Contrast-Induced Nephropathy

Reviewing the Literature

Bladder Cancer continued Contrast-Induced Nephropathy Sodium Bicarbonate to Reduce Contrast-Induced Nephropathy Reviewed by Dean G. Assimos, MD Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC creatinine within 2 days of contrast administration. Contrast-induced nephropathy developed in 1.7% of those receiving sodium bicarbonate and 13.6% of those administered saline (P
.02). Urologists should consider this regimen for their patients who are at risk for contrast-induced nephropathy including those with diabetes mellitus or known renal insufficiency. Further studies are warranted to determine whether the combination of sodium bicarbonate and Nacetylcysteine would further attenuate this risk or whether sodium bicarbonate taken orally would have the same impact. [Rev Urol. 2005;7(3):190] References © 2005 MedReviews, LLC 1. significant number of urologic patients are evaluated with imaging studies in which iodinated contrast is administered intravenously. Contrast-induced nephropathy is a potential sequel of such studies. It is thought that free radical generation is a causative factor of this problem.1 The administration of N-acetylcysteine, the use of the iso-osmolar contrast agent iodixanol, and hemofiltration before and after contrast administration have been used to reduce renal dysfunction after contrast loads.2-4 Free radical generation occurs more readily in an acidic environment and is attenuated by higher extracellular pH. Merten and colleagues performed a randomized controlled trial to assess whether hydration with the administration of intravenous sodium bicarbonate before, during, and after contrast administration limits the risk of renal dysfunction. A Prevention of Contrast-Induced Nephropathy with Sodium Bicarbonate 2. 3. 4. Bakris GL, Gaber AO, Jones JD. Oxygen free radical involvement in urinary Tamm-Horsfall protein excretion after intrarenal injection of contrast medium. Radiology. 1990;175:57-60. Tepel M, Van der Giet M, Schwarzfeld C, et al. Prevention of radiographiccontrast-agent-induced reductions in renal function by N-acetylcysteine. N Engl J Med. 2000;343:180-184. Aspelin P, Aubry P, Fransson SG, et al. Nephrotoxic effects in high-risk patients undergoing angiography. N Engl J Med. 2003;348:491-499. Marenzi G, Marana I, Lauri G, et al. The prevention of radiocontrast-agentinduced nephropathy by hemofiltration. N Engl J Med. 2003;349:1333-1340. Bladder Cancer Choosing Earlier Therapy for Muscle-Invasive Bladder Cancer Reviewed by John P. Stein, MD, FACS Merten GJ, Burgess WP, Gray LV, et al. Department of Urology, Keck School of Medicine and the Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA JAMA. 2004;291:2328-2334. [Rev Urol. 2005;7(3):190-192] At a single medical center, 119 adults with serum creatinine ranging from 1.1 to 8.0 mg/dL were randomized to receive either intravenous sodium bicarbonate or intravenous saline starting 1 hour before, during, and for 6 hours after a radiographic study in which iopamidol, a nonionic con- © 2005 MedReviews, LLC Contrast-induced nephropathy developed in 1.7% of those receiving sodium bicarbonate and 13.6% of those administered saline. trast agent, was administered. Contrast-induced nephropathy was defined as an increase of 25% or more in serum 190 VOL. 7 NO. 3 2005 REVIEWS IN UROLOGY ne of the most difficult clinical challenges urologists face is the management of superficial bladder cancer. Approximately 70% of patients who present with bladder cancer have tumors confined to the mucosa or submucosa, so-called superficial bladder cancers. These superficial bladder tumors represent a heterogeneous group of cancers with varying degrees of malignant potential. The overall treatment goals for superficial bladder cancer are twofold: 1) reducing tumor recurrence and the subsequent need for additional therapies (ie, cystoscopy, transurethral resection, and intravesical therapy) and the morbidity associated with these treatments, and 2) O