Nephrology Dialysis Transplantation, Vol 14, Issue 5 1146-1149, Copyright © 1999 by Oxford University Press
C Erley, S Duda, D Rehfuss, B Scholtes, J Bock, C Muller, H Osswald and T Risler
Background. Radiographic contrast media (CM)
application causes a decline in renal function, especially in patients with
pre-existing renal dysfunction. In addition to hydration, several
vasodilating substances have been evaluated for their ability to prevent
renal damage after CM application. In a prospective, double-blind,
placebo-controlled study we investigated the effect of the oral
administration of theophylline, an adenosine receptor antagonist, on
changes in renal haemodynamics and tubular injury induced by CM in well
hydrated patients with mild-to-moderate renal insufficiency.
Methods. We studied 80 patients with pre-existing
chronic renal insufficiency (creatinine >1.5 mg/dl) who received
more than 100 ml iopromide. Hydration (either oral or intravenous) started
at least 24 h before and lasted until 24 h after CM application. In
addition, patients were randomly assigned to receive either theophylline
(810 mg daily) or placebo. Serum creatinine and creatinine clearance were
measured before and for 3 days after CM application. Urine was collected to
measure N-acetyl-{beta}-glucosaminidase (NAG)
enzymuria for the same period. Sixty-four patients completed the entire
study protocol (theophylline, n=35 and placebo,
n=29). Results. During the study
period serum creatinine concentration and creatinine clearance did not
change significantly in either group. Acute renal failure (increase of
serum creatinine of at least 0.5 mg/dl) could be observed in two patients
from the theophylline group (5.7%) and one from the placebo group (3.4%).
The increase in NAG excretion reached statistical significance
(P<0.05) in the placebo group on days 2 and 3
after CM application. Conclusions. Our results
indicate a role for adenosine in CM-induced tubulotoxicity. However, the
glomerular filtration rate is preserved by hydration alone in these
patients. The application of theophylline did not bring an additional
benefit. The use of adenosine antagonists may be beneficial in patients
where sufficient hydration may be impossible or in patients with a
concomitant decrease in renal blood flow (e.g. congestive heart failure).
Keywords: acute renal failure; adenosine; contrast
media; contrast-media toxicity; hydration; theophylline
ORIGINAL ARTICLES
Prevention of radiocontrast-media-induced nephropathy in patients with pre-existing renal insufficiency by hydration in combination with the adenosine antagonist theophylline
University of Tuebingen, Departments of Internal Medicine III, Diagnostic Radiology and Pharmacology, Eberhard-Karls-Universitat, Tubingen, Germany; Corresponding author
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