Nephropathy Clinical Trial
Official title:
Retrospective Analysis of the Influence of Iodinated Contrast Volume Injected During Coronarography on Contrast Nephropathy.
Coronary heart disease remains one of the main causes of death in the world. One of the
treatments for coronary heart disease is percutaneous coronary intervention (PCI). This
requires the arterial administration of iodinated contrast medium (ICP) to visualize the
state of the coronary arteries and possibly apply the treatment.
For the vast majority of the population, exposure to ICP is perfectly well tolerated.
Nevertheless, some complications can occur including a nephropathy induced by the injection
of a contrast product (NIC). NIC is the third cause of an acquired acute renal failure within
the hospital.It significantly increases morbidity and mortality and prolongs the hospital
stay.
Of all the procedures requiring ICP administration, PCI is associated with the highest rate
of NIC.This evidence is explained by the fact that patients benefiting from such exploration
have a higher risk profile in terms of cardiovascular comorbidities and associated
pathologies.Age, preexisting alteration of renal function, diabetes mellitus, polypharmacy,
congestive heart failure, type and volume of iodinated contrast medium are the main risk
factors for developing NIC.
Nowadays, the use of PCI in the assessment of coronary heart disease in patients with these
risk factors is becoming more frequent. This is linked to the aging of the population and the
increasing incidence of cardiovascular diseases.
ICP-induced nephrotoxicity results from two main phenomena: the renal medullary hypoxia
caused by the vasoconstriction of peritubular capillaries and a direct cytotoxicity towards
tubular epithelial cells.These intra-renal mechanisms lead to an acute renal function
impairment.NIC is defined as an increase of serum creatinemia ≥ 0.5 mg / dL (or a 25%
increase) from the baseline in the 48-72h following PC injection with no other obvious
etiology. It reaches its peak between the 3rd and 5th day with a resolution in 10 to 21 days.
The prevention of NIC based primarily on the identification of patients at risk and the use
of pharmacological means (as hydration protocol). In contrast, there is little data on the
relationship between NIC and the PCI volume used. To the investigator's knowledge, the
threshold of toxic volume is not well defined. Taking into account these elements, the
investigators propose to study the relation between the volume of iodinated contrast product
injected during an ICP and the occurrence of a NIC according to the criteria mentioned above.
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