A study of adverse drug reactions to iodinated contrast agents in tertiary care teaching hospital

Background: Contrast agents have long been used for the imaging of anatomic boundaries and to explore normal and abnormal findings in X-ray based imaging technique. These agents are not completely devoid of risk. Adverse effects from administration of contrast media vary from minor physiological disturbance to rare life threatening situation.Methods: A cross-sectional retrospective observational study over one-year duration from 1st August 2015 to 31st July 2016 was conducted at radiology department of a Pandit Deendayal Upadhyay Government Medical College and Teaching hospital, Rajkot, Gujarat. Adverse drug reactions were analyzed to study the nature of reactions caused by iodinated contrast agents. The temporal relationship of time of administration of contrast agents to the occurrence of adverse reaction was analyzed and classified as immediate or delayed type of reaction.Results: Out of 868 patients that were analysed 15 out of 497 male patients and 11 out of 371 female patients developed adverse reaction. Age range of patients that developed reactions was 20-55 years. Most common adverse drug reaction occurred in our study was nausea and vomiting which was treated by parenteral Ondansetron. All the reactions were found to be 憄robable� in causality as per WHO causality assessment scale and Naranjo抯 algorithm.Conclusions: Physicians performing diagnostic or therapeutic procedures with contrast agents must be aware of the risk, preventability & treatment so that reactions can be prevented. Sensitization of physicians is required to increase reporting of adverse drug reactions occurred due to radiocontrast agents.

CHA2DS2-VASc score as a novel predictor for contrast-induced nephropathy after percutaneous coronary intervention in acute coronary syndrome

Background CHA2DS2-VASc score, used for atrial fibrillation to assess the risk of embolic complications, have shown to predict adverse clinical outcomes in acute coronary syndrome (ACS), irrespective of atrial fibrillation. This study envisaged to assess the predictive role of CHA2DS2-VASc score for contrast-induced nephropathy (CIN) in patients with ACS undergoing percutaneous coronary intervention (PCI). Methods A total of 300 consecutive patients with ACS undergoing PCI were enrolled in this study. CHA2DS2-VASc score was calculated for each patient. These patients were divided into two groups as Group 1 (with CIN) and Group 2 (without CIN). CIN was defined as increase in serum creatinine level ≥0.5 mg/dL or ≥25% increase from baseline within 48 h after PCI. After receiver operating characteristic curve analysis, the study population was again classified into two groups: CHA2DS2-VASc score ≤3 group (Group A) and score ≥4 group (Group B). Results CIN was reported in 41 patients (13.6%). Patients with CIN had a higher frequency of hypertension, diabetes mellitus, and had a lower left ventricular ejection fraction and baseline estimated glomerular filtration rate. Receiver operating characteristic curve analysis showed good predictive value of CHA2DS2-VASc score for CIN (area under the curve 0.81, 95% CI 0.73–0.90). Patients with a CHA2DS2-VASc score of ≥4 had a higher frequency of CIN as compared with patients with score ≤3 (56.8% vs 4.8%; p = 0.0001) with multivariate analysis demonstrating CHA2DS2-VASc score of ≥4 to be an independent predictor of CIN. Conclusion In patients with ACS undergoing PCI, CHA2DS2-VASc score can be used as a novel, simple, and a sensitive diagnostic tool for the prediction of CIN

Electronic Consultation Support System for Radiocontrast Media Hypersensitivity Changes Clinicians' Behavior

