Frequency of Contrast Induced Nephropathy (CIN) Following Exposure to Contrast in Coronary Angiography, in Diabetics with Previously Normal Renal Function
Authors: Sajjad Uzma , Ali Irtza , Akram Zubair 
Published: January 2017

<p class="MsoNormal" style="margin-bottom: 6.0pt; text-align: justify; tab-stops: .25in;"><strong><span style="font-size: 13pt;">Abstract</span></strong></p><p class="MsoNormal" style="text-align: justify; tab-stops: .25in;"><strong><span style="font-size: 11pt;">Introduction: </span></strong><span style="font-size: 11pt;">Contrast – induced nephropathy (CIN), is an acute kidney injury state, which has managed to catch the attention of cardiologists, as a result of increasing cardiac invasive interventions. Lately there has been a lot of research to get insight in the etiology, pathogenesis, recognition, diagnosis and prevention of CIN, so that the long term adverse effects can be avoided. Much of the research has been in the form of retrospective or observational studies on groups of patients undergoing angiographic contrast exposure.</span></p><p class="MsoNormal" style="text-align: justify; tab-stops: .25in;"><strong><span style="font-size: 11pt;">Objective: </span></strong><span style="font-size: 11pt;">The objective of the study was to:</span></p><p class="MsoListParagraph" style="margin: 0in 0in 0.0001pt; text-align: justify;"><span style="font-family: 'Times New Roman', serif;">Determine the frequency of CIN in diabetics under-going coronary angiography.</span></p><h1 style="margin: 0in; margin-bottom: .0001pt; text-align: justify; page-break-after: auto; tab-stops: .25in;"><span style="font-size: 11pt; font-family: 'Times New Roman', serif;">Study Design: </span><span style="font-size: 11pt; font-family: 'Times New Roman', serif; font-weight: normal;">Case series.</span></h1><p class="MsoNormal" style="text-align: justify; tab-stops: .25in;"><strong><span style="font-size: 11pt;">Settings: </span></strong><span style="font-size: 11pt;">Department of Cardiology, Jinnah Hospital, Lahore.</span></p><p class="MsoNormal" style="text-align: justify; tab-stops: .25in;"><strong><span style="font-size: 11pt;">Duration of Study: </span></strong><span style="font-size: 11pt;">Six months (1<sup>st</sup> June, 2014 to 30<sup>th</sup></span> <span style="font-size: 11pt;">November, 2014).</span></p><p class="MsoNormal" style="margin-bottom: .5pt; text-align: justify; tab-stops: .25in;"><strong><span style="font-size: 11pt;">Subjects and Methods: </span></strong><span style="font-size: 11pt;">155 patients fulfilling the selection criteria were included in the study. They were admitted through medical emergency and out-door department and admitted in CCU, Jinnah Hospital Lahore. Written informed consent was taken. Patient related information (name, age, sex and address) was obtained. These patients underwent coronary angiography. Post angiogram, serum analysis was done daily during hospital stay of patient to assess serum creatinine. CIN was labeled as per operational definition and thus frequency of CIN in type I and type II diabetics undergoing angiography was determined by serial creatinine monitoring.</span></p><p class="MsoNormal" style="margin-bottom: .5pt; text-align: justify; tab-stops: .25in;"><strong><span style="font-size: 11pt;">Results: </span></strong><span style="font-size: 11pt;">The frequency of increase in serum create-nine ? 0.5 mg/dl after PCI leading to CIN in diabetics undergoing coronary angiography was recorded in 7.10% (n = 11) out of a total of 155 cases.</span></p><p class="MsoNormal" style="margin-bottom: .5pt; text-align: justify; tab-stops: .25in;"><strong><span style="font-size: 11pt;">Conclusion: </span></strong><span style="font-size: 11pt;">We concluded that the frequency of CIN is not very high in diabetic patients undergoing coronary angiography. However, it continues to be a clinically challenging adverse event in all patients, especially diabetics, having coronary angiography for diagnostic or therapeutic purposes. Therefore, these patients should be recognized and monitored carefully to avoid long-term adverse effects of CIN.