Donadio C, Lucchesi A, Tramonti G, Calderazzi A, Gibilisco G, Paolicchi A, Giordani R, Bianchi C
Unità di Nefrologia Clinica Medica 2, Univeristà di Pisa, Italy.
Ren Fail. 1996 Jul;18(4):657-66. doi: 10.3109/08860229609047691.
The aim of this study is to evaluate the nephrotoxicity of two contrast media (CM), with different physicochemical characteristics: diatrizoate (ionic high-osmolar), iopromide (nonionic low-osmolar). Intravenous urography was performed in 34 patients: 17 were examined with diatrizoate and 17 with iopromide, randomly assigned. Different parameters of glomerular and tubular function were measured before and at 6, 24, and 48 h after urography. Both contrast media induced a reversible increase of urine enzymes, which was significantly higher after diatrizoate. In particular, diatrizoate determined a relevant increase of brush border enzymes gamma-glutamyltransferase (GGT) and alkaline phosphatase (ALP) and of cytosolic enzyme lactate dehydrogenase (LDH), while, after iopromide increases of urinary enzymes were less evident and were significant only for GGT and ALP. In addition, diatrizoate affected other tubular functions (clearances of phosphorus and uric acid) and slightly decreased glomerular function in a few patients. In no case did these glomerular and tubular effects have a clinical relevance. In conclusion, the nonionic low-osmolar contrast medium iopromide appeared less nephrotoxic than diatrizoate. The cost-benefit ratio needs further examination.
本研究旨在评估两种具有不同理化特性的造影剂（CM）的肾毒性：泛影葡胺（离子型高渗）、碘普罗胺（非离子型低渗）。对34例患者进行了静脉肾盂造影：随机分配，17例用泛影葡胺检查，17例用碘普罗胺检查。在静脉肾盂造影前以及造影后6小时、24小时和48小时测量肾小球和肾小管功能的不同参数。两种造影剂均导致尿酶可逆性升高，泛影葡胺后的升高幅度明显更大。具体而言，泛影葡胺导致刷状缘酶γ-谷氨酰转移酶（GGT）和碱性磷酸酶（ALP）以及胞质酶乳酸脱氢酶（LDH）显著升高，而碘普罗胺后尿酶升高不太明显，仅GGT和ALP显著升高。此外，泛影葡胺影响了其他肾小管功能（磷和尿酸清除率），并使少数患者的肾小球功能略有下降。这些肾小球和肾小管效应在任何情况下都没有临床相关性。总之，非离子型低渗造影剂碘普罗胺的肾毒性似乎比泛影葡胺小。成本效益比需要进一步研究。
