely available imaging technique that helps in the diagnosis of vascular pathologies. Contrast administration is needed to accurately assess the arteries. On non-contrast computed tomography, arteries are hardly distinguishable from the brain tissue, therefore, radiologists do not consider this imaging modality appropriate for the evaluation of vascular pathologies. There are known contraindications to administering iodinated contrast media, and in these cases, the patient has to undergo another examination to visualize cerebral arteries, such as magnetic resonance angiography. Deep learning for image segmentation has proven to perform well on medical data for a variety of tasks. The aim of this research was to apply deep learning methods to segment cerebral arteries on non-contrast computed tomography scans and consequently, generate angiographies without the need for contrast administration. The dataset for this research included 131 patients who underwent brain non-contrast computed tomography directly followed by computed tomography with contrast administration. Then, the segmentations of arteries were generated and aligned with non-contrast computed tomography scans. A deep learning model based on the U-net architecture was trained to perform the segmentation of blood vessels on non-contrast computed tomography. An evaluation was performed on separate test data, as well as using cross-validation, reaching Dice coefficients of 0.638 and 0.673, respectively. This study proves that deep learning methods can be leveraged to quickly solve problems that are difficult and time-consuming for a human observer, therefore providing physicians with additional information on the patient. To encourage the further development of similar tools, all code used for this research is publicly available.


Assuntos
Encéfalo/diagnóstico por imagem , Angiografia Cerebral/métodos , Meios de Contraste , Aprendizado Profundo/tendências , Angiografia por Tomografia Computadorizada/métodos , Meios de Contraste/efeitos adversos , Meios de Contraste/farmacologia , Feminino , Humanos , Processamento de Imagem Assistida por Computador/métodos , Masculino , Estudos Retrospectivos
5.
Radiología (Madr., Ed. impr.) ; 62(4): 292-297, jul.-ago. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-ET6-358

RESUMO

La European Society of Urogenital Radiology (ESUR) ha actualizado la guía de profilaxis de la lesión renal aguda poscontraste (LRA-PC) yodado en 2018, guía ESUR 10.0. Esta guía reduce drásticamente las indicaciones de la realización de la profilaxis de la LRA-PC yodado, rebajando el dintel de realización de profilaxis a filtrados glomerulares menores de 30 ml/min/1,73m2 y eliminando la mayoría de los considerados factores de riesgo previamente. En los casos en que se considera necesario, las pautas de hidratación indicadas son más cortas que en la guía previa. Esta guía ha sido suscrita por la mayoría de las sociedades radiológicas, pero también ha sido criticada por su excesiva relajación en cuanto a los factores de riesgo, especialmente por la comunidad nefrológica. En este artículo revisamos los cambios que supone esta guía en relación con la anterior y planteamos las críticas a la misma


The European Society of Urogenital Radiology (ESUR) updated its guidelines for prophylaxis against postcontrast acute kidney injury (PC-AKI) in 2018 (ESUR 10.0). These guidelines drastically reduce the indications for prophylaxis against PC-AKI after iodine-based contrast administration, lowering the cutoff for administering prophylaxis to glomerular filtration rates <30ml/min/1.73m2 and eliminating most of the prior risk factors. Moreover, in cases where prophylaxis is considered necessary, the periods of hydration are shorter than in the previous version. These guidelines have been approved by most radiological societies, although they have also been criticized for excessive relaxation regarding risk factors, especially by the nephrological community. In this article, we critically review the changes to the guidelines


Assuntos
Humanos , Insuficiência Renal/diagnóstico por imagem , Guias de Prática Clínica como Assunto , Meios de Contraste/efeitos adversos , Taxa de Filtração Glomerular , Tomografia Computadorizada por Raios X , Fatores de Risco , Meios de Contraste/administração & dosagem
6.
Br J Radiol ; 93(1113): 20200340, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32644824