PURPOSE: Patients with a history of radiocontrast media (RCM) hypersensitivity can be overlooked, resulting in repeated reactions. Therefore, a consultation support system for RCM hypersensitivity has been in operation at Seoul National University Bundang Hospital since December 2011. We analyzed the effect of this system on physicians' practice. METHODS: A retrospective study was conducted on patients with previous RCM reactions (December 1, 2010 to November 30, 2012). The control period was December 2010 to November 2011, and the intervention period was December 2011 to November 2012. The primary outcome was the composite outcome of premedication and consultation. Premedication was defined as preventive medication prescribed by the physician who ordered RCM-enhanced computed tomography (CT) at the same time. The secondary outcome was the recurrence rate after using the consultation support system. RESULTS: A total of 189 clinicians prescribed 913 CT scans during the control period and 225 clinicians performed 1,153 examinations during the intervention period. The odds ratio (OR) of achieving the composite outcome increased significantly after use of the consultation support system (OR, 1.54; 95% confidence interval [CI], 1.15–2.05). Clinicians in both medical (OR, 1.48; 95% CI, 1.06–2.07) and surgical (OR, 2.07; 95% CI, 1.24–3.46) departments showed significant changes in their behavior, whereas those in the emergency department did not (OR, 1.07; 95% CI, 0.41–2.78). Professors (OR, 1.47; 95% CI, 1.06–2.04) and trainees (OR, 1.97, 95% CI, 1.22–3.18) showed significant changes in their behavior toward patients with previous RCM reactions. The behavior of 86 clinicians who ordered CT scans during both the control and intervention periods was unchanged. CONCLUSIONS: The consultation support system for those with previous RCM hypersensitivity reactions changed physicians' practice patterns and decreased recurrent RCM hypersensitivity reactions as well.

Clinical characteristics of adverse reaction to radiocontrast media in children - A single center experience

PURPOSE: Radiocontrast media are widely used in medical imaging to improve diagnostic accuracy. However, studies on the adverse reactions of radiocontrast media in children are limited. We aimed to describe the characteristics of adverse reactions to radiocontrast media among children who had a computed tomography scan or magnetic resonance imaging in a tertiary university hospital. METHODS: We retrospectively collected data on adverse reactions to radiocontrast media by the reporting system of a tertiary university hospital. We selected data from children under the age of 19 from July 2011 to December 2017 and analyzed their characteristics. We focused mainly on the characteristics of the index case which is defined by the first adverse event of each subject. RESULTS: During the period, a total of 88,050 radiocontrast media-enhanced imaging studies were performed and 184 cases of adverse reactions were reported. A total of 71 were identified as index cases. Forty-nine (69.0%) were male and the mean age was 12.7±3.2 years. The incidence of radiocontrast media-related adverse reactions was 0.09% and severe reactions were 0.002%. The most common clinical feature was skin manifestations (54.9%), followed by gastrointestinal symptoms (40.8%) and neuropsychiatric symptoms (7.4%). CONCLUSION: Adverse reactions to radiocontrast media rarely occur in children and the incidence of severe reactions is low. Most reactions are mild and are related to the skin and gastrointestinal system. This report would provide good evidence for establishing a management strategy in children scheduled for imaging studies using radiocontrast media.

Radiocontrast media-induced acute generalized exanthematous pustulosis: A safe administration of alternative radiocontrast media using patch tests

Acute generalized exanthematous pustulosis (AGEP) is rarely caused by radiocontrast media (RCM). The role of skin tests for the diagnosis and evaluation of cross-reactivity in a delayed type of RCM-induced hypersensitivity have yet to be determined. Here, we report a case of iodixanol-induced AGEP where we safely administered alternative RCM using patch tests. A 44-year-old woman had coronary artery angiography (CAG) for the evaluation of ischemic heart disease. She was on regular hemodialysis because of end-stage renal disease. She was given iodixanol (Visipaque) during CAG. Approximately 1 day after CAG, she developed AGEP. The patient was rehospitalized for CAG again after 1 year. We performed skin tests to choose safe alternative RCM. Intradermal tests with iodixanol, iohexol (Bonorex) and Iopamidol (Pamiray) showed negative responses. Patch tests showed a positive response to iodixanol, equivocal to iohexol, and negative to Iopamidol. We finally chose Iopamidol and performed CAG successfully without any adverse reaction. Patch tests may be a useful tool for the diagnosis and choice of safe alternatives in RCM-induced delayed-type hypersensitivity reactions such as AGEP.

