Keyword : contrast-induced nephropathy, cystatin C, kidney injury molecule-1
Background: Contrast-induced nephropathy (CIN) is a complication that is underestimated in clinical practice after cardiac catheterization. In the present study, we sought to investigate whether serum cystatin C, neutrophil gelatinase-associated lipocalin (NGAL), urinary kidney injury molecule-1 (KIM-1) may be an early diagnostic marker of CIN after percutaneous coronary intervention (PCI).
Methods and Results: In 51 stable angina patients undergoing primary PCI, serum creatinine (Cr) and cystatin C were measured at baseline and 24, 48 hours after PCI. Contrast-induced nephropathy was defined as a rise in Cr 0.5 mg/dl or 25% above baseline. Serum NGAL, Urinary KIM-1 were measured immediately before, and 4, 24 and 48 hours after PCI. Urinary creatinine concentration was also checked for correction of urinary KIM-1. CIN occurred in 4 patients(7.8%). Baseline BMI(body mass index) was higher in CIN patients than in those without CIN (30 ± 3 kg/m2 vs 24 ± 3 kg/m2, p=0.001). Total cholesterol, LDL cholesterol, triglyceride was higher in contrast-induced nephropathy patients(232 ± 82 mg/dl vs 166 ± 33 mg/dl, 131 ± 41 mg/dl vs 100 ± 26 mg/dl, 352 ± 383 mg/dl vs 148 ± 65 mg/dl respectively, p<0.05). Serum Cystatin C levels were higher at 24hr and 48hr in contrast-induced nephropathy patients than in those without CIN (p<0.05). Serum NGAL levels were not statistically different between two groups. However, serum NGAL levels were increased significantly after 4 hours and maximally after 24 hours. (p<0.05) Urinary KIM-1/urinary creatinine levels were not significantly different between two groups.
Conclusions: In this study, BMI, total cholesterol, LDL cholesterol, triglyceride, 24hr serum creatinine, 24hr and 48hr cystatin C level was higher in contrast-induced nephropathy patients. But serum NGAL and urinary KIM-1 was not significantly different in contrast-induced nephropathy group. Further studies with larger sample sizes are needed to validate our findings.
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Table. Time-course changes in serum cystatin C, NGAL and urinary KIM-1, IL-18 according to the presence of contrast induced nephropathy
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Before PCI |
After 4 h |
After 24 h |
After 48 h |
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CIN
(-) |
Creatinine
Cystatin C
Serum NGAL
UKIM-1/UCr |
0.84 ± 0.19
1.07 ± 0.37
99.6 ± 69.3
0.82 ± 0.66 |
0.83 ± 0.19
0.99 ± 0.34
153.2 ± 120*
1.28 ± 2.13 |
0.82 ± 0.20$
1.11 ± 0.33$
156.5 ± 114*
0.85 ± 0.52 |
0.85 ± 0.23
1.06 ± 0.32$
140.6 ± 92.8*
0.86 ± 0.6 |
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CIN
(+) |
Creatinine
Cystatin C
Serum NGAL
UKIM-1/UCr |
1.05 ± 0.3
1.45 ± 0.62
92.4 ± 38.6
1.27 ± 0.92 |
1.05 ± 0.19
1.5 ± 0.61
107.0 ± 47.7
1.27 ± 0.84 |
1.13 ± 0.28$
1.58 ± 0.79$
117.6 ± 56.0
1.40 ± 1.14 |
1.18 ± 1.40
1.62 ± 0.85$
216.3 ± 145.1
1.27 ± 0.63 |
Datas given are mean values ± SD CIN ; contrast induced nephropathy, NGAL ; neutrophil-gelatinase-associated lipocalcin, KIM-1 ; Kidney injury molecule-1, IL-18 ; interleukin-18, PCI ; percutaneous coronary intervention
* p < 0.05 vs. baseline, $ p<0.05 CIN(-) vs. CIN(+)
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