LOGO
PL

Contrast-induced acute kidney injury in children with cardiovascular defects – results of a pilot study

Daria Tomczyk1, Anna Jander1, Sławomir Chrul1, Tomasz Moszura2, Paweł Dryżek2, Wojciech Krajewski3, Ewa Głowacka4, Marcin Tkaczyk1,5

Affiliation and address for correspondence
Pediatr Med Rodz 2016, 12 (4), p. 436–444
DOI: Pediatr Med Rodz 2016, 12 (4), p. 436–444
PlumX metrics:
Abstract

Introduction: Contrast-induced nephropathy – acute kidney injury is an acquired kidney injury that is an important factor in short- and long-term cardiovascular complications. Contrast-induced nephropathy – acute kidney injury continues to be diagnosed based on serum creatinine level. Serum creatinine, however, is a delayed indicator of contrast-induced nephropathy, as its levels typically peak between 1 and 3 days following contrast exposure. Currently, more sensitive biomarkers of kidney injury are sought, with human neutrophil lipocalin (also known as neutrophil gelatinase-associated lipocalin) highlighted in literature as a troponin-like biomarker of early nephropathy. Aim of the study: Changes in serum and urine neutrophil gelatinase-associated lipocalin levels were assessed in children with congenital heart diseases, following a scheduled cardiac catheterization procedure. Material and methods: The group studied comprised 16 patients. The neutrophil gelatinaseassociated lipocalin and creatinine levels, along with urine and serum neutrophil gelatinase-associated lipocalin/creatinine ratio were evaluated five times at different time intervals from the procedure. The group did not vary in respect of kidney function, preprocedure management, and volume expansion (hydration therapy) prior to the procedure. Results: In the assessed material, median neutrophil gelatinase-associated lipocalin rose as early as 2 hours after exposure to contrast as compared with baseline [median = 28.2 ng/mL (Quartile 1 = 22.8 – Quartile 3 = 33.77) vs. median = 25.87 ng/mL (Quartile 1 = 19.4 – Quartile 3 = 29.6)]. Serum neutrophil gelatinase-associated lipocalin level peaked in hour 6 of our study: median – 30.6 ng/mL (Quartile 1 = 22.32 – Quartile 3 = 42.17), then reverting to normal. Urine neutrophil gelatinaseassociated lipocalin peaked in hour 24 of the study, subsequently dropping below baseline in hour 48. Glomerular filtration was slightly impaired between hour 2 and 6, and later improvement of estimated glomerular filtration rate was noted. Conclusions: The analysis of the obtained results indicates the usefulness of measuring neutrophil gelatinase-associated lipocalin level for the diagnosis of early contrast-induced nephropathy – acute kidney injury in paediatric patients. Contrastinduced nephropathy – acute kidney injury biomarkers in such clinical circumstances elevate as early as 2 hours after intravenous administration of contrast agents.

Keywords
contrast-induced nephropathy – acute kidney injury, congenital heart defects, angiography, neutrophil gelatinase-associated lipocalin

Oświadczam, że posiadam prawo wykonywania zawodu lekarza i jestem uprawniony do otrzymywania specjalistycznych informacji medycznych. Chcę zapoznać się z informacją z serwisu.