Martín, Cláudia Matsunaga; Kogika, Marcia Mery; Miyashiro, Samantha Ive; Fonseca-Pinto, Ana Carolina Brandão de Campos

doi:10.1590/S0100-736X2017000700018

ABSTRACT:

Contrast-induced nephropathy (CIN) is an acute disease, secondary to intravascular administration of iodinated contrast media (ICM). The most important mechanisms of this nephropathy are intrarenal prolonged vasoconstriction, medular hypoxia, and ischemia associated with renal tubular damage due to contrast cytotoxicity. Owing to the limited information available in veterinary literature regarding these mechanisms this study aims to compare the renal effects of intravenous administration of two nonionic ICM of different osmolarities in groups of dogs with risk factors for CIN development, by using a B-mode, color, power- and pulsed-wave Doppler ultrasonography, and other laboratory tests, in order to indirectly estimate the nephrotoxic potential of each contrast. The following two groups were established according to the nonionic ICM used: the GIH group [11 dogs administered iohexol (low osmolarity)] and the GID group [seven dogs administered iodixanol (iso-osmolarity)]. Both the groups were administered the same dose (600mgI/kg/IV). The following renal aspects were evaluated before administration of ICM (baseline) and after 1h30min, 24h, and 48h: renal morphometry (length and volume), renal morphology, cortical echogenicity, renal perfusion, and intrarenal vascular resistance (resistive and pulsatility indices); in addition, urinalysis was performed, and urinary gamma-glutamyl transferase:creatinine ratio (GGT:C), urinary protein:creatinine ratio (UPC), and serum creatinine were also measured. Both groups showed similar characteristics with respect to the length, volume, UPC ratio, urinalysis, and serum creatinine levels. No similarity was observed with respect to the pulsatility index (PI) in both the groups and there were no significant differences between baseline and 1h30min, 24h and 48h time points. With respect to the IR and urinary GGT:C, both groups showed no similarity, and significant increases were observed in the resistive index (RI) and urinary GGT:C only in the GIH group, 1h30min after contrast administration. In conclusion, RI can be used to monitor intrarenal hemodynamics, and along with the urinary GGT:C, revealed that iohexol had higher nephrotoxic potential than iodixanol. Thus, iodixanol is considered a favorable option for dogs with risk factors for CIN development.

INDEX TERMS:
B-mode; Doppler ultrasonography; kidneys; intravenous iodinated contrast media; nephrotoxicity; radiocontrast media; osmolarity; dog.

[1] *Autor para correspondência: cmmartin@uol.com.br

Variável	Momentos Grupos	T0			T1		T2		T3		valor p
Variável	Momentos Grupos	Média	DP	Média	DP	Média	DP	Média	DP	interação	grupo	tempo
Comprimento (cm)	GIH	5,47	1,30	5,68	1,30	5,60	1,26	5,52	1,18	0,369	0,107	0,001
Comprimento (cm)	GID	6,42	1,05	6,52	0,97	6,43	1,01	6,45	1,08	0,369	0,107	0,001
Volume(cm³)	GIH	30,89	17,15	34,01	21,46	31,92	18,83	30,10	15,83	0,054	0,050	0,031
Volume(cm³)	GID	45,58	18,38	45,61	18,10	45,88	18,48	46,09	18,28	0,054	0,050	0,031
IR	GIH	0,64	0,06	0,68	0,08	0,66	0,07	0,64	0,05	0,026	0,899	0,074
IR	GID	0,65	0,04	0,67	0,04	0,64	0,03	0,66	0,03	0,026	0,899	0,074
IP	GIH	1,20	0,24	1,45	0,45	1,31	0,27	1,22	0,20	0,032	0,888	0,071
IP	GID	1,23	0,22	1,34	0,19	1,18	0,15	1,24	0,14	0,032	0,888	0,071
GGT:C	GIH	0,212	0,108	0,572	0,496	0,296	0,104	0,251	0,161	0,009	0,115	0,001
GGT:C	GID	0,368	0,148	0,378	0,150	0,471	0,314	0,362	0,136	0,009	0,115	0,001
RPC	GIH	0,646	1,321	0,607	1,224	0,515	0,909	0,762	1,736	0,275	0,540	0,839
RPC	GID	0,407	0,308	0,442	0,288	0,377	0,231	0,398	0,238	0,275	0,540	0,839
Densidade urinária	GIH	1,024	0,010	1,042	0,016	1,019	0,010	1,020	0,012	0,623	0,011	<0,001
Densidade urinária	GID	1,014	0,006	1,025	0,005	1,012	0,007	1,013	0,008	0,623	0,011	<0,001
Creatinina sérica (mg/dL)	GIH	0,91	0,28	0,89	0,28	1,00	0,37	0,92	0,27	0,297	0,752	0,171
Creatinina sérica (mg/dL)	GID	0,87	0,28	0,84	0,25	0,86	0,26	0,89	0,23	0,297	0,752	0,171