Ultrassonografia modo B e Doppler na avaliação renal de cães submetidos à tomografia computadorizada após administração intravenosa de diferentes meios de contraste iodado / B-mode and Doppler ultrasonography in the renal evaluation of dogs undergoing computed tomography after intravenous administration of different iodinated contrast media

A nefropatia induzida por contraste (NIC) é uma doença de caráter agudo, secundária à administração intravascular de meios de contraste iodado (MCI). Dentre os mecanismos fisiopatológicos desta enfermidade destacam-se a vasoconstrição intrarrenal prolongada, consequente redução da perfusão renal, hipóxia e isquemia medulares, associada ao dano tubular renal devido à citotoxicidade do contraste. Frente à existência de poucas informações relacionadas a estes mecanismos na literatura médico-veterinária, objetivaram-se comparar os efeitos renais da administração intravenosa de MCI não iônicos de diferentes osmolaridades, em grupos de cães com fatores de risco para o desenvolvimento da NIC, por meio das avaliações ultrassonográficas modo B, Doppler colorido, de amplitude e pulsado, pareada aos exames laboratoriais, a fim de estimar indiretamente o potencial nefrotóxico de cada contraste. Constituíram-se dois grupos de acordo com o MCI utilizado: o grupo GIH [11 cães receberam iohexol (baixa osmolaridade)] e o grupo GID [sete cães receberam iodixanol (isosmolar)]. Administrou-se a dose de 600mgI/kg/IV em ambos. Avaliaram-se os seguintes aspectos renais antes da administração do MCI (momento basal) e após 1h30min, 24 horas e 48 horas: morfometria (comprimento e volume), morfologia, ecogenicidade cortical e perfusão renais e resistência vascular intrarrenal (índices hemodinâmicos de resistividade e pulsatilidade). Realizou-se ainda exame de urina e se mensuraram as razões gama-glutamil transferase:creatinina (GGT:C) e proteína:creatinina (RPC) urinárias e a concentração sérica de creatinina. Os grupos apresentaram comportamentos similares para comprimento, volume, RPC, exame de urina e creatinina sérica. Em relação ao índice de pulsatilidade (IP), os grupos apresentaram comportamentos não similares, mas sem diferenças significantes entre o momento basal e os demais. Para o índice de resistividade (IR) e a razão GGT:C urinária, os grupos revelaram comportamentos não similares e se constataram aumentos significantes do IR e da razão GGT:C urinária no período de 1h30min após a administração do contraste, somente para o grupo que recebeu iohexol. Concluiu-se que o IR pode ser utilizado para monitorar a hemodinâmica intrarrenal, visto que junto com a razão GGT:C urinária, demonstrou a existência de maior potencial nefrotóxico do iohexol, quando comparado ao iodixanol. Dessa forma, considera-se o uso do iodixanol, opção favorável para cães com fatores de risco para o desenvolvimento da NIC.(AU)

Contrast-induced nephropathy (CIN) is an acute disease, secondary to intravascular administration of iodinated contrast media (ICM). The most important mechanisms of this nephropathy are intrarenal prolonged vasoconstriction, medular hypoxia, and ischemia associated with renal tubular damage due to contrast cytotoxicity. Owing to the limited information available in veterinary literature regarding these mechanisms this study aims to compare the renal effects of intravenous administration of two nonionic ICM of different osmolarities in groups of dogs with risk factors for CIN development, by using a B-mode, color, power- and pulsed-wave Doppler ultrasonography, and other laboratory tests, in order to indirectly estimate the nephrotoxic potential of each contrast. The following two groups were established according to the nonionic ICM used: the GIH group [11 dogs administered iohexol (low osmolarity)] and the GID group [seven dogs administered iodixanol (iso-osmolarity)]. Both the groups were administered the same dose (600mgI/kg/IV). The following renal aspects were evaluated before administration of ICM (baseline) and after 1h30min, 24h, and 48h: renal morphometry (length and volume), renal morphology, cortical echogenicity, renal perfusion, and intrarenal vascular resistance (resistive and pulsatility indices); in addition, urinalysis was performed, and urinary gamma-glutamyl transferase:creatinine ratio (GGT:C), urinary protein:creatinine ratio (UPC), and serum creatinine were also measured. Both groups showed similar characteristics with respect to the length, volume, UPC ratio, urinalysis, and serum creatinine levels. No similarity was observed with respect to the pulsatility index (PI) in both the groups and there were no significant differences between baseline and 1h30min, 24h and 48h time points. With respect to the IR and urinary GGT:C, both groups showed no similarity, and significant increases were observed in the resistive index (RI) and urinary GGT:C only in the GIH group, 1h30min after contrast administration. In conclusion, RI can be used to monitor intrarenal hemodynamics, and along with the urinary GGT:C, revealed that iohexol had higher nephrotoxic potential than iodixanol. Thus, iodixanol is considered a favorable option for dogs with risk factors for CIN development.(AU)

