Early and Sustained Systemic and Renal Hemodynamic Effects of Intravenous Radiocontrast

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Abstract

Background and Aims: To measure the extended renal hemodynamic changes induced by intravenous radiocontrast. Methods: Cross-ewes were studied in a randomized cross-over study. Intravenous saline or radiocontrast were administered, and continuous measurement of cardiac output and renal blood flow (RBF) was performed with flow probes. Results: Radiocontrast induced early but transient increases in cardiac output with vasodilatation, followed by return to baseline values within 2 h. There was an initial decline in RBF (–5.2 ± 4.5 vs. 2.1 ± 5.3%; p < 0.0001) and decreased renal vascular conductance (–4.0 ± 7.2 vs. 3.3 ± 7.1%, p < 0.0001; vasoconstriction). This renal vasoconstriction resolved within 2 h and was followed by sustained (72 h) renal vasodilatation with higher RBF (270 ± 13 vs. 236 ± 11 ml/min; p < 0.0001). Conclusions: Radiocontrast induces short renal vasoconstriction followed by sustained vasodilatation and increased RBF. Short-term studies are not representative of the overall sustained renal hemodynamic effects of radiocontrast.

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Effects of saline, mannitol, and furosemide to prevent acute decreases in renal function induced by radiocontrast agents.

Keith R. Solomon, Raquel Raick P. da Silva, Daniela S P Silva … (1994)

Injections of radiocontrast agents are a frequent cause of acute decreases in renal function, occurring most often in patients with chronic renal insufficiency and diabetes mellitus. We prospectively studied 78 patients with chronic renal insufficiency (mean [+/- SD] serum creatinine concentration, 2.1 +/- 0.6 mg per deciliter [186 +/- 53 mumol per liter]) who underwent cardiac angiography. The patients were randomly assigned to receive 0.45 percent saline alone for 12 hours before and 12 hours after angiography, saline plus mannitol, or saline plus furosemide. The mannitol and furosemide were given just before angiography. Serum creatinine was measured before and for 48 hours after angiography, and urine was collected for 24 hours after angiography. An acute radiocontrast-induced decrease in renal function was defined as an increase in the base-line serum creatinine concentration of at least 0.5 mg per deciliter (44 mumol per liter) within 48 hours after the injection of radiocontrast agents. Twenty of the 78 patients (26 percent) had an increase in the serum creatinine concentration of at least 0.5 mg per deciliter after angiography. Among the 28 patients in the saline group, 3 (11 percent) had such an increase in serum creatinine, as compared with 7 of 25 in the mannitol group (28 percent) and 10 of 25 in the furosemide group (40 percent) (P = 0.05). The mean increase in serum creatinine 48 hours after angiography was significantly greater in the furosemide group (P = 0.01) than in the saline group. In patients with chronic renal insufficiency who are undergoing cardiac angiography, hydration with 0.45 percent saline provides better protection against acute decreases in renal function induced by radiocontrast agents than does hydration with 0.45 percent saline plus mannitol or furosemide.

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Renal blood flow in experimental septic acute renal failure.

C. Langenberg, L Wan, M Egi … (2006)

Reduced renal blood flow (RBF) is considered central to the pathogenesis of septic acute renal failure (ARF). However, no controlled experimental studies have continuously assessed RBF during the development of severe septic ARF. We conducted a sequential animal study in seven female Merino sheep. Flow probes were implanted around the pulmonary and left renal arteries. Two weeks later, systemic hemodynamics and RBF were monitored continuously during a 48-h control period and, after a week, during a 48-h period of hyperdynamic sepsis induced by continuous Escherichia coli infusion. Infusion of E. coli induced hyperdynamic sepsis with significantly increased cardiac output (3.8+/-0.4 vs 9.8+/-1.1 l/min; P<0.05), decreased mean arterial pressure (89.2+/-3.2 vs 64.3+/-5.3 mm Hg; P<0.05), and increased total peripheral conductance (42.8+/-3.5 in controls vs 153.7+/-24.7 ml/min/mm Hg in septic animals; P<0.05). Hyperdynamic sepsis was associated with marked renal vasodilatation (renal conductance: 3.0+/-0.7 vs 11.4+/-3.4 ml/min/mm Hg; P<0.05) and a marked increase in RBF (262.3+/-47.7 vs 757.4+/-250.1 ml/min; P<0.05). Serum creatinine increased over 48 h (73+/-18 vs 305+/- micromol/l; P<0.05) whereas creatinine clearance decreased (95.5+/-25.9 vs 20.1+/-19.3 ml/min; P<0.05). After 24 h, urine output decreased from 1.4 to 0.3 ml/kg/h (P<0.05). Infusion of E. coli induced hyperdynamic sepsis and ARF. Septic ARF in this setting was associated with a marked increase in RBF and with renal vasodilatation.

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Nephrotoxicity of ionic and nonionic contrast media in 1196 patients: A randomized trial

for the Iohexol Cooperative Study, Douglas VanFossen, Martin B. Cohen … (1995)

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Author and article information

Journal

Journal ID (publisher-id): BPU

Journal ID (nlm-ta): Blood Purif

Journal ID (doi): 10.1159/issn.0253-5068

Title: Blood Purification

Publisher: S. Karger AG

ISSN (Print): 0253-5068

ISSN (Electronic): 1421-9735

Publication date Subscription-year: 2010

Publication date (Print): June 2010

Publication date (Electronic): 31 March 2010

Volume: 29

Issue: 4

Pages: 339-346

Affiliations

^aHoward Florey Institute, University of Melbourne, Parkville, Vic., ^bDepartment of Intensive Care and Department of Medicine, Austin Hospital and University of Melbourne, Heidelberg, Vic., and ^cAustralian and New Zealand Intensive Care Research Centre, Prahran, Vic., Australia; ^dDivision of Critical Care Medicine, University of Alberta, Edmonton, Alta., Canada

Article

Publisher ID: 302721 Other ID: Blood Purif 2010;29:339–346

DOI: 10.1159/000302721

PubMed ID: 20357433

SO-VID: a8a78e39-7ea6-45a4-993f-b3add2f9724d

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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

History

Date received : 02 October 2009

Date accepted : 11 May 2009

Page count

Figures: 4, Tables: 1, References: 30, Pages: 8

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Early and Sustained Systemic and Renal Hemodynamic Effects of Intravenous Radiocontrast

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Karger: Nephrology

Most cited references 26

Effects of saline, mannitol, and furosemide to prevent acute decreases in renal function induced by radiocontrast agents.

Renal blood flow in experimental septic acute renal failure.

Nephrotoxicity of ionic and nonionic contrast media in 1196 patients: A randomized trial

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