</span></p><p class="MsoListParagraph" style="margin: 0in 0in 0.0001pt; text-align: justify;"><strong><span style="font-family: 'Times New Roman', serif;">Keywords: </span></strong><span style="font-family: 'Times New Roman', serif;">Coronary artery disease, coronary angiography, diabetes, contrast induced nephropathy, frequency.</span></p><p class="MsoNormal" style="text-align: justify; tab-stops: .25in;"><strong><span style="font-size: 11pt;">Introduction: </span></strong><span style="font-size: 11pt;">Contrast – induced nephropathy (CIN), is an acute kidney injury state, which has managed to catch the attention of cardiologists, as a result of increasing cardiac invasive interventions. Lately there has been a lot of research to get insight in the etiology, pathogenesis, recognition, diagnosis and prevention of CIN, so that the long term adverse effects can be avoided. Much of the research has been in the form of retrospective or observational studies on groups of patients undergoing angiographic contrast exposure.</span></p><p class="MsoNormal" style="text-align: justify; tab-stops: .25in;"><strong><span style="font-size: 11pt;">Objective: </span></strong><span style="font-size: 11pt;">The objective of the study was to:</span></p><p class="MsoListParagraph" style="margin: 0in 0in 0.0001pt; text-align: justify;"><span style="font-family: 'Times New Roman', serif;">Determine the frequency of CIN in diabetics under-going coronary angiography.</span></p><h1 style="margin: 0in; margin-bottom: .0001pt; text-align: justify; page-break-after: auto; tab-stops: .25in;"><span style="font-size: 11pt; font-family: 'Times New Roman', serif;">Study Design: </span><span style="font-size: 11pt; font-family: 'Times New Roman', serif; font-weight: normal;">Case series.</span></h1><p class="MsoNormal" style="text-align: justify; tab-stops: .25in;"><strong><span style="font-size: 11pt;">Settings: </span></strong><span style="font-size: 11pt;">Department of Cardiology, Jinnah Hospital, Lahore.</span></p><p class="MsoNormal" style="text-align: justify; tab-stops: .25in;"><strong><span style="font-size: 11pt;">Duration of Study: </span></strong><span style="font-size: 11pt;">Six months (1<sup>st</sup> June, 2014 to 30<sup>th</sup></span> <span style="font-size: 11pt;">November, 2014).</span></p><p class="MsoNormal" style="margin-bottom: .5pt; text-align: justify; tab-stops: .25in;"><strong><span style="font-size: 11pt;">Subjects and Methods: </span></strong><span style="font-size: 11pt;">155 patients fulfilling the selection criteria were included in the study. They were admitted through medical emergency and out-door department and admitted in CCU, Jinnah Hospital Lahore. Written informed consent was taken. Patient related information (name, age, sex and address) was obtained. These patients underwent coronary angiography. Post angiogram, serum analysis was done daily during hospital stay of patient to assess serum creatinine. CIN was labeled as per operational definition and thus frequency of CIN in type I and type II diabetics undergoing angiography was determined by serial creatinine monitoring.</span></p><p class="MsoNormal" style="margin-bottom: .5pt; text-align: justify; tab-stops: .25in;"><strong><span style="font-size: 11pt;">Results: </span></strong><span style="font-size: 11pt;">The frequency of increase in serum create-nine ? 0.5 mg/dl after PCI leading to CIN in diabetics undergoing coronary angiography was recorded in 7.10% (n = 11) out of a total of 155 cases.</span></p><p class="MsoNormal" style="margin-bottom: .5pt; text-align: justify; tab-stops: .25in;"><strong><span style="font-size: 11pt;">Conclusion: </span></strong><span style="font-size: 11pt;">We concluded that the frequency of CIN is not very high in diabetic patients undergoing coronary angiography. However, it continues to be a clinically challenging adverse event in all patients, especially diabetics, having coronary angiography for diagnostic or therapeutic purposes. Therefore, these patients should be recognized and monitored carefully to avoid long-term adverse effects of CIN.</span></p><p class="MsoListParagraph" style="margin: 0in 0in 0.0001pt; text-align: justify;"><strong><span style="font-family: 'Times New Roman', serif;">Keywords: </span></strong><span style="font-family: 'Times New Roman', serif;">Coronary artery disease, coronary angiography, diabetes, contrast induced nephropathy, frequency.</span></p>