The efficacy of single premedication with antihistamines for radiocontrast media hypersensitivity

BACKGROUND: Single premedication with antihistamines for radiocontrast media (RCM) hypersensitivity is frequently used in real world at the emergent situation although its efficacy is not proven. OBJECTIVE: To evaluate the effect of intravenous antihistamines as a premedication in general population who had experience of mild adverse reactions to iodinated RCM. METHODS: A retrospective observational study on 14,785 subjects who had RCM-enhanced computed tomography scans between January 2014 and December 2015 in Seoul National University Hospital Gangnam Healthcare Center, Seoul, South Korea. RESULTS: Among 453 subjects who had a history of mild RCM-induced hypersensitivity reactions, 273 subjects had a single premedication of intravenous antihistamine. When comparing antihistamine-premedication group and nonpremedication group, there is no protective effect of antihistamines on the incidence rate and severity of hypersensitivity (10.6% vs. 11.7%, p = 0.729). CONCLUSION: The clinical efficacy of a single premedication of antihistamines for mild RCM-induced hypersensitivity was not confirmed.

Ultrassonografia modo B e Doppler na avaliação renal de cães após administração intravenosa de meio de contraste iodado: validação da técnica / B-mode and Doppler ultrasonography in the renal evaluation of dogs after intravenous administration of iodinated contrast media: technical validation

Meios de contraste iodado podem promover efeitos hemodinâmicos relacionados à vasoconstrição intrarrenal prolongada e redução da perfusão, predispondo à hipóxia e isquemia medular. Alterações de resistência vascular renal podem representar os primeiros sinais de mudança funcional desse órgão. A técnica Doppler pulsado é considerada acessível, não invasiva e permite avaliar a dinâmica vascular dos rins, por meio da aferição dos índices de resistividade (IR) e pulsatilidade (IP). Contudo, na espécie canina, a aquisição de traçados espectrais pode ser penosa devido às dificuldades de varredura e captação de sinal Doppler, sobretudo em relação ao rim direito, devido à sua localização dorsocranial na cavidade abdominal, o que prolonga substancialmente a realização do exame. O objetivo deste estudo é comprovar que a avaliação Doppler pulsado das artérias intrarrenais do rim esquerdo de cães representa a repercussão hemodinâmica renal da administração intravenosa de meios de contraste iodado não sendo necessária a realização do exame nos dois rins. Foram avaliados ambos os rins de seis cadelas adultas em quatro momentos distintos: antes da infusão intravenosa do contraste radiológico e após 1,5 horas, 24 horas e 48 horas, por meio da análise subjetiva da morfologia, ecogenicidade cortical e grau de perfusão renais e análise objetiva do comprimento, volume e resistência vascular intrarrenais (IR e IP). Os parâmetros avaliados ao modo B e Doppler dos rins direito e esquerdo não apresentaram diferenças estatisticamente significativas entre si em cada momento avaliado. Assim, constatou-se que o exame ultrassonográfico Doppler pulsado do rim esquerdo representou a repercussão hemodinâmica renal da aplicação intravenosa de meios de contraste iodado, desde que morfometria, morfologia, ecogenicidade cortical e perfusão de ambos os rins fossem consideradas semelhantes na abordagem ultrassonográfica inicial...

