| Abstract: |
SUMMARY AND CONCLUSIONThis work has been carried out in cardiology department, faculty of medicine, Zagazig University during the period from October 2003 to December 2004.This study is aimed to evaluate the effects of iodinated contrast media ”urografin” on kidney functions and left ventricular diastolic function indices in patients underwent cardiac catheterization for coronary angiography.The work included (100) patients with normal kidney function (serum creatinine 0.5-1.5 mg/dl), 57 were male (57%) and 43 were female (43%). Their ages ranged from 35 to 69 years with mean age of 52±9.6 years.The patients are classified into four groups group (A) included diabetic hypertensive patients, group (B) included diabetic patients only, group (C) included hypertensive patients only and group (D) included non diabetic, non-hypertensive patients.All patients had undergone the following:1- Complete history taking and thorough clinical examination.2- Resting 12 lead surface ECG.3- Abdominal ultrasonography to exclude renal medical diseases.4- Echo-Doppler study before, immediately and 7-days after cardiac catheterization for assessment of left ventricular diastolic function.5- Kidney function tests in form of blood urea, serum creatinine and creatinine clearance before cardiac catheterization, immediately, 3 days and 7 days after cardiac catheterization.6- Cardiac catheterization for coronary angiography.Our results demonstrated that:· The population characteristics and dose of contrast media were comparable in the four studied groups (P> 0.05).· There was an increase in blood urea, serum creatinine and decrease in creatinine clearance following administration of radiocontrast agents, but not reach the significant level at the first day after contrast administration (P> 0.05).However, the maximal significant effect of these contrast agent on kidney functions was reached at the third day (P< 0.05) and return to normal at the seventh day (P< 0.05).· The level of serum creatinine is maximally changed after three days of contrast administration, where the mean values were 1.11±0.19 before coronary angiography changed to 1.24±0.17 immediately after coronary angiography and 1.79±0.13 three days after coronary angiography and 1.27±0.12 after seven days of coronary angiography.· From these changes it is noted that the level of serum creatinine is increased by ³ 25% or ³ 0.5 mg/dl from the base line value and decline to nearly normal level after seven days of coronary angiography.· The effects of contrast agents on kidney functions were significantly higher in groups (A) and (B) than that of groups (C) and (D). Evidenced by more significant increase in blood urea, serum creatinine and significant decrease in creatinine clearance (P< 0.01).· There was a significant positive correlation between the dose of contrast media and kidney functions (P< 0.05).· Regarding the diastolic functions, there was a non-significant effect of the radio contrast media on the left ventricular diastolic function indices in the four studied groups (P> 0.05) immediately after and seven days after radio contrast administration.· Also, there was a non-significant correlation between the dose of contrast media and diastolic function parameters immediately after and seven days after coronary angiography (P> 0.05).Finally we conclude that:· The effect of radiocontrast agents on kidney functions is benign and transient, it usually increases within 1-2 days after contrast media administration, reaches a peak value at 3-5 days and then return to base line within 7-10 days.· The effect of radiocontrast agents on kidney functions in diabetic hypertensive patients is significantly higher than that in non-diabetic, non-hypertensive patients.· There was a positive correlation between the dose of contrast media and kidney functions.· The ionic contrast media exerts negligible alterations on left ventricular diastolic functions indices when used for coronary angiography.· There was a non-significant correlation between the dose of contrast media and diastolic function indices. Recommendations:· We recommend to study the effect of ionic contrast agents versus non-ionic contrast agents on kidney function and diastolic function and in a large number of patients with renal impairments as well as in patients undergoing PCI.
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