RESUMO

OBJECTIVES: To investigate if low-keV virtual monoenergetic images (VMI40keV) from abdominal spectral detector CT (SDCT) with reduced intravenous contrast media application (RCM) provide abdominal assessment similar to conventional images with standard contrast media (SCM) dose. METHODS: 78 patients with abdominal SDCT were retrospectively included: 41 patients at risk for adverse reactions who received 44 RCM examinations with 50 ml and 37 patients who underwent 44 SCM examinations with 100 ml of contrast media (CM) and who were matched for effective body diameters. RCM, SCM images and RCM-VMI40keV were reconstructed. Attenuation and signal-to-noise ratio (SNR) of liver, pancreas, kidneys, lymph nodes, psoas muscle, aorta and portal vein were assessed ROIs-based. Contrast-to-noise ratios (CNR) of lymph nodes vs aorta/portal vein were calculated. Two readers evaluated organ/vessel contrast, lymph node delineation, image noise and overall assessability using 4-point Likert scales. RESULTS: RCM were inferior to SCM images in all quantitative/qualitative criteria. RCM-VMI40keV and SCM images showed similar lymph node and muscle attenuation (p = 0.83,0.17), while for all other ROIs, RCM-VMI40keV showed higher attenuation (p ≤ 0.05). SNR was comparable between RCM-VMI40keV and SCM images (p range: 0.23-0.99). CNR of lymph nodes was highest in RCM-VMI40keV (p ≤ 0.05). RCM-VMI40keV received equivalent or higher scores than SCM in all criteria except for organ contrast, overall assessability and image noise, where SCM were superior (p ≤ 0.05). However, RCM-VMI40keV received proper or excellent scores in 88.6/94.2/95.4% of the referring cases. CONCLUSIONS: VMI40keV counteract contrast deterioration in CM reduced abdominal SDCT, facilitating diagnostic assessment. ADVANCES IN KNOWLEDGE: SDCT-derived VMI40keV provide adequate depiction of vessels, organs and lymph nodes even at notable CM reduction.


Assuntos
Abdome/diagnóstico por imagem , Meios de Contraste/administração & dosagem , Tomografia Computadorizada por Raios X , Aorta/diagnóstico por imagem , Meios de Contraste/efeitos adversos , Feminino , Humanos , Injeções Intravenosas , Compostos de Iodo/administração & dosagem , Rim/diagnóstico por imagem , Fígado/diagnóstico por imagem , Linfonodos/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pâncreas/diagnóstico por imagem , Veia Porta/diagnóstico por imagem , Músculos Psoas/diagnóstico por imagem , Estudos Retrospectivos , Razão Sinal-Ruído
7.
Cerebrovasc Dis Extra ; 10(2): 59-65, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32610309

RESUMO

BACKGROUND: Although mechanical thrombectomy is a standard endovascular therapy for patients with acute ischemic stroke (AIS), the incidence of and risk factors for contrast-induced nephropathy (CIN) following mechanical thrombectomy are infrequently reported. OBJECTIVES: The aim of this study was to investigate the incidence and risk factors for CIN following mechanical thrombectomy for AIS, and whether the incidence of CIN is related to a poor prognosis. METHODS: We examined consecutive patients who underwent a mechanical thrombectomy in the period from January 2014 to March 2018. The patients' clinical backgrounds, treatments, and clinical prognoses were analyzed. CIN was defined as an increase in the serum creatinine level of ≥44.2 µmol/L (0.5 mg/dL) or 25% above baseline within 72 h after exposure to the contrast medium. RESULTS: In total, 80 patients (46 men and 34 women aged 74.5 ± 11.5 years) who met our inclusion criteria were analyzed. CIN occurred in 8.8% (7/80) of the patients following mechanical thrombectomy. Although no patients needed permanent dialysis, 1 required temporary dialysis. The median amount of contrast medium was 109 mL. A comparison between the groups with and without CIN showed a significant difference in white blood cell (WBC) count at the time of admission (11.6 ± 2.7 × 103/µL and 8.1 ± 2.7 × 103/µL; p < 0.01) and the cut-off value was 9.70 × 103/µL. In multivariate analysis, contrast volume/estimated glomerular filtration rate by creatinine and WBC count were significantly associated with the incidence of CIN, with odds ratios of 1.64 (95% CI 1.02-2.65; p = 0.04) and 1.61 (95% CI 1.15-2.25; p < 0.01), respectively. CONCLUSIONS: This study found that CIN occurred in 8.8% of patients with AIS following mechanical thrombectomy. High WBC count was associated with an increased risk of CIN and may be helpful for predicting CIN.