Iodinated contrast media can provide hemodynamic effects related to prolonged intrarenal vasoconstriction and reduced perfusion, predisposing to hypoxia and medular ischemia. Changes in the renal vascular resistance may represent the first sign of impaired renal function. Pulsed wave Doppler sonography is low cost, non-invasive and allows renal hemodynamic evaluation by resistivity (RI) and pulsatility (PI) indices. However in dogs, spectral Doppler waveform may be hard to obtain due to scanning difficulties and lack of signal Doppler. This fact occurs mostly in the right kidney because of its cranial and dorsal position in the abdominal cavity and may prolong the exam. The purpose of this study is to prove that the pulsed wave Doppler interrogation of the canine left kidney intrarenal arteries represent the renal hemodynamic effects of intravenous administration of iodinated contrast media and is not necessary to perform the exam in both kidneys. Right and left kidneys of six adult dogs were evaluated at four different times: before intravenous contrast infusion and after 1.5 hours, 24 hours and 48 hours, subjectively by using renal morphology, cortical echogenicity and renal perfusion, and objectively by using renal length, renal volume and intrarenal vascular resistance (RI and PI). No significant differences were noted between the parameters assessed by B mode and Doppler sonography of the right and left kidney in each evaluated moment. Thus, it was noted that pulsed wave Doppler sonographic evaluation of the left kidney represented the renal hemodynamic response of intravenous iodinated contrast media administration, only if both kidneys presented similar morphometry, morphology, cortical echogenicity, and perfusion during the first assessment...

Intraductal Ultrasonography without Radiocontrast Cholangiogram in Patients with Extrahepatic Biliary Disease

BACKGROUND/AIMS: Intraductal ultrasonography (IDUS) has been performed as an adjunct to endoscopic retrograde cholangiography (ERC) during radiocontrast cholangiography (RC). Radiation exposure during RC poses a health risk to both patients and examiners. We evaluated the feasibility of IDUS without RC in various extrahepatic biliary diseases. METHODS: IDUS was performed with the insertion of an IDUS probe from the papilla of Vater to the confluent portion of the common hepatic duct without fluoroscopy. The technical success rate and procedure-related complications were evaluated retrospectively. RESULTS: Wire-guided IDUS without RC was performed in 105 patients. The mean age was 66.5 years, and 50 (47.6%) were male. The IDUS diagnoses included choledocholithiasis (73, 69.5%), benign biliary stricture (11, 10.5%), choledocholithiasis with biliary pancreatitis (9, 8.6%), bile duct cancer (5, 4.8%), pancreatic cancer (1, 0.9%), and others (6, 5.7%). After IDUS, 66 (62.8%) underwent stone removal, 19 (18.1%) underwent biliary drainage, and 7 (6.6%) underwent brush cytology and biopsy. No significant complications such as perforation or severe pancreatitis occurred. CONCLUSIONS: IDUS without RC was a feasible and safe approach in patients with various extrahepatic biliary diseases. We anticipate a potentially important role of IDUS in various ERC procedures because it lacks the hazards of RC.

A study of adverse drug reactions to radio contrast media in a tertiary care teaching rural hospital.

Background: Most common ADRs associated with radiocontrast media are rash, fever, nausea, vomiting and shivering. Rarely life threatening anaphylaxis and acute hypersensitivity reaction may also occur. Very few studies are carried out in India focusing on this aspect. Aims & Objective: To study and report the Adverse Drug Reactions (ADR) caused by radio contrast media in a tertiary care teaching rural hospital. Material and Methods: Two hundred and fifty seven patients from Radiology department were observed for occurrence of adverse drug events (ADEs) from 01 Jul 2012 to 31 Jul 2012. ADEs were either spontaneously reported or elucidated from personal interviews were analysed. Results: Total 8 (3.11%) out of 257 patients who had undergone for ionic radio contrast dye investigation had a single event of ADR. Total occurrence rate of ADR is 3.11%. Most common ADR was rash followed by shivering, nausea, vomiting and fever with use of ionic contrast media. All Adverse Drug Reactions, according to WHO-UMC and Naranjo’s scale were of “probable” category. All the ADRs were at level-3 according to Modified Hartwig and Siegel severity scale. All the ADRs according to Modified Schumock and Thornton criteria for Preventability of an ADR are of “not preventable” category. All the ADRs were of “Bizarre” type. All the patients were treated with antihistaminic and steroids. Conclusion: It is recommended to use non-ionic contrast media instead of ionic media by all the health care professionals. Treatment with steroids and antihistaminic in patients who develop ADRs due to radiocontrast media can be effective.

