荧光素钠会导致造影剂肾病吗？,Nephrology Dialysis Transplantation

当前位置： X-MOL 学术 › Nephrol. Dial. Transplant. › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

荧光素钠会导致造影剂肾病吗？
Nephrology Dialysis Transplantation ( IF 4.8 ) Pub Date : 2019-11-26 , DOI: 10.1093/ndt/gfz243
Donghwan Yun ₁ , Dong Ki Kim ₁ , Jung Pyo Lee _{1,

2} , Yon Su Kim ₁ , Sohee Oh ₃ , Chun Soo Lim _{1,

2}

Affiliation

背景造影剂肾病(CIN) 是急性肾损伤(AKI) 的常见原因，当AKI 病因不明时，可通过造影剂以外的方式进行诊断。使用荧光素钠染料的荧光血管造影 (FAG) 通常被认为对肾病患者是安全的。然而，FAG 是否能诱发 CIN 仍未解决。方法选取2001-2017年2家三级医院接受FAG并在FAG前4周内和FAG后3天内检测血清肌酐结果的患者。同时进行碘对比成像或透析的病例被排除在分析之外。CIN 由两个标准定义： CIN 标准为 FAG 后 3 天内血清肌酐 (sCr) 水平升高 >0.5 mg/dL 或 >25%，对比剂诱导的急性肾损伤 (CIAKI) 标准为 FAG 后 2 天内增加 ≥ 0.3 mg/dL 或 7 天内增加 ≥ 50%。结果共筛查了 979 名患者，发现 124 名 FAG 后 AKI 患者。剔除FAG以外AKI明确病因的32例患者后，CIN标准的CIN发生率为7.3%，CIAKI标准为6.4%。根据 CIN 标准中的慢性肾脏病 (CKD) 分期，CIN 发病率呈 U 形分布，而 CIAKI 标准中发现 CIN 发病率与 CKD 分期之间呈线性相关。Kaplan-Meier 曲线显示 CIN 组与终末期肾病 (ESRD) 进展显着相关（在 CIN 标准和 CIAKI 标准中，log-rank P < 0.001），多变量 Cox 回归调整后的风险比为 2。在 CIN 标准中为 23 [95% 置信区间 (CI) 1.468-3.378]，在 CIAKI 标准中为 2.17 (95% CI 1.462-3.232)。结论根据 CIN 和 CIAKI 标准，FAG 可能导致 CIN，并且似乎是 ESRD 进展的一个可能的危险因素。然而，CIN 或 CIAKI 标准本身可能会高估 AKI，并需要仔细注意结果的解释。

"点击查看英文标题和摘要"

Can sodium fluorescein cause contrast-induced nephropathy?

BACKGROUND Contrast-induced nephropathy (CIN) is a common cause of acute kidney injury (AKI), and can be diagnosed when the etiology of AKI is unclear other than via a contrast agent. Fluorescent angiography (FAG) with fluorescein sodium dye is generally considered to be safe for patients with kidney diseases. However, it remains unresolved whether or not FAG can induce CIN. METHODS Patients from two tertiary hospitals who underwent FAG and had serum creatinine results within 4 weeks before FAG and 3 days after FAG between 2001 and 2017 were retrieved. Cases with concurrent iodinated contrast imaging or undergoing dialysis were excluded from the analysis. CIN was defined by two criteria: CIN criteria as >0.5 mg/dL or >25% increase in serum creatinine (sCr) level within 3 days after FAG, and contrast-induced acute kidney injury (CIAKI) criteria as ≥0.3 mg/dL increase within 2 days or ≥50% increase within 7 days after FAG. RESULTS A total of 979 patients were screened, and we found 124 patients with AKI after FAG. After excluding 32 patients with clear causes of AKI other than FAG, the incidence rates of CIN were 7.3% by CIN criteria and 6.4% by CIAKI criteria. CIN incidence had a U-shaped distribution according to chronic kidney disease (CKD) stages in CIN criteria, while linear association between CIN incidence and CKD stages were found in CIAKI criteria. Kaplan-Meier curves showed the CIN group was significantly associated with end-stage renal disease (ESRD) progression (log-rank P < 0.001, in both CIN criteria and CIAKI criteria), and adjusted hazard ratios by multivariable Cox regression were 2.23 [95% confidence interval (CI) 1.468-3.378] in CIN criteria and 2.17 (95% CI 1.462-3.232) in CIAKI criteria. CONCLUSIONS According to CIN and CIAKI criteria, FAG may cause CIN and appeared to be a possible risk factor for ESRD progression. However, CIN or CIAKI criteria themselves may overestimate AKI and require meticulous attention to the interpretation of results.

更新日期：2019-11-26

点击分享查看原文

点击收藏

阅读更多本刊新发论文本刊介绍/投稿指南