Assuntos
Isquemia Encefálica/terapia , Meios de Contraste/efeitos adversos , Nefropatias/induzido quimicamente , Leucócitos , Acidente Vascular Cerebral/terapia , Trombectomia/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Isquemia Encefálica/sangue , Isquemia Encefálica/diagnóstico por imagem , Creatinina/sangue , Feminino , Humanos , Incidência , Nefropatias/sangue , Nefropatias/diagnóstico , Nefropatias/terapia , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Diálise Renal , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/diagnóstico por imagem , Fatores de Tempo , Resultado do Tratamento , Regulação para Cima
8.
PLoS One ; 15(7): e0234921, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32673348

RESUMO

BACKGROUND: Subjects with chronic kidney disease are at increased risk for contrast-induced acute kidney injury (CI-AKI). Risk stratification is traditionally based on glomerular filtration rate (GFR) and proteinuria. The present trial examines, whether tubular and inflammatory biomarkers are able to identify subjects at increased risk as well. METHODS: We performed a prospective study in 490 patients undergoing coronary angiography. An increase of serum creatinine concentration ≥ 0.3 mg/dl from baseline to day 2-3 was defined as primary endpoint (CI-AKI). Urinary neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and calprotectin were assessed < 24h before coronary angiography. Prognostic accuracy was assessed by receiver operating characteristics (ROC) calculations. RESULTS: 30 (6.1%) patients suffered from CI-AKI (27 AKIN stage I, 3 AKIN stage II, 0 AKIN stage III). Those subjects who developed CI-AKI had 3.1 fold higher baseline urinary NGAL/creatinine ratios than those without CI-AKI (60.8 [IQR 18.7-93.1] µg/mg vs. 19.9 [IQR 12.3-38.9] µg/mg, p = 0.001). In those subjects without clinically overt CKD (eGFR > 60 ml/min, urinary albumin creatinine ratio <30 mg/g), the NGAL/creatinine ratio was 2.6 higher in CI-AKI vs. no CI-AKI (47.8 [IQR 11.8-75.3] vs. 18.6 [IQR 11.7-36.3] µg/mg). No significant differences were obtained for KIM-1 and calprotectin (p>0.05 each). ROC analyses revealed an area under the curve (AUC) of 0.68 (95% CI 0.60-0.81) for NGAL/creatinine. An NGAL/creatinine ratio < 56.4 µg/mg has a negative predictive value of 96.5%. CONCLUSIONS: The present study is the largest investigation on the use of urinary biomarkers for CI-AKI risk stratification so far. It shows that NGAL provides prognostic information beyond the glomerular biomarkers eGFR and proteinuria.


Assuntos
Lesão Renal Aguda/etiologia , Lesão Renal Aguda/prevenção & controle , Meios de Contraste/efeitos adversos , Lesão Renal Aguda/induzido quimicamente , Idoso , Área Sob a Curva , Biomarcadores/sangue , Angiografia Coronária/efeitos adversos , Creatinina/sangue , Feminino , Taxa de Filtração Glomerular , Receptor Celular 1 do Vírus da Hepatite A/análise , Humanos , Complexo Antígeno L1 Leucocitário/urina , Lipocalina-2/urina , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Proteinúria , Curva ROC , Insuficiência Renal Crônica/complicações
9.
PLoS One ; 15(5): e0233433, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32437415

RESUMO

OBJECTIVES: To determine the incidence of post-contrast acute kidney injury (PC-AKI) and presumed contrast-induced acute kidney injury (CI-AKI) following contrast-enhanced CT (CECT) with intravenous application of a reduced dose of the iso-osmolar contrast agent iodixanol in cancer patients with chronic kidney disease. METHODS: 198 oncology patients with a baseline estimated glomerular filtration rate (eGFR) <60ml/min/1.73m2 undergoing a total of 237 CECTs using a reduced dose of 60ml iodixanol were retrospectively analyzed. Statistical analysis was performed for the entire cohort and subgroups. The effect of additional risk factors on the occurrence of PC-AKI was evaluated. RESULTS: The overall PC-AKI incidence was 6.3%. Excluding patients with concurrent medical conditions known to directly and independently impact kidney function and patients with AKI preceding the CT-scan resulted in a presumed CI-AKI incidence of 3.8%. No permanent post-contrast worsening of renal function and no AKI treatment were required. Subgroups considering baseline eGFR yielded PC-AKI incidences of 4.6% (eGFR 45-60ml/min/1.73m2, n = 130), 7.4% (eGFR 30-45ml/min/1.73m2, n = 95) and 16.7% (eGFR <30ml/min/1.73m2, n = 12). Additional patient related risk factors did not show any significant effect on the occurrence of PC-AKI. CONCLUSIONS: Low incidences of PC-AKI/CI-AKI suggest that a reduced dose of an iso-osmolar contrast agent is safe in high-risk oncological patients with impaired renal function.