Management of adverse reaction to iodinated radiocontrast media

Application of iodinated radiographic contrast media (RCM) has increased recently because of the number of computed tomography examinations using RCM is increasing rapidly. The awareness regarding potential adverse reactions due to contrast media and the necessary precautions to be taken is of utmost importance both for radiologists and referring physicians since the adverse reactions including hypersensitivity reactions to RCM are still unpredictable and reported in significantly increasing number among exposed patients year by year. In 2011, Korean guideline for the safe use of RCM was published by the Korean Society of Radiology and Korean Academy of Asthma, Allergy and Clinical Immunology. On behalf of these organizations a committee named Korean Network of Allergists & Radiologists for Research of Radio-contrast Media-associated Adverse Reactions (KOAR3A) was formed and collaborated to develop guidelines. Its major purpose is to provide a clinically practical and evidence-based manual full of useful information regarding patient screening, premedication, recognition of adverse reactions, and emergency treatment of such reactions in daily practice as well as other problems, especially kidney toxicity and endocrine problems in consultation with the corresponding medical specialists.

Is Oral N-acetylcysteine Effective on the Prevention of Radiocontrast induced Nephropathy in Patients with Acute Renal Failure?

PURPOSE: N-acetylcysteine (NAC) has been known to have protective effects on the prevention of radiocontrast induced nephropathy (RCIN) in chronic renal failure (CRF). We investigated the effects of NAC in acute renal failure (ARF). METHODS: From January to June 2006, we retrospectively enrolled patients with ARF who were checked with contrast computed tomography (CT) at an emergency department. We divided patients into the NAC group and the control group. We compared baseline demographic characteristics, underlying diseases, infused fluid volume, blood urea nitrogen (BUN), and serum creatinine (Cr) level before and after CT scan. ARF was defined as serum Cr>1.5. mg/dL. RCIN was defined as an increase in serum Cr level of at least 0.5 mg/dL or 25% 48 hours after CT. RESULTS: Of a total 106 cases, 23 patients were the NAC group and 83 were the control group. There were no significant differences in baseline findings including underlying disease, cause of ARF and serum Cr level. The volume of infused fluid before and after CT were not different between the two groups (before; p=0.183 after; p=0.149). After CT scan, BUN and serum Cr level were decreased without statistical significance in both groups (NAC vs control group: BUN; 21.0+/-12.9 vs 20.5+/-14.2 p=0.863 Cr; 1.3+/-0.5 vs 1.4+/-0.5 p=0.451). RCIN developed in total 3 cases, 2 cases in the NAC group and 1 in the control group (p=0.524) and one of the NAC group performed hemodialysis. CONCLUSION: In case of patients with ARF, there was no protective effect of NAC on RCIN.