Grupos	Momentos	Volume (cm³)^a	IR	IP	GGT:C
GIH vs GID	T0	0,052	0,733	0,950	0,017
	T1	0,094	0,828	0,978	0,632
	T2	0,055	0,347	0,307	0,171
	T3	0,026	0,416	0,553	0,050
GIH	T0 vs T1	0,011	0,009	0,086	<0,001
	T0 vs T2	0,863	0,012	0,098	0,005
	T0 vs T3	0,252	0,947	0,762	0,609
	T1 vs T2	0,165	0,617	0,234	0,104
	T1 vs T3	0,009	0,042	0,019	0,008
	T2 vs T3	0,257	0,010	0,058	0,096
GID	T0 vs T1	0,231	0,141	0,116	0,859
	T0 vs T2	0,121	0,691	0,232	0,414
	T0 vs T3	0,042	0,364	0,578	0,985
	T1 vs T2	0,825	0,020	0,021	0,575
	T1 vs T3	0,462	0,277	0,244	0,919
	T2 vs T3	0,442	0,150	0,191	0,248

Variável	Momentos
Variável	T0 vs T1	T0 vs T2	T0 vs T3	T1 vs T2	T1 vs T3	T2 vs T3
Densidade urinária	<0,001	0,257	0,197	<0,001	0,970	<0,001
Comprimento (cm)	<0,001	0,095	0,460	0,102	0,208	0,010

Momentos Variável	Todos os momentos		T0		T1		T2		T3
Momentos Variável	IR	IP	IR	IP	IR	IP	IR	IP	IR	IP
GGT:C	0,033	0,064	-0,018	0,022	0,078	0,219	-0,320	-0,164	-0,002	-0,070
RPC	0,088	0,003	0,041	-0,131	0,275	0,355	0,090	0,068	0,034	-0,022
Densidade urinária	0,090	0,140	0,145	0,126	0,161	0,103	-0,089	-0,194	-0,239	-0,130
Creatinina sérica (mg/dL)	0,045	0,151	0,064	0,210	0,064	0,071	0,082	0,174	0,144	0,279

Todos os momentos
Variável	IR	IP	PAS	PAD	PAM	FC
IR	1	0,865^a	-0,316^a	-0,158	-0,250a	-0,127
IP	0,865^a	1	-0,201	-0,139	-0,183	0,017
Momento T0
Variável	IR	IP	PAS	PAD	PAM	FC
IR	1	0,925^a	-0,468	-0,157	-0,303	-0,026
IP	0,925^a	1	-0,288	-0,066	-0,165	0,182
Momento T1
Variável	IR	IP	PAS	PAD	PAM	FC
IR	1	0,845^a	-0,233	-0,121	-0,193	0,127
IP	0,845^a	1	-0,152	-0,102	-0,139	0,348
Momento T2
Variável	IR	IP	PAS	PAD	PAM	FC
IR	1	0,898^a	-0,026	-0,03	-0,037	0,052
IP	0,898^a	1	0,033	0,022	0,025	0,137
Momento T3
Variável	IR	IP	PAS	PAD	PAM	FC
IR	1	0,783^a	-0,516^a	-0,188	-0,352	-0,431
IP	0,783^a	1	-0,228	-0,236	-0,264	-0,361

Brasil

Brasil

B-mode and Doppler ultrasonography in the renal evaluation of dogs undergoing computed tomography after intravenous administration of different iodinated contrast media

ABSTRACT: