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Cyanotic nephropathy and use of non-ionic contrast agents during cardiac catherization in patients with cyanotic congenital heart disease

Published online by Cambridge University Press:  19 August 2008

Sven Dittrich ,
Katrin Kurschat ,
Ingo Dähnert ,
Michael Vogel ,
Christian Müller  and
Peter E. Lange
Sven Dittrich*
Affiliation:
Deutsches Herzzentrum BerlinCharité, Campus Virchow – Clinics, Humboldt University, Berlin, Germany
Katrin Kurschat
Affiliation:
Deutsches Herzzentrum BerlinCharité, Campus Virchow – Clinics, Humboldt University, Berlin, Germany
Ingo Dähnert
Affiliation:
Deutsches Herzzentrum BerlinCharité, Campus Virchow – Clinics, Humboldt University, Berlin, Germany
Michael Vogel
Affiliation:
Deutsches Herzzentrum BerlinCharité, Campus Virchow – Clinics, Humboldt University, Berlin, Germany
Christian Müller
Affiliation:
Department of Clinical Chemistry and Biochemistry, Charité, Campus Virchow – Clinics, Humboldt University, Berlin, Germany
Peter E. Lange
Affiliation:
Deutsches Herzzentrum BerlinCharité, Campus Virchow – Clinics, Humboldt University, Berlin, Germany
*
Dr. Sven Dittrich, Deutsches Herzzentrum Berlin, Abteilung Angeborene Herzfehler/Kinderkardiologie, Augustenburger Platz 1, Berlin, Germany. Tel: +49–30–4593–2800; Fax +49–30–4593–2900; E-mail: svsditrr@aol.com
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Abstract

Background

Chronic cyanosis with its associated rheologic changes is a known risk factor for glomerular nephropathy. Therefore, contrast-induced nephrotoxicity should be an important consideration for angiographers comparable to diabetics. On the other hand, progressions in diagnostic and interventional techniques have led to expanded indications and a more widespread use of x-ray contrast agents. The aim of this study was to investigate the risk of contrast-induced nephropathy in the small group of patients with cyanotic heart disease prior to surgical repair.

Methods

We investigated 23 cyanotic patients with an oxygen saturation of 82 (50–92)%, age 25 (5–63) years, and 13 control subjects with atrial septal defect, age 37 (20–66) years. Blood viscosity was measured before and after cardiac catherization. Renal damage was evaluatated by selective analysis of urinary proteins and enzymes.

Results

Before cardiac catheterization, 48% of the cyanotic patients had a moderate glomerulopathy. Cardiac catherization was performed with 3.0 (1.2 – 6.8) mls/kg non ionic contrast medium. Only one of the 23 patients (4.3%) with normal urinary analysis before cardiac catheterization showed renal damage, which involved tubular and glomerular function. Elevated blood viscosity in cyanotic patients was slightly reduced by the contrast. None of the acyanotic controls had contrast-induced nephropathy.

Conclusions

The use of non-ionic contrast medium does not worsen cyanotic glomerulopathy. This finding may be due to the reduction of blood viscosity by the application of the contrast medium. The finding of contrast-induced nephropathy in one patient underlines the importance of monitoring renal function after cardiac catheterization.

Keywords

cardiac catheterizationcyanotic congenital heart diseaserenal failureblood viscositycontrast-induced nephrotoxicity
Type
Original Articles
Information
Cardiology in the Young , Volume 10 , Issue 1 , January 2000 , pp. 8 - 14
Copyright
Copyright © Cambridge University Press 2000

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