The role of N-acetylcysteine in radiocontrast nephropathy / 대한내과학회지

Radiocontrast nephropathy (RCN) is one of the most common etiologies of hospital-acquired acute kidney injury (AKI), accounting for more than 10% of cases. Although most patients who develop RCN have mild and transient decrement in renal function and do not require renal replacement therapy, RCN is associated with significant prolongation of hospitalization and increased morbidity and mortality. Volume expansion with isotonic saline or isotonic sodium bicarbonate before and after radiocontrast administration has been shown to decrease the risk of RCN in high-risk patients. The infusion of isotonic saline or sodium bicarbonate has significant clinical limits, requiring the need for overnight hospitalization and causing volume overload in patients with renal dysfunction. On the contrary, N-acetylcysteine (NAC) is inexpensive, convenient and free of significant complications. It is therefore reasonable to employ this agent, albeit with recognition that its benefit may be limited in published trials. In this issue of the Journal, Seo and Kim compare the efficacy of oral NAC alone with half saline hydration for preventing radiocontrast nephropathy in patients with renal dysfunction. They found that there was no significant difference in the incidence of RCN in the two groups. In addition, although there was no statistical difference between both groups, they stressed the role of nitric oxide (NO) in the prevention of RCN. Consequently, they conclude that oral NAC alone may be effective to prevent RCN in patients with the risk of volume overload after bolus hydration. However, this is a single-center study and requires validation across additional clinical settings including the group of more rapid infusion rate than 12 h pre- and postprocedure used in this study. Therefore, additional large, multicenter, randomized, controlled trials will be required to define the true role of NAC in preventing RCN.

Apoptotic Effect of Radiocontrast Media on Human Umbilical Vein Endothelial Cells

The damage of vascular endothelial cells leads to the progression of vascular disease. Apoptotic damage of endothelial cells is an important mechanism in vascular disease. Recently, it has been reported that radiocontrast can induce vascular endothelial cell injury. The present study used terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) and FACScan analysis to examine whether radiocontrast agenst, such as iopromide, sodium-meglumine-ioxithalamate or gadopentetate dimeglumine, induce apoptotic injury in human umbilical vein endothelial cells. In the study, iopromide, sodium-meglumine-ioxithalamate and gadopentetate dimeglumine brought about human umbilical vein endothelial cell death in phase-contrast microscopic findings. According to TUNEL and FACScan analysis, iopromide and sodium-meglumine- ioxithalamate induced apoptosis in vascular endothelial cells in a dose-dependent. The apoptotic effect of sodium-meglumine-ioxithalamate was shown to be greater than that of iopromide. Gadopentetate dimeglumine also induced apoptosis in human umbilical vein endothelial cells as observed by TUNEL and FACScan analysis. These results suggest that iopromide, which is a non-ionic radiocontrast agent, proved to be less apoptotic than sodium-meglumine-ioxithalamate. Gadopentetate dimeglumine, which is used MRI, has an apoptotic effect in vascular endothelial cells. Thus, apoptosis of endothelial cells by radiocontrast agents might induce deleterious effects on vascular endothelial integrity.

Bilateral Renal Artery Stenosis with Renal Insufficiency: Successful Angioplasty Using Gadopentetate Dimeglumine as a Contrast Agent / 대한신장학회잡지

With the increasing number of interventional angiographic procedures, iodinated contrast induced nephropathy has become an important cause of iatrogenic acute renal failure. Gadopentetate dimeglumine, gadolinium chelated by DTPA, are widely used in magnetic resonance imaging without adverse effect on renal function in patients with renal insufficiency. It also has sufficient radiographic density to allow visualization and has been described as an alternative contrast agent for angiography. Here we report a case of successful angioplasty using gadopentetate dimeglumine as a contrast agent in a patient with both renal artery stenosis and renal insufficiency. The patient had a history of iodinated contrast induced acute renal failure. Using this contrast agent, angioplasty was successfully performed and contrast induced acute renal failure did not occur after this procedure.

A report about the cusing factors in contrast nephropathy / 中国实用内科杂志

Objective To explore the causing factors of radiocontrast-induced nephropathy (RCIN) after coronary angiography and the rule of hydratation.Methods 279 cases of coronary angiography were retrospectively analyzed,and the clinical features,basic renal function and volume of intra-venous fluid received on operation day between the patients with and without RCIN were compared.Results The total mortality rates of radiocontrast-induced nephropathy were 6.81%(19/279);in patients with hypertension,the RCIN rates were 8.65%(16/185);in patients with diabetic,the RCIN rates were 12.1%(12/99);in patients with preexisting renal dysfunction,the RCIN rate was 0%(0/16);the multifactor Logistic analysis showed that the factors causing RCIN were age,diabetic,the volume of intra-venous fluid,however,the factors such as gender,smoking,hypertension,coronary heart disease,chronic renal failure were irrelative with RCIN.Conclusion The incidence of RCIN in people over 60 years old is much higher.Such condition may be partly cansed by the decreasing renal reserve capacity.Sufficient hydration is an effective way to decrease RCIN.

