Urinary KIM-1, IL-18and Cys-c As Early Predictive Biomarkers In The Elderly Patients With Gadolinum Contrast-Induced Nephropathy

Objective:To explore the changes and clinical significance of urinary kidney injury molecule-1(KIM-1), interleukin-18(IL-18), cystatin C (Cys C) and N-acetyl-β-D-glucosaminidase (NAG) in the elderly patients after intravenous injection of gadolinium contrast agent.Methods:Sixty elderly patients undergone gadolinium enhanced magnetic resonance imaging were studied from December2010to December2011admitted to the Second Xiangya Hospital of Central South University. The urine sample at baseline,24h,48h after angiography, and serum samples at baseline,48h after angiography were collected respectively. The serum creatinine, urinary creatinine and NAG levels were measured by automatic biochemical analyzer. Urinary KIM-1, IL-18and CysC levels were detected by enzyme linked immune sorbent assay (ELISA).Results:1. There8cases among the60patients (13.3%) were diagnosed Gd-CIN with diagnostic standards.2. Compared with non-Gd-CIN group, the urinary KIM-1, IL-18, CysC levels24h after contrast media administration and urinary IL-18level of48h after contrast media administration were significantly increased (P<0.05). There was no significant difference in urinary KIM-1, CysC levels between Gd-CIN and non-Gd-CIN group (P>0.05).3. The urinary KIM-1, IL-18, CysC and NAG levels24h after gadolinium contrast agent administration in the Gd-CIN group were significantly higher than before that (P <0.05); Compared with the baseline values, there were no significant changes in urinary KIM-1, IL-18, CysC and NAG levels48h after the procedure (P>0.05); the above indicators24h and48h after gadolinium contrast agent administration showed no significant difference in the non-Gd-CIN group (P>0.05).4. The logistic regression analysis indicated that the urine IL-18and KIM-124h after gadolinium contrast agent administration were independent risk factors of Gd-CIN. The area under Receiver operating characteristic (ROC) curve for urinary KIM-1was91%(P<0.05;95%Cl=0.835-985) and for urinary IL-18was87.7%(P<0.05;95%Cl=0.757-0.998).Conclusion:l.The incidence of Gd-CIN in elderly patients undergone gadolinium enhanced magnetic resonance imaging was13.3%.2.Urinary KIM-11、 IL-18and CysC levels might be better diagnostic biomarkers for early-stage Gd-CIN. Urinary KIM-1and IL-18as early independent predictive biomarkers in gadolinium contrast-induced nephropathy. 3. On the basis of urinary KIM-1IL-18and CysC levels, Gd-CIN could be diagnosed at24h earlier than by SCr.