Su Hua, Ye Chen, Wen Qian, Zhu Hong-Yan, Yi Li-Xia, Zhang Chun
Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
BMC Nephrol. 2018 Mar 6;19(1):53. doi: 10.1186/s12882-018-0844-2.
It is well-recognized that injection of iodinated radiographic contrast media (CM) sometimes causes acute renal injury via multiple mechanisms, such as vasoconstriction, toxicity on glomerular endothelium and tubular epithelium and so forth.
A 51-year-old man developed acute renal injury with proteinuria after CM administration. To our surprise, in his renal biopsy sample the myelin figure like structure was observed in glomerular endothelium and mesangial cells by transmission electron microscopy. However the patient didn't has any clinic clues of Fabry disease and other lysosomal storage disorders. Moreover in vitro cultured glomerular endothelial and mesangial cells we found CM triggers lipid aggregation along with the increased CD36 and decreased ABCA1 abundance. Thus this patient was administrated statin to correct the aberrant lipid trafficking, 2 months later at his next visit we found his renal function partially recovered with reduced proteinuria.
Besides the well-known underlying mechanisms, CM may cause renal impairment by triggering the dysregulated transportation of lipid. Furthermore statin is suggested to be a very promising medicine to decrease side effects of CM.
众所周知，注射碘化放射造影剂（CM）有时会通过多种机制导致急性肾损伤，如血管收缩、对肾小球内皮和肾小管上皮的毒性等。
一名51岁男性在使用CM后出现急性肾损伤并伴有蛋白尿。令我们惊讶的是，在他的肾活检样本中，通过透射电子显微镜在肾小球内皮和系膜细胞中观察到髓鞘样结构。然而，该患者没有任何法布里病和其他溶酶体贮积症的临床线索。此外，在体外培养的肾小球内皮细胞和系膜细胞中，我们发现CM会引发脂质聚集，同时伴有CD36增加和ABCA1丰度降低。因此，该患者接受了他汀类药物治疗以纠正异常的脂质转运，2个月后复诊时，我们发现他的肾功能部分恢复，蛋白尿减少。
除了众所周知的潜在机制外，CM可能通过引发脂质转运失调导致肾损伤。此外，他汀类药物被认为是一种非常有前景的药物，可以减少CM的副作用。