A case of anaphylactoid reaction to nonionic radiocontrast media iopromide (Ultravist) / 천식및알레르기

Because the risk of adverse reactions is lower with nonionic radiocontrast media than with conventional ionic agent, it is recommended that high-risk patients receive lower osmolality, a nonionic radiocontrast for their examination. However, the occurrence of a severe, life-threatening anaphylactoid reaction to even a small dose of nonionic radiocontrast has been reported. We report the first case in Korea of near-fatal anaphylactoid reaction to a nonionic contrast media. A 21-year-old lady with an abdominal mass due to benign mucinous cystadenoma received an injection of iopromide (Ultravist ) for abdominal computerized tomogram. Two minutes after the injection, perioral swelling and erythema, vomiting, seizure, and cardiopulmonary arrests developed. Immediate cardiopulmonary resuscitation and administrations of antihistamine, steroid, and sympathomimetics were performed with successful recovery. She had a history of allergic rhinitis and showed mild airway hyperresponsiveness on histamine bronchoprovocation test. Since a pretreatment with corticosteroid & antihistamine regimen in addition to use of nonionic agent helped to reduce the further occurrence of anaphylactoid reactions in previous contrast reactors, this near-fatal anaphylactoid reaction in an atopic individual suggests that a use of pretreatment plus nonionic agent is desirable in all patients with atopy or asthma.

A Study of Radiocontrast Media Induced Nephrotoxicity

PURPOSE: This study was aimed at determining whether tri-iodinated compounds with greater solubility and low osmolality, Na or meglumine ioxaglate(Hexabrix 320, Guerbet Lab., France) had deleterious effects on renal function after cardiac angiography for the evaluation of congenital heart disease(CHD) and determining whether correction of dehydration using iv hydration given before cardiac angiography were effective in prventing renal dysfunction. METHODS: For the study of radiocontrast media induced nephrotoxicity, 21 children with various CHDs admitted to the hospital for the evaluation of their CHDs. None of them had any evidence of renal dysfunction before study. They were devided into 2 groups, one was low-dose group(ioxaglate given, < 2.0 mL/kg) and the other one was high-dose group(>2.0 mL/kg). Renal function studies including serum creatinine(Scr), fractional excretion of sodium(FENa) and urinary beta2-microglobulin excreton(mg of beta2- microglobulin per gm creatinine) were done before and after ioxaglate administration. For the study of hydration effect on radiocontrast media induced nephrotoxicity, 9 children with CHDs were subjected. Thery were hydated with 5% D/S 1 hr before cardiac angiography using high-dose ioxaglate(> 2.0 mL/kg) and maintained on fluid therapy during the examination. Renal function studies were done before and after ioxaglate administration. Statistical analyses were done using Wilcoxon signed rank test. RESULTS: 1) Scr level and FENa were not increased significantly after administration of ioxaglate in both of low-dose and high-dose group. 2) A significant increase of urinary beta2M per creatinine excretion(mg/gm creatinine) was observed after administration of ioxaglate n the high-dose group(0.24 vs 0.57, p0.05) 3) Hydration before ioxaglate administration made urinary B2M per creatinine excretion insignificant even in patients who received high-dose ioxaglate, more than 3.0 ml/kg(0.22 vs 0.27, p>0.55). 4) Uric acid and/or calcium oxalate crystaluria appeared after ioxaglate administration, particularly in patients with dehydration. CONCLUSIONS: Ioxaglate, a low osmolality ionic dimer contrast media, could induce renal tubular dysfunction, which depended on dose used. Correction of dehydration before ioxaglate administration significantly reduced the risk of ioxaglate induced nephrotoxicity.