ABSTRACT
BACKGROUND: The aim of the present study was to assess the influence of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) use on the incidence of contrast-induced nephropathy (CIN) in patients undergoing coronary angiography. METHODS: A retrospective case control study was conducted on a total of 201 patients divided into 2 groups (CIN group and control group). CIN was defined as an increase in serum creatinine by more than 25% from baseline within 48 hours of radiocontrast exposure. The CIN group had 96 patients, and the control group had 105 patients. The 2 groups were matched for variables such as age, sex, weight, baseline serum creatinine, diabetes, dye load, use of diuretics, statins and preprocedure prophylactic measures for CIN. RESULTS: The incidence of CIN was found to be 4.55%. The CIN group had 96 patients out of which 56 patients (58.3%) were on chronic ACEI or ARB, while the control group had 105 patients, but only 36 of patients (34.3%) were on ACEI or ARB (p<0.001).The odds ratio for development of CIN with respect to ACEI or ARB use was 2.68 (95% confidence interval, 1.51-4.76). CONCLUSION: Use of ACEI or ARB is an independent risk factor for developing CIN. It is reasonable to discontinue their use 48 hours prior to exposure to radiocontrast agents, especially in patients with multiple risk factors.
Subject(s)
Angiotensin II Type 1 Receptor Blockers/adverse effects , Angiotensin-Converting Enzyme Inhibitors/adverse effects , Contrast Media/adverse effects , Coronary Angiography/adverse effects , Kidney Diseases/chemically induced , Aged , Aged, 80 and over , Biomarkers/blood , Creatinine/blood , Female , Humans , Incidence , Kidney Diseases/blood , Kidney Diseases/diagnosis , Kidney Diseases/epidemiology , Male , Middle Aged , Odds Ratio , Pennsylvania/epidemiology , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Up-RegulationABSTRACT
INTRODUCTION: Venous thromboembolism (VTE) is a well-known complication of nephrotic syndrome (NS). Proteinuria, a marker of chronic kidney disease, discovered at the time of VTE, may be the first presentation in patients with occult chronic kidney disease and/or NS. METHODS: Electronic medical records at a community teaching hospital were retrospectively reviewed to measure the percentage of patients with acute VTE who had a urinalysis (UA) and/or an evaluation of 24-hour urine protein collection or urine protein to creatinine ratio. Thromboembolic events were defined as acute deep vein thrombosis and/or pulmonary embolism. NS was defined as ≥3.5 g proteinuria in 24 hours or by urine protein to creatinine ratio exceeding 3.5. RESULTS: UA was done in 198 patients (63%) on the same admission for VTE and in 83 patients (26%) at a later date. Proteinuria, on routine UA, was identified in 154 (54%) patients. However, only 29 of 154 patients (19%) with proteinuria on UA had a formal evaluation of urine protein excretion, either by 24-hour collection or by spot protein to creatinine ratio. Eight of these 29 patients (28%) had NS. CONCLUSIONS: Patients suffering from VTE may have proteinuria if not frank NS. The UA should be part of the routine evaluation of a patient with VTE given the unexpectedly high prevalence of proteinuria and even NS in this cohort.
Subject(s)
Nephrotic Syndrome/epidemiology , Proteinuria/epidemiology , Venous Thromboembolism/diagnosis , Aged , Aged, 80 and over , Cohort Studies , Creatinine/urine , Female , Humans , Male , Middle Aged , Nephrotic Syndrome/physiopathology , Nephrotic Syndrome/urine , Pennsylvania/epidemiology , Prevalence , Proteinuria/physiopathology , Proteinuria/urine , Pulmonary Embolism/diagnosis , Pulmonary Embolism/epidemiology , Pulmonary Embolism/physiopathology , Retrospective Studies , Risk Factors , Tomography, X-Ray Computed , Ultrasonography, Doppler , Venous Thromboembolism/epidemiology , Venous Thromboembolism/physiopathology , Venous Thrombosis/diagnosis , Venous Thrombosis/epidemiology , Venous Thrombosis/physiopathology , Ventilation-Perfusion RatioSubject(s)
Graft Rejection/epidemiology , Kidney Diseases/surgery , Kidney Transplantation/statistics & numerical data , Adolescent , Adult , Age Factors , Aged , Female , Follow-Up Studies , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors , Treatment Outcome , United States/epidemiology , Young AdultABSTRACT
Patients with coronary artery disease (CAD) commonly have varying degrees of coexisting cerebrovascular disease (CVD) and chronic kidney disease (CKD), and proper management is complicated partly because of a lack of unifying guidelines. The aim of this article is to review the current literature and propose the optimal treatment regimen in patients with all three disease states. Angiotensin-converting enzyme inhibitors (ACE-I) should be universally administered. High-dose statin therapy to reach a target low-density lipoprotein (LDL) of 70-100 mg/dL is advocated, although patients with a history of cerebral bleeding must be carefully monitored for possible recurrence. Beta-blockers are appropriate after a recent coronary event, and amlodipine or thiazide diuretics should be used after a recent stroke (within 6 months). Patients with a history of stroke (with or without coexisting CAD and CKD) should receive aspirin (75-150 mg/day) indefinitely. Clopidogrel or aspirin plus extended-release dipyridamole (ER-DP) may be prescribed in patients allergic or resistant to aspirin. If stroke is attributable to cardiogenic embolism, anticoagulation is indicated. In patients with acute coronary syndromes (ACS) (excluding ST-elevated myocardial infarct) who undergo percutaneous coronary intervention (PCI), aspirin plus clopidogrel is indicated for secondary prevention for up to 12 months. There are no data supporting the use of aspirin plus clopidogrel in patients with CKD who develop ACS. Aspirin plus clopidogrel is contraindicated for stroke prevention.