Assuntos
Lesão Renal Aguda/induzido quimicamente , Meios de Contraste/efeitos adversos , Tomografia Computadorizada por Raios X/efeitos adversos , Ácidos Tri-Iodobenzoicos/efeitos adversos , Lesão Renal Aguda/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/diagnóstico por imagem , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/diagnóstico por imagem , Estudos Retrospectivos
12.
Angiology ; 71(9): 799-803, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32462903

RESUMO

The purpose of this study is to investigate the relation between residual SYNTAX score (rSS) and contrast-induced nephropathy (CIN) development in patients with non-ST segment elevation myocardial infarction (NSTEMI) with normal or near-to-normal left ventricular ejection fraction (LVEF) who underwent percutaneous coronary intervention (PCI). A total of 306 patients who underwent PCI with NSTEMI were included in our study. SYNTAX scores were calculated for the periods before and after PCI. Patients were divided into 2 groups as developed CIN following PCI (CIN +) and patients did not (CIN -). Fifty-four (17.6%) of patients who were included in the study developed CIN. Age (P = .001) and rSS (P = .002) were significantly higher and LVEF was lower (P = .034) in the CIN (+) group. Age (P = .031, odds ratio [OR]: 1.031, 95% CI, 1.003-1.059) and rSS (P = .04, OR: 1.036, 95% CI, 1.002-1.071) were independent predictors for CIN. In receiver operating characteristic analyses, when the cutoff value of rSS was taken as 3.5, it determined CIN with 79% sensitivity and 65% specificity. Contrast-induced nephropathy may develop more frequently in patients with increased rSS value. The rSS may be useful to follow-up these patients for CIN development.


Assuntos
Meios de Contraste/efeitos adversos , Nefropatias/induzido quimicamente , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio sem Supradesnível do Segmento ST/terapia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio sem Supradesnível do Segmento ST/fisiopatologia , Razão de Chances , Intervenção Coronária Percutânea , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Volume Sistólico
14.
Radiology ; 295(2): 490-494, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32310732

RESUMO

HistoryA 64-year-old woman with a medical history notable for hypertension, hyperlipidemia, cigarette smoking, type II diabetes mellitus, and end-stage renal disease requiring dialysis presented to the emergency department with tender swelling of her neck, which began 2 days prior to presentation.Four days prior to presentation, her dialysis catheter (Palindrome; Medtronic, Mannsfield, Mass) was partially pulled during dialysis. The next day, she underwent successful percutaneous transluminal balloon angioplasty with an iodinated contrast medium (20 mL Iopamiro; Bracco, Milano, Italy) via the existing right subclavian vein dialysis catheter because of stenosis in the superior vena cava. In addition, exchange of the dialysis catheter via guidewire was performed, without any reported complications. The following day, the patient underwent an uneventful scheduled hemodialysis treatment via the newly exchanged catheter.The patient denied trauma prior to the swelling. She had no known allergies, and prior exposure to iodinated contrast media on two occasions (2 months and 5 years before this presentation) was uneventful.Upon examination, the patient was fully alert and calm without any signs of distress and had bilateral submandibular firm nonpulsatile tender masses, each estimated at 3-4 cm in diameter.Because of a recent major vascular intervention, CT angiography of the neck was urgently performed.


Assuntos
Angioplastia com Balão , Arteriopatias Oclusivas/terapia , Angiografia por Tomografia Computadorizada , Meios de Contraste/efeitos adversos , Iopamidol/efeitos adversos , Glândula Submandibular/efeitos dos fármacos , Glândula Submandibular/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Diálise Renal , Artéria Subclávia
15.
AJR Am J Roentgenol ; 215(1): 15-24, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32348183

RESUMO

OBJECTIVE. The purpose of this study was to determine whether contrast medium volume and method of administration and baseline estimated glomerular filtration rate influence the efficacy of prophylactic hydration for prevention of acute kidney injury after contrast administration. MATERIALS AND METHODS. An online search of PubMed conducted on August 25, 2017, produced a total of 697 studies. After the reports were reviewed, nine were included in this study. The extracted data on all patients in these studies were separated into a group that received prophylactic hydration and a group that did not. The following three parameters were used for subgroup analysis: contrast medium volume, contrast administration method, and baseline estimated glomerular filtration rate. The t test was performed, and study-level odds ratios with 95% CIs and p values were calculated. Tests of heterogeneity were conducted. RESULTS. When the volume of contrast agent administered exceeded 100 mL, hydration was beneficial in the prevention of contrast-induced acute kidney injury (odds ratio, 0.546). If the volume was less than 100 mL, hydration had no efficacy in preventing contrast-induced acute kidney injury (odds ratio, 0.917). Administration route and baseline estimated glomerular filtration rate exerted no effect on the efficacy of prophylactic hydration. CONCLUSION. For patients who receive less than 100 mL of contrast medium, the prevalent practice for contrast-enhanced CT studies, prophylactic hydration may not be necessary, regardless of the estimated glomerular filtration rate or route of contrast administration. For patients undergoing procedures requiring administration of large volumes of contrast medium, however, hydration is recommended to prevent contrast-induced acute kidney injury.


Assuntos
Lesão Renal Aguda/induzido quimicamente , Lesão Renal Aguda/prevenção & controle , Meios de Contraste/administração & dosagem , Meios de Contraste/efeitos adversos , Hidratação/métodos , Taxa de Filtração Glomerular/efeitos dos fármacos , Humanos
16.
PLoS One ; 15(4): e0230781, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32243440

RESUMO

BACKGROUND: Gadolinium-based contrast agent (GBCA)-enhanced magnetic resonance imaging (MRI) scans often must be used repeatedly in pediatric oncologic patients. Although GBCAs are usually well tolerated, severe and life-threatening allergic reactions might occur, which can result in overly cautions adherence to special precautions in patients. PURPOSE: To evaluate the management of the reported GBCA-associated adverse reactions in subsequent contrast-enhanced MRIs in pediatric patients, distinguishing non-allergic and allergic reactions. MATERIALS AND METHODS: In this retrospective, cross-sectional study, consecutive pediatric neurooncological patients who underwent GBCA-enhanced MRI at our university hospital, between 2007 and 2016, were eligible. The patients' history was evaluated with regard to any adverse events after GBCA administration. In a subset of patients with reported adverse reactions, the institutional premedication regime or an allergy work-up in clinical practice were performed, using either skin-prick tests or intravenous provocation tests in a double-blind procedure. RESULTS: Included were 8156 contrast-enhanced MRI scans in 2109 patients. Nineteen acute adverse events (19/8156; 0.23%) in 17 patients (17/2109; 0.81%) were reported. Despite a premedication regime in 14 patients, three patients (3/14; 21.4%) reported a breakthrough reaction. None of the 12 patients who underwent skin-prick tests or intravenous provocation tests showed allergic reactions. At least one well-tolerated GBCA was identified in almost every tested patient. CONCLUSION: A fast-track allergy work-up can help to distinguish non-allergic and allergic reactions and to identify a well-tolerated GBCA, thus avoiding unnecessary premedication for subsequent GBCA administrations.


Assuntos
Meios de Contraste/efeitos adversos , Hipersensibilidade a Drogas/etiologia , Gadolínio/efeitos adversos , Hipersensibilidade Imediata/etiologia , Imagem por Ressonância Magnética/efeitos adversos , Administração Intravenosa/métodos , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Método Duplo-Cego , Feminino , Humanos , Masculino , Pré-Medicação/métodos , Estudos Retrospectivos , Testes Cutâneos/métodos
17.
Int J Cardiovasc Imaging ; 36(6): 983-991, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32285318

