Celal KERVANCIOĞLU, Berkten BERKALP, Ömer AKYÜREK, Sibel TURHAN, Metin ÖZENCİ, Mustafa KILIÇKAP, Tamer SAYIN, Çetin EROL

Gadolinium: Non-ionic contrast media (1:) coronary angiography in patients with impaired renal function

Amaç: Renal disfonksiyonu olan ve koroner anjiyografi planlanan hastalarda gadolinyum (manyetik rezonans görüntüleme kontrast maddesi) : non-iyonik düşük ozmolar kontrast madde (1:1) karışımının kontrast nefropati gelişmesini önlemede etkinliğini değerlendirmek. Gereç ve Yöntem: Bazal kreatinin değeri 1.5 mg/dl veya üzeri olan hastalar çalışmaya alındı. Kontrast nefropati riskini en aza indirebilmek amacıyla bütün hastalar yoğun bir şekilde hidrate edildi ve n-asetil sistein ile tedavi edildi. İşlemden sonra 1, 2 ve 3. günde böbrek fonksiyon testleri tekrar ölçüldü. Kreatinin düzeyinde 0.5 mg/dl ve üzeri artış veya diyaliz ihtiyacı kontrast nefropati olarak değerlendirildi. Bulgular: Çalışmaya 26 hasta alındı. Hastaların 10’u kadın 16’sı erkek yaş ortalaması ise 65.7 ± 11 idi. Bazal ortalama kreatinin değeri 2. 47 ± 0.74 mg/dl idi. Bire : bir derişiminde kulanılan ortalama opak madde miktarı 57.1 ± 27.2 ml idi. Çalışma grubunda işlemle ilgili kardiyak komplilkasyon veya kontrast nefropati izlenmedi. Hafif bir görüntü kalite kaybı yaşanmakla beraber karar vermek ve işlem yapabilmek için yeterli görüntü kalitesine ulaşılabildi. Sonuç: Gadolinyum X-ışını anjiografisi için üretilip ruhsatlandırılmamış olmasına rağmen 1:1 derişiminde non iyonik düşük ozmolar kontrast ajanla kullanımı kontrast nefropati ihtimalini azaltabilmek için etkin bir alternatif olabilir.

Renal disfonksiyonu olan hastalarda gadolinyum: Non-iyonik kontrast madde (1:1) karışımı ile koroner anjiyografi

Aim: To evaluate efficacy and safety of gadolinium (magnetic resonance imaging contrast media): non-ionic low osmolar contrast media (1:1) in avoiding contrast nephropathy in patients with renal dysfunction referred for coronary angiography. Material and Methods: Patients with a baseline creatinine of 1.5 mg /dl or more were included. In order to minimize contrast nephropathy risk all patients were thoroughly hydrated and treated by N-acetyl cystein. After coronary angiography and/or percutaneous coronary intervention renal function tests were re-measured on day 1,2 and 3. A rise of 0.5 mg/dl in creatinine value in the following 3 days or need for dialysis was considered as a contrast nephropathy event. Results: Twenty six patients were enrolled in this study. Ten were women and 16 were men, mean age was 65.7 ± 11 Baseline creatinine value was 2. 47 ± 0.74 mg/dl. Total amount of contrast media used on 1:1 fashion was 57.1 ± 27.2 ml. No procedure related cardiac complication or contrast nephropathy event occurred in this study. Although there was slight image quality loss what we had was adequate for performing the procedures. Conclusion: Although “off label” using gadolinium contrast media in a 1:1 mixture with standard non-ionic low osmolar contrast media seems to be a viable option in decreasing the likelihood of contrast nephropathy.

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