Khoury G A, Hopper J C, Varghese Z, Farrington K, Dick R, Irving J D, Sweny P, Fernando O N, Moorhead J F
Br J Radiol. 1983 Sep;56(669):631-5. doi: 10.1259/0007-1285-56-669-631.
We assessed the nephrotoxicity of ionic and non-ionic radiocontrast material (CM) in two groups of patients in a prospective study. One group of 25 potential live kidney donors was studied following conventional renal angiography, carried out as part of the routine pre-operative assessment. The other group of 49 renal transplant patients with varying degrees of renal impairment was studied following digital vascular imaging carried out for investigation of hypertension. Plasma creatine, urinary N-acetyl-D-glucosaminidase (NAG), urinary microglobulin (B2M) and urinary protein excretion were measured before and after the imaging procedure. There were no significant changes in these parameters following digital vascular imaging, but there were increases in plasma creatinine (p less than 0.005) and urinary NAG creatinine ratio (p less than 0.002) in the conventional angiography group following the procedure. Substantial proteinuria developed in 35% of patients following conventional angiography. The differences in nephrotoxicity of radiocontrast agents during the two procedures could not be accounted for by the dose of material used, but probably reflect the effect of differences in the route of administration on the maximal concentration of the material reaching the kidney. Non-ionic radiocontrast material proved less toxic than ionic and may be preferable in conventional angiography.
在一项前瞻性研究中，我们评估了离子型和非离子型放射性造影剂（CM）对两组患者的肾毒性。一组为25名潜在的活体肾供者，在作为常规术前评估一部分进行的传统肾血管造影术后接受研究。另一组为49名有不同程度肾功能损害的肾移植患者，在为调查高血压而进行数字血管成像术后接受研究。在成像检查前后测量血浆肌酐、尿N-乙酰-D-氨基葡萄糖苷酶（NAG）、尿微球蛋白（B2M）和尿蛋白排泄量。数字血管成像术后这些参数无显著变化，但传统血管造影组术后血浆肌酐（p<0.005）和尿NAG/肌酐比值（p<0.002）升高。35%的患者在传统血管造影术后出现大量蛋白尿。两种检查过程中造影剂肾毒性的差异不能用所用造影剂的剂量来解释，而可能反映了给药途径差异对到达肾脏的造影剂最大浓度的影响。非离子型放射性造影剂的毒性低于离子型，在传统血管造影中可能更可取。
