Dynamic Change Of Renal Function In Patients With Cerebrovascular Disease After Digital Subtraction Cerebral Angiography

ObjectiveDigital subtraction cerebral angiography and endovascular intervention are commonly used in neurology examinations and treatments.Some patients may have contrast induced nephropathy after angiography or interventional therapy.To study the incidence of CIN,collect baseline data,test renal function including serum creatinine,urea,uric acid,cystatin C and retinol binding protein after cerebral angiography,analyze the risk factors of CIN and observe any deterioration of renal function at 3 months follow-up.Methods139 patients with cerebrovascular diseases who underwent digital subtraction cerebral angiography or endovascular intervention therapy were collected.Clinical baseline data such as gender,age,smoking,drinking,medical history including chronic renal insufficiency,hypertension,diabetes mellitus anemia,medication history including metformin,NSAIDS,contrast agent type and dosage,etc.The renal function indicators including serum creatinine,urea,uric acid,cystatin C and retinol binding protein were measured before operation and 6h,24h,72h after operation.All patients receiving CM should have an optimal volume status at the time of exposure.Patients were followed up by telephone or face-to-face at 3 months after operation.The follow-up items including backache,lumbago,urine.And serum creatinine,urea,uric acid were also collected at 3 months.Results1)A total of 139 patients with cerebrovascular disease were collected,having symptomatic cerebral infarction 33 cases(23.74%),and other cerebrovascular diseases 106 cases(76.26%);mean age was 63.42±11.76 years;103 cases were men;serum creatinine 68.87±17.52 μmol/L,eGFR 106.7±29.34 mL/min/1.73m2,urea 4.76±1.24 mmol/L,uric acid 289.1±85.75 pmol/L,cystatin C 0.99±0.22 mg/L,retinol binding protein 32.55±9.23μg/mL.2)The analysis of variance with repeated measurements showed that the renal function biomarkers including uric acid,cystatin C and retinol binding protein uric acid changed significantly after 6-24 hours of operation(P<0.05),and returned to baseline values within 72 hours.Serum creatinine and urea were not significantly different before and after operation(P>0.05).The overall incidence of CIN was 1.44%.There was no significant change in serum creatinine value after operation in 3 months of follow-up.3)The renal function has some correlation with the contrast dose and operation time,but there were not statistically significant differences(P>0.05).The operation time was negatively correlated with the renal index including there were g urea acid(r=0.-248,P=0.012)and retinol-binding protein level(r=0.-239,P=0.022).4)Serum creatinine and retinol-binding protein level before operation in eGFR≤90ml/min/1.73m2 group were significantly lower than those after operation(P<0.05).eGFR level after operation was significantly higher than that before operation(P=0.001).Serum creatinine,cystatin C and retinol-binding protein level after operation in eGFR>90ml/min/1.73m2 group were significantly higher than those before operation(P<0.05).eGFR level after operation was significantly lower than that before operation(P<0.001).5)Cystatin C and uric acid level after operation were significantly lower than those in age higher than 65 years old group before operation(P<0.05).Retinol-binding protein level after operation in age lower than 65 years old group was significantly lower than that before operation(P=0.001).6)Cystatin C and retinol-binding protein after operation in symptomatic cerebral infarction group were significantly lower than those before operation(P<0.05).7)Uric acid level after operation was significantly lower than that before operation of both diabetes and non-diabetes group(P<0.05).Cystatin C and retinol-binding protein in non-diabetes group after operation were significantly lower than those before operation.(P<0.05).8)Uric acid level of both aspirin group and non-aspirin group after operation was significantly lower than that before operation(P<0.05).Cystatin C in aspirin group after operation was significantly higher than that before operation(P=0.009).Retinol-binding protein level was significantly lower than that before operation(P<0.001).9)Uric acid level after operation was significantly lower than that before operation of both smoking and non-smoking group(P<0.05).Retinol-binding protein in smoking group decreased significantly after operation(P=0.001),and cystatin C in non-smoking group was also dropped obviously.(P=0.001).10)The correlation analysis between renal function and creatinine showed that eGFR was negatively correlated with serum creatinine(r=-0.698,P<0.001),with uric acid(r=-0.324,P=0.001),and uric acid was negatively correlated with urea(r=0.552,P<0.001).The uric acid level was positively correlated with serum creatinine level(r=0.343,P<0.001),with retinol-binding protein level(r=0.332,P=0.002),and the retinol-binding protein level was positively correlated with cystatin C level(r=0.231,P=0.027).Conclusion:1)The incidence of CIN after digital subtraction cerebral angiography is low;the sensitive renal function biomarkers are uric acid,cystatin C and retinol binding protein,and they usually begin to change within6-24 hours of CM exposure,and returning to baseline values within 72 hours.2)The abnormality of renal function index in patients after operation is related to age,primary disease,drug,contrast dose and time.