ESPN 51th Annual Meeting

ESPN 2018


 
ACUTE KIDNEY INJURY AFTER GADOLINIUM AND IODINATED-BASED CONTRAST MEDIA EXPOSURE IN CHILDREN WITH NORMAL RENAL FUNCTION
BRANKICA SPASOJEVIC-DIMITRIJEVA 1 JELENA KOTUR-STEVULJEVIC 2 MILAN DJUKIC 1 JADRANKA MITROVIC 3 MIRJANA CVETKOVIC 3 GORDANA MILOSEVSKI-LOMIC 3 DUSAN PARIPOVIC 1 IVANA GOJKOVIC 3 MIRJANA KOSTIC 1

1- UNIVERSITY CHILDRENS HOSPITAL, BELGRADE, SERBIA, SCHOOL OF MEDICINE, UNIVERSITY OF BELGRADE
2- FACULTY OF PHARMACY, UNIVERSITY OF BELGRADE
3- UNIVERSITY CHILDRENS HOSPITAL, BELGRADE, SERBIA
 
Introduction:

Radiocontrast media administration is one of the important causes of acute kidney injury (AKI), mostly reported in adult patients.Contrast induced-AKI (CI-AKI) occurs in up to 15% of the general population receiving intravascular iodinated-based contrast media (ICM). Gadolinium chelate based contrast media (GBCM) are considered to be safe and not nephrotoxic in standard magnetic resonance imaging (MRI). Our aim is to investigate the occurrence of CI-AKI in children with normal renal function after GBMC and ICM administration. The second aim is the early CI-AKI  detection by using new biomarkers (neutrophil gelatinase-associated lipocalin, NGAL and kidney injury molecule-1, KIM-1).

Material and methods:

The first group (n=58) of patients with congenital heart disease or hypertension were undergoing angiography with ICM (iopromide) contrast administration. The second group (n=65) consisted of patients with suspected urinary tract anomalies or renal artery stenosis (both of them were excluded) who were undergoing MR angiography/urography with GBCM (gadopentetate dimeglumine) administration. In addition to conventional biochemistry, urinary NGAL and KIM-1 were measured four times (pre-contrast, then at 4, 24 and 48 hours after contrast exsposure), and serum NGAL was measured three times (before the procedure, and at 24 and 48 hours after contrast administration).

Results:

In the GBCM group, 48h after procedure, the urinary KIM-1 rose higher than in the ICM group (GBCM: ΔuKIM-1 50.9 (IQR 200.7) pg/ml, p=0.015; ICM: ΔuKIM-1 34.5 (IQR 210,45) pg/ml, p=0.23. The difference between groups were statistically significant (p=0.012). In the ICM group, 2 patients (3.9%) were diagnosed with CI-AKI as did 6 patients (9.7%) in the GBCM group.Urinary KIM-1 measured after 24 hours post contrast exposure were significantly higher in the CI-AKI group of patients (CI-AKI: 367.3 (IQR 221.5) pg/ml; non CI-AKI: 308.2 (IQR 192.1) pg/ml, p=0.009). The results of the ROC analyses for the normalized urinary KIM-1 show the AUC of the uKIM-1/uCr at 24 hours post CM exposure was 0.757  (95% confidence interval [CI]:0.629-0.885, P=0.035). At 24 hours after CM exposure, values in normalized urinary KIM-1 with concentrations > 214 pg/mg had a sensitivity of 83.3 %, and a specificity of  54.2% for the early detection of CI-AKI.

Conclusions:

The use of gadolinium in children with normal renal function might lead to similar nephrotoxicity as with the application of iodinated contrast media. Potentially, the implementation of new biomarkers such as NGAL and KIM-1 may help identify the subset of patients with subclinical CI-AKI among children undergoing radiological procedures using contrast agents. Normalized urinary KIM-1 could be one of the most useful non-invasive marker in detecting CI-AKI after iodine and gadolinium-based media exposure.