Role of N-Acetyl Cysteine to prevent nephrotoxicityin Patients with Impaired Renal Functionundergoing angioplasty

ABSTRACT

Contrast-induced nephrotoxicity [CIN],is an important cause of acute renal failure. The incidence of CIN has risen as the number of diagnostic and interventional procedures using contrast media increased in recent years. Only intravenous and intra-arterial administration of contrast media is associated with CIN. Oral contrast agents, such as Gastro grafin, do not cause CIN. CIN is now the third leading cause of new onset acute renal failure in hospitalized patients. Sequelae of CIN may include prolonged hospital stay, need for temporary or permanent dialysis [about 5% of cases], or death. This study was to evaluate the role of N-Acetyl Cysteine [NAS] oral administration in patients with impaired renal function undergoing angioplasty. Forty- eight consecutive patients undergoing to Percutaneous coronary angioplasty [PCI]. 33 patients with impaired renal function Serum createnine level [>1.5mg/dl] .And 15 patients without impaired renal function referred to International Hospital center at Ahmad Helmy Street Cairo one day before PCI. The PCI was done at Cardiovascular-Cath .lab Centre [CCC] Eldoki . Cairo at the period between May 2008 and March 2009. All patients were subjected to the following ,Full history taking ,clinical examinations ,12 lead resting ECG, blood samples for serum Urea, Creatinine and k one day before and 24 hours after PCI ,hepatitis B and C virus ,600 mg orally twice daily for four doses starting on the day prior to the procedure. Bothgroups of patients were hydrated with 0.9% normal saline at 1 ml/ kg/hour for 12 hours prior to and 12 hours following PCI . All patients underwent the same procedure for PCI. RESULTS ;There was highly statistically significant value improvement in renal function [serum creatinine and urea] in both groups before and after PCI .Also highly statistically significant improvement in serum K level in Group I with [P value 0.000] but no significant in Group II with [P value 0.082]. One out of 33patients Group I developed Acute renal failure and need renal dialysis [contrast induced nephropathy].- CONCLUSION; We conclude that prophylactic administration. Of N-Acetyl Cysteine along with hydration diminishes the incidence of deterioration of renal function induced by contrast agents in patients with renal insufficiency during coronary angioplasty procedures