Early Diagnosis Of Contrast-induced Renal Damage And The Protective Effect Of Hydration Therapy

Objective To investigate whether urine neutrophil gelatinase apolipoprotein (NGAL) and kidney injury factor1(KIM-1) may be an early diagnostic markers of CIN, and to assess the effectiveness of the hydration therapy in the prevention of CIN.Methods One hundred and twenty patients were divided into control group and treatment group according to whether to accept hydration therapy. The patients of treatment group were received hydration therapy through intravenous fluid infusion. Urine samples were taken for detecting the value of albumin (mAlb), al-MG,NAG,NGAL, and KIM-1before surgery (TO), after12h (T1),24h (T2),48h (T3),72h (T4) by ELISA assay, The levels of urinary albumin (mAlb), Scr, BUN and cystatin C were detected at the same time.Results (1) The urine NGAL/Cr and KIM-1/Cr significantly increased to more than twice the baseline value at the time of12h after PCI in87of120cases of the participants. There are eight cases occurred CIN (6.67%). One case occurred in hydration treatment group (1.7%), seven cases occurred in control group (11.7%), the difference was statistically significant.(2)There were not significantly different in BUN, Scr, mAlb/Cr, Cys-C, GFR value between two groups and the internal comparison group (P>0.05).(3) al-MG, NAG were elevated at T2in both groups (P<0.01). In hydration treatment group al-MG, NAG were substantially decreased to the level of TO at T4, while in the control group they were not significantly decreased to the level of TO (P<0.01).(4) NGAL/Cr, KIM-1/Cr were elevated at T1in both groups (P<0.01). In hydration treatment group NGAL/Cr, KIM-1/Cr were substantially decreased to the level of TO at T4, while in the control group they were not significantly decreased to the level of TO (P<0.01).(5)Area under the ROC curve (AUC) of NGAL/Cr, KIM-1/Cr12h after PCI were0.931(95%CI:0.889to0.973),0.811(0.736to0.886) respectively(all P<0.05).Conclusions NGAL and KIM-1are sensitive and specific indicators for predicting early renal injury induced by contrast medium and can be used for early diagnose of CIN. Hydration therapy can better control the contrast agent-induced renal damage occurred.