Osman ÖZDEMİR, Ayşe Deniz OĞUZ, Abdülkadir EREN

Cystatin C as biomarker of contrast-induced nephropathy in pediatric cardiac angiography

The purpose of this study is to find the frequency of contrast-induced nephropathy (CIN) and to show the risk factors in the development of CIN and the diagnostic utility of serum cystatin C (CysC) and serum and urine neutrophil gelatinase-associated lipocalin (NGAL) during childhood following cardiac angiography. Materials and methods: In this prospective study, we studied 46 children with congenital heart disease. The levels of serum creatinine, serum CysC, and serum NGAL were measured at 4, 24, and 48 h, while levels of urine NGAL and urine creatinine were measured at 4 to 8 and 48 h following cardiac angiography. Results: According to serum creatinine levels, with a cutoff value of 4.1 mL/kg for development of CIN, sensitivity, specificity, area under the receiver-operating characteristic curve, and positive likelihood ratio were calculated as 69%, 70%, 0.67, and 2.29, respectively. The levels of serum CysC and serum creatinine significantly increased at 4, 24, and 48 h after the application of the contrast agent. Conclusion: The results of this study show that according to the definition of CIN, the incidence of CIN is significantly increased in pediatric patients with congenital heart disease. Moreover, the results support that serum CysC levels may allow the detection of CIN after cardiac angiography, like serum creatinine in present study.

Anahtar Kelimeler:

Key words: Cardiac angiography, contrast media, creatinine, cystatin C, lipocalin, nephropathy

Cystatin C as biomarker of contrast-induced nephropathy in pediatric cardiac angiography

Keywords:

Key words: Cardiac angiography, contrast media, creatinine, cystatin C, lipocalin, nephropathy,

PDF

___

Thomsen HS, Morcos SK. Radiographic contrast media. BJU Int 2000; 86 (Suppl. 1): 1–10.
Brasch RC. Contrast media toxicity in children. Pediatr Radiol 2008; 38 (Suppl. 2): 281–284.
McCullough PA. Contrast-induced acute kidney injury. Nephron Physiol 2008; 109: 61–72.
Pucelikova T, Dangas G, Mehran R. Contrast-induced nephropathy. Catheter Cardiovasc Interv 2008; 71: 62–72.
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: 368–375.
Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis 2002; 39: 930–936.
Nguyen MT, Devarajan P. Biomarkers for the early detection of acute kidney injury. Pediatr Nephrol 2008; 23: 2151–2157.
Devarajan P. Biomarkers for the early detection of acute kidney injury. Curr Opin Pediatr 2011; 23: 194–200.
Hirsch R, Dent C, Pfriem H, Allen J, Beekman RH 3rd, Ma Q, Dastrala S, Bennett M, Mitsnefes M, Devarajan P. NGAL is an early predictive biomarker of contrast-induced nephropathy in children. Pediatr Nephrol 2007; 22: 2089–2095.
Bachorzewska-Gajewska H, Malyszko J, Sitniewska E, Malyszko JS, Dobrzycki S. Neutrophil gelatinase associated lipocalin (NGAL) correlations with cystatin C, serum creatinine and eGFR in patients with normal serum creatinine undergoing coronary angiography. Nephrol Dial Transplant 2007; 22: 295– 2
Rickli H, Benou K, Ammann P, Fehr T, Brunner-La Rocca HP, Petridis H, Riesen W, Wüthrich RP. Time course of serial cystatin C levels in comparison with serum creatinine after application of radiocontrast media. Clin Nephrol 2004; 61: 98–102.
Ajami G, Derakhshan A, Amoozgar H, Mohamadi M, Borzouee M, Basiratnia M, Abtahi S, Cheriki S, Soltani M. Risk of nephropathy after consumption of nonionic contrast media by children undergoing cardiac angiography: a prospective study. Pediatr Cardiol 2010; 31: 668–673.
Du Bois D, Du Bois EF. A formula to estimate the approximate surface area if height and weight be known. 1916. Nutrition 1989; 5: 303–311.
National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004; 114: 555–76.
Lai WW, Geva T, Shirali GS, Frommelt PC, Humes RA, Brook MM, Pignatelli RH, Rychik J; Task Force of the Pediatric Council of the American Society of Echocardiography; Pediatric Council of the American Society of Echocardiography. Guidelines and standards for performance of a pediatric echocardiogram: A report from the Task Force of the Pediatric Council of the American Society of Echocardiography. J Am Soc Echocardiogr 2006; 19: 1413–1430.
Schwartz GJ, Munoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, Furth SL. New equations to estimate GFR in children with CKD. J Am Soc Nephrol 2009; 20: 629–637.
Sagy M, Aladjem M, Shem-Tov A, Eshkol A, Orda S, Hegesh J, Boichis H. The renal effects of radiocontrast administration during cardioangiography in two different groups with congenital heart disease. Eur J Pediatr 1984; 141: 236–239.
Niboshi A, Nishida M, Itoi T, Shiraishi I, Hamaoka K. Renal function and cardiac angiography. Indian J Pediatr 2006; 73: 49–
Noyan A, Küçükosmanoğlu O, Yıldızdaş D, Özbarlas N, Anarat A, Anarat R. Evaluation of renal functions in children with congenital heart disease before and after cardiac angiography. Turk J Pediatr 1998; 40: 97–101.
Kavukçu S, Tavli V, Fadiloğlu M, Akhunlar H, Oran B, Akçoral A. Urinary enzyme changes in children undergoing cineangiographic evaluation using iopromid. Int Urol Nephrol 1995; 27: 131–135.
Kashani IA, Higgins SS, Griswold W, Swensson RE, Higgins CB. Renal function in children after large dose contrast medium angiocardiography. Jpn Heart J 1985; 26: 451–456.
McCullough PA, Adam A, Becker CR, Davidson C, Lameire N, Stacul F, Tumlin J; CIN Consensus Working Panel. Risk prediction of contrast-induced nephropathy. Am J Cardiol 2006; 98: 27K–36K.
Solomon R, Werner C, Mann D, D’Elia J, Silva P. Effects of saline, mannitol, and furosemide to prevent acute decreases in renal function induced by radiocontrast agents. N Engl J Med 1994; 331: 1416–1420.
Stevens MA, McCullough PA, Tobin KJ, Speck JP, Westveer DC, Guido-Allen DA, Timmis GC, O’Neill WW. A prospective randomized trial of prevention measures in patients at high risk for contrast nephropathy: results of the P.R.I.N.C.E. Study. Prevention of Radiocontrast Induced Nephropathy Clinical Evaluation. J Am Coll Cardiol 1999; 33: 403–411.
Mueller C, Buerkle G, Buettner HJ, Petersen J, Perruchoud AP, Eriksson U, Marsch S, Roskamm H. Prevention of contrast media-associated nephropathy: randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty. Arch Intern Med 2002; 162: 329–336.
Stacul F, Adam A, Becker CR, Davidson C, Lameire N, McCullough PA, Tumlin J; CIN Consensus Working Panel. Strategies to reduce the risk of contrast-induced nephropathy. Am J Cardiol 2006; 98: 59K–77K.