Aleks DEĞİRMENCİOĞLU, Gültekin KARAKUŞ, Ertuğrul ZENCİRCİ, Ahmet AKYOL

KONTRAST NEFROPATİSİ CİDDİ BÖBREK YETERSİZLİĞİ OLAN BİR HASTADA BİLE DİKKATLİ BİR YAKLAŞIM İLE AŞILABİLİR

Kontrast nefropatisi perkütan koroner girişim PKG sırasında meydana gelebilecek en önemli komplikasyonlardan biri olup özellikle yüksek kreatinin seviyeleri varlığında dializ gereksinimine yol açabilir. Burada medikal tedaviye dirençli angina pektoris yakınması olan ve çok yüksek kreatinin seviyesi 6.3 mg/dl olan bir hastaya koroner anjiografi ve sonrasında sol ön inen artere başarılı PKG yapılan bir hasta sunulmaktadır. Bu vaka koroner arter hastalığı olan bir hastada, ciddi renal yetersizlik varlığında dahi önleyici tedbirler ve yakın takip ile invaziv yaklaşımın potansiyel rolünü ortaya koymaktadır

Contrast Induced Nephropathy Can Be Surpassed With Meticulous Attention Even In Patients With Severe Renal Dysfunction

Contrast induced nephropathy CIN is one of the most important complications of the percutaneous coronary intervention PCI and may lead to dialysis especially in the presence of baseline high creatinine level. Here we describe coronary angiography and subsequent successful PCI of proximal left anterior descending LAD artery lesion without developing CIN in patient who has medically refractory angina pectoris and baseline very high creatinine level 6.3 mg/dl . This case report illustrates the potential role of invasive approach in patients with coronary artery disease even in the presence of severe renal dysfunction by using preventive measures and close monitoring

Keywords:

Dialysis contrast media, creatinine, nephropathy, percutaneous coronary intervention,

PDF

___

Rihal CS, Textor SC, Grill DE, Berger PB, Ting HH, Best PJ et al. Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention. Circulation 2002;105:2259-64.

Nikolsky E, Aymong ED, Dangas G, Mehran R. Radiocontrast nephropathy: identifying the high-risk patient and the implications of exacerbating renal function. Rev Cardiovasc Med. 2003;4 Suppl 1:S7-S14.

McCullough PA, Wolyn R, Rocher LL, Levin RN, O’Neill WW. Acute renal failure after coronary intervention: incidence, risk factors and relationship to mortality. Am J Med 1997;103:368-75.

Manske CL, Sprafka JM, Strony JT, Wang Y. Contrast nephropathy in azotemic diabetic patients undergoing coronary angiography. Am J Med 1990;89:615-20.

Parfrey PS, Griffiths SM, Barrett BJ. Contrast material-induced renal failure in patients with diabetes mellitus, renal insufficiency, or both. N Engl J Med 1989;320:143-49.

Mehran R, Aymong ED, Nikolsky E. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol 2004;44:1393-99.

Freeman RV, O Donnell M, Share D, Meengs WL, Kline-Rogers E, Clark VL et al. Nephropathy requiring dialysis after percutaneous coronary intervention and the critical role of an adjusted contrast dose. Am J Cardiol 2002;90:1068-73.

Rich MW, Creceius CA. Incidence, risk factors, and clinical course of acute renal insufficiency after cardiac catheterization in patients 70 years of age or older. Arch Intern Med 1990;150:1237-42.

Barrett BJ, Carlisle EJ. Meta-analysis of the relative nephrotoxicity of high and low- osmolality iodinated contrast media. Radiology 1993;188:171-78.

Heyman SN, Brezis M, Greenfeld Z, Rosen S. Protective role of furosemide and saline in radiocontrast-induced acute renal failure in the rat. Am J Kidney Dis 1989;14:377-85.