Mustafa ÜNLÜ, Turgay ARINSOY, Enver HASANOĞLU, Alper SANCAK, Deniz ERBAŞ, Ülver DERİCİ

Effects of contrast media on endothelin and nitric oxide system after computed tomography

Amaç: Renal iskemik zedelenme kontrast maddeye bağlı gelişen renal yetmezlik mekanizmaları arasında başlıca nedendir ve gelişen bu hemodinamik değişikliklere bir takım vazoaktif maddeler aracı olmaktadır. Bu çalışma, KM nefrotoksite oluşumunda nitrik oksit(NO) ve endotelinin(ET) rolünü tespit etmeye yöneliktir. Toplam 20 hastaya abdominal tomografi çekimi esnasında şu 3 düşük osmalariteli KM den biri kullanılmıştır: iopamidol, iopromid veya iohekzol. İşlemden hemen önce ile KM uygulamasından 10 dakika sonra ET ve NO metabolitleri(Nox: nitrat, nitrit) için kan örnekleri alınmıştır. Serum kreatinin seviyeleri KM uygulanmasından önce ve uygulamanın 1. ve 3. günlerinde kontrol edilmiştir. Endotelin ölçümü radyoimmünoassayle, NOx ölçümü ise Sievers Instrument Model 280A NO Analyser ile yapılmıştır. İntravenöz KM uygulaması ile plazma ET seviyesinde bir artış izlenmesine karşın, bu istatiksel olarak önemli değildi(p=0.154). Ayrıca KM, nitrat(0.709) ve nitrit(p=0.699) seviyelerini de anlamlı olarak etkilemedi. Bazal ET seviyesi ile 3 gün içindeki serum kreatinin değişimi arasında zayıf bir korelasyon bulunmaktaydı(r=0.39, p=0.088). Bu çalışmada sonuç olarak, kontrast maddenin serum NOx ve endotelin seviyelerini etkiemediğini tespit ettik. Kontrast maddenin başlattığı hemodinamik etkilerde NO in bariz bir rolünün olmadığını bu sonuçlarla önerebiliriz. Ancak çalışma protokolüne bağlı olarak predispozan faktöre sahip hastaların çalışma dışı bırakılması nedeniyle endotelinin KM nefrotoksitesinde rolünü ekarte etmemiz mümkün olmamaktakır.

Bilgisayarlı tomografi sonrası kontrast maddenin endotelin ve nitrik oksid sistemi üzerine etkisi

Purpose : Among the mechanisms of contrast media induced renal dysfunction, renal ischemic injury is the main reason and some of the vasoactive substances may mediate the renal haemodynamic effects of contrast media(CM). The present study was designed to determine the role of nitric oxide and endothelin on occurrence of contrast media nephrotoxicity. Methods : A total of 20 patients were given one of the following low osmolar CM; iopamidol, iopromid or iohexol for abdominal computed tomography scanning. Blood samples for endothelin and nitric oxide metabolites (NOx; nitrate, nitrite) were drawn just prior to and 10 minutes after the contrast media administration. Serum creatinine levels were determined prior to the administration of contrast media and on the first and third postscanning days. Radioimmunoassay for endothelin was performed while NOx was measured by using Sievers Instruments Model 280 A Nitric Oxide Analyser. Results: Intravascular administration of CM appeared to elicit a rise in plasma endothelin but this was not statistically significant (p=0.154). Contrast media also did not affect the nitrate (p=0.709) and nitrite(p=0.699) levels significantly. Mean serum creatinine levels increased significantly from 0.62±0.13mg/dl to 0.72±0.22 mg/dl (p=0.049). There was a weak correlation between baseline endothelin levels and the change in serum creatinine over the three days (r=0.39, p=0.088). Conclusion : In this study, we have demonstrated that CM did not interfere with serum NOx and endothelin levels. It is feasible to suggest that nitric oxide is unlikely play a major role in the haemodynamic effects induced by CM. However the role of ET in the pathophysiology of contrast media nephrotoxicity cannot be eliminated in this study because of the study protocol which excluded the patients with predisposing factors.

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