RESUMO

The majority of prediction models for contrast-induced nephropathy (CIN) have moderate performance. Therefore, we aimed to develop a better pre-procedural prediction tool for CIN following contemporary percutaneous coronary intervention (PCI) or coronary angiography (CAG). A total of 3469 patients undergoing PCI/CAG between January 2010 and December 2013 were randomly divided into a training (n = 2428, 70%) and validation data-sets (n = 1041, 30%). Random forest full models were developed using 40 pre-procedural variables, of which 13 variables were selected for a reduced CIN model. CIN developed in 78 (3.21%) and 37 of patients (3.54%) in the training and validation datasets, respectively. In the validation dataset, the full and reduced models demonstrated improved discrimination over classic Mehran, ACEF CIN risk scores (AUC 0.842 and 0.825 over 0.762 and 0.701, respectively, all P < 0.05) and common estimated glomerular filtration rate. Compared to that for the Mehran risk score model, the full and reduced models had significantly improved fit based on the net reclassification improvement (all P < 0.001) and integrated discrimination improvement (P = 0.001, 0.028, respectively). Using the above models, 2462 (66.7%), 661, and 346 patients were categorized into low (< 1%), moderate (1% to 7%), and high (> 7%) risk groups, respectively. Our pre-procedural CIN risk prediction algorithm (http://cincalc.com) demonstrated good discriminative ability and was well calibrated when validated. Two-thirds of the patients were at low CIN risk, probably needing less peri-procedural preventive strategy; however, the discriminative ability of CIN risk requires further external validation. TRIAL REGISTRATION: ClinicalTrials.gov NCT01400295.


Assuntos
Lesão Renal Aguda/induzido quimicamente , Algoritmos , Meios de Contraste/efeitos adversos , Angiografia Coronária/efeitos adversos , Técnicas de Apoio para a Decisão , Taxa de Filtração Glomerular/efeitos dos fármacos , Rim/efeitos dos fármacos , Intervenção Coronária Percutânea/efeitos adversos , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Rim/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Medição de Risco , Fatores de Risco
18.
Rev Cardiovasc Med ; 21(1): 9-23, 2020 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-32259900

RESUMO

Contrast-induced acute kidney injury (CI-AKI) is a serious complication that can affect outcome and prognosis of patients undergoing percutaneous diagnostic and interventional procedures in catheterization laboratories. There have been advancements in case definition and epidemiology. Additionally strategies have emerged that are positioned to have impact in the catheterization laboratory for patients undergoing cardiovascular procedures. The aim of this review is to provide the state-of-the-art of diagnosis, prevention and management of CI-AKI in interventional cardiology.


Assuntos
Lesão Renal Aguda/induzido quimicamente , Meios de Contraste/efeitos adversos , Angiografia Coronária/efeitos adversos , Intervenção Coronária Percutânea/efeitos adversos , Radiografia Intervencionista/efeitos adversos , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/terapia , Animais , Meios de Contraste/administração & dosagem , Humanos , Valor Preditivo dos Testes , Prognóstico , Medição de Risco , Fatores de Risco
19.
Rev Cardiovasc Med ; 21(1): 139-145, 2020 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-32259913

RESUMO

Serum creatinine and serum albumin levels were measured prior to surgery, and serum creatinine level was also measured at 72 hours following percutaneous coronary intervention in 819 (January 1st, 2015 and December 31th, 2018). According to whether patients developed contrast-induced acute kidney injury or not, they were assigned to either a contrast-induced acute kidney injury group (72 cases, 8.8%) or a non-contrast-induced acute kidney injury group (747 cases; control). Serum albumin was significantly lower in the contrast-induced acute kidney injury group than control (39.33 ± 5.09 g/l and 42.69 ± 5.19 g/l, respectively, P < 0.001). The results of a receiver-operating curve analysis indicated a serum albumin level of 40.5 g/L was the optimal cut-off value for prediction of contrast-induced acute kidney injury and according to a multivariate logistic regression analysis, serum albumin was an independent biomarker for prediction of (95% confidence interval: 0.836-0.935, odds ratio: 0.884, P < 0.001). Serum albumin, a low-cost and easily assessable laboratory protein, was independently related to a greater risk of contrast-induced acute kidney injury among patients that received percutaneous coronary intervention. It is proposed that under these circumstances SA is a potential biomarker for contrast-induced acute kidney injury.


Assuntos
Lesão Renal Aguda/induzido quimicamente , Meios de Contraste/efeitos adversos , Angiografia Coronária/efeitos adversos , Intervenção Coronária Percutânea/efeitos adversos , Albumina Sérica Humana/metabolismo , Lesão Renal Aguda/sangue , Lesão Renal Aguda/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Meios de Contraste/administração & dosagem , Creatinina/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
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