THE CHALLENGE OF KIDNEY DAMAGE DURING INTERVENTIONAL CARDIOLOGY PROCEDURES
Authors: Ztati H. , Mikdam N. , Chettati M. , Fadili W. , Laouad I. , Ztati M. S. , hattaoui M. El 
Published: January 2024

Introduction: Contrast nephropat(CN) is a frequent cause of acute renal failure (ARF). The diagnosis is based on an elevation of serum creatinine of 0.5 mg/dl (= 44.2 Âµmol/l) and/or ? 25% of baseline creatinine. In 90% of patients developing AKI on PC, it classically occurs between 24 and 72 hours after the examination. Diuresis is generally preserved, proteinuria is minimal, and urine sediment shows only granular cylinders and few cells. The differential diagnosis is that of ARF caused by cholesterol emboli from invasive procedures in the suprarenal aorta. In the short term, AKI following coronary angiography is associated with procedural complications, a longer hospital stay (8.1 days versus 4.7 days p < 0.001), and higher one-year mortality (12.1% versus 3.7%). Patients at risk of developing PC-related nephropathy, particularly those with chronic renal failure or concomitant hypovolemia, have the need for extrarenal purification in some cases, in addition to the risk of cardiovascular mortality. This makes contrast media nephropathy a serious event for which clinicians must be prepared. Objective:the aim of this work was to determine the incidence of NIPC in patients undergoing primary angioplasty and/or coronary angiography procedures and generate hypotheses about risk factors. Materials and methods In collaboration with the cardiology department, we conducted a longitudinal descriptive study between January 2019 and January 2021. It included a cohort of 180 patients undergoing emergency or cold angiocoronary angiography for diagnostic or therapeutic purposes. Clinical and biological follow-up was 3 months for all patients. Patients with a blood test including creatininelevels before the examination and creatinine levels at 3 days, 15 days, 1 month, and 3 months after the procedure were included. Those who had undergone PCI for anexamination other than coronary Results Characteristics of the overall population All patients hadnormal creatinine levels and were predominantly male (70.0%) with an average age of 60.8 years. Of these patients, 20.6% had diabetes, 18.2% hypertension and 6.4% heart failure (HF). The rate of IR was 20.8%. Descriptive study Comparison of patient characteristics with and without NCI: The multivariate logistic regression study demonstrated that diabetes mellitus (Odds Ratio (OR)=2.26 95% confidence interval (CI95%): 1.29-3.98, p=0.005), a left ventricular ejection fraction (LVEF) < 45% (OR=2. 03 IC95% :1.22-3.39, p=0.007) and a quantity of iodinated contrast medium (ICP) > 90ml (1.72 IC95%:.of iodinated contrast medium (ICP) > 90ml (1.72 IC95%: 0.99-2.99, p=0.05) were predictive of the occurrence of NCI. It should be noted that age was linked to creatinine clearance, and it was through a reduction in renal function that advanced age was responsible for a higher incidence of CIN. Furthermore, the search for correlations between these five independent factors 2 by 2 showed a significant relationship between diabetes and reduced renal function in the co-presence of these two factors, their effects are reciprocally potentiated and are responsible for an increased risk. Preventive measures showed? their efficacÃ½ only in the diabetic group, where prior hydration with saline significantly reduced the incidence of CIN: 16% versus 50% in diabetics who did not receive saline infusion Conclusion: Despite current management, this pathology affects the cardiovascular prognosis of patients, even though normalization of renal function is usually achieved within a month of exploration. In addition to identifying factors predictive of NIPC with a view to implementing appropriate preventive measures in patients at risk, we stress the importance of ensuring a good hemodynamic state intra-procedurally27.