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CONTRAST-INDUCED NEPHROPATHY IN INTERVENTIONAL CARDIOLOGY
AND ANGIOLOGY
Lutfullaev Oltin Oybekovich
Asian International University
Tel: +998911329697
oltinlutfullayev @ gmail . com
ABSTRACT:
Cardiovascular diseases are the leading cause of death in industrialized
countries. High-quality and accurate diagnostics, including cardiac and vascular imaging,
are of great importance for adequate assessment, treatment, and prevention of cardiovascular
diseases. Intravenous or intra-arterial administration of radiocontrast agents (or simply
contrast agents) allows for precise determination of the vascular anatomy, the nature and
localization of lesions in them, and assessment of the blood supply to various organs and
tissues. Without such information, modern treatment would be simply impossible. Selective
angiography and computed tomography with the introduction of contrast agents (CA) are
used everywhere in practical medicine. Therefore, safety issues of examination or
intervention using CA are of great importance. Despite significant progress in the
development of CA, they have a number of adverse effects, including nephrotoxicity.
Prevention of the nephrotoxic effect of CA, the so-called contrast-induced nephropathy
(CIN), remains a pressing issue, since It is known that CIN is often a harbinger of chronic
renal failure, which worsens the prognosis (McCullough, P. A. et al. 1997, Rihal, C. S. et al.
2002). Active use of X-ray computed tomography with intravenous administration of KB at
the diagnostic stage increases not only the total radiation load, but also nephrotoxicity.
Endovascular interventions, in which the risk of developing CIN is increased, are
increasingly carried out in severely ill older patients with multifocal atherosclerosis, diabetes
mellitus, arterial hypertension, heart failure, chronic kidney disease, etc. The interventions
themselves are becoming more complex, often multi-stage, with the use of a large volume of
KB. The dissertation is devoted to a topical issue - the prevention of CIN in patients who
undergo endovascular interventions on the coronary and peripheral arteries.
CONCLUSIONS
KB are organic compounds containing a benzene ring and iodine atoms, and differ in
chemical structure, in the number of ionized or non-ionized side chains. Differences in
chemical structure determine chemotacticity during interaction of KB with organs and
tissues. They also determine the physicochemical differences in KB in osmolarity and
viscosity. The osmolarity of a solution is determined by the number of particles dissolved in
it, respectively, the osmolarity of KB will be determined by the number of iodine atoms and
osmolarly active ions. KB containing ionized residues have a significantly higher osmolarity
than non-ionic KB. Large-molecular KB, on the contrary, are less osmolar, since they
contain fewer molecules per unit volume. But solutions of large-molecular compounds are
more viscous than low-molecular ones, since the viscosity of a solution is due to the
property of fluid bodies to resist the movement of one of their parts relative to another.
Accordingly, KB, the molecule of which contains two benzene rings - dimers, have a higher
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viscosity, but lower osmolarity than monomeric KB, which include one benzene ring. Ionic
KB of the previous generation, for example, meglumine diatrizoate (Urografin, Schering,
Germany), were distinguished by high osmolarity, 5-6 times exceeding the osmolarity of
plasma (Parfrey P.S. et al. 1989, Davidson S.J. et al. 1989, Rudnik M.R. et al. 1995) and
when introduced into the vascular bed in large volumes, the osmolarity of plasma, which
under normal conditions is a fairly constant value, quickly increases. Hyperosmolar plasma
has a negative effect on renal function and can lead to transient acute renal dysfunction
(Schwab S.J., et al. 1989, Cigarroa R.G. et al. 1989, Lautin E.M. et al. 1991). In contrast to
high-osmolar first-generation KB, the osmolarity of modern non-ionic KB, such as Iogexol
(Omnipaque, GE Healthcare, USA), Iopromide (Ultravist, Schering, Germany), Ioversol
(Tyco Healthcare Group AG, Switzerland) is significantly lower (500 - 850 mcosmol/kg).
Low-osmolar KB are less toxic to the kidneys and significantly less often than high-osmolar
KB cause adverse reactions, including and renal dysfunction (Lautin E.M. et al. 1991.
Rudnick M.R. et al. 1994, Barret B.J. ey al. 1994, Solomon et al. 1998). It was expected that
CB with lower osmolarity (comparable to plasma osmolarity) could be even less toxic to the
kidneys. These were the prerequisites for the creation of isoosmolar CB with osmolarity
equal to plasma osmolarity (Aspelin P. et al. 2003). Today, the only isoosmolar nonionic CB
used in practical medicine is the dimer Iodixanol (Visipaque, GE Healthcare, USA). The
osmolarity of Iodixanol is 290 mCosmol/kg. However, as noted above, due to the dimeric
structure of the Iodixanol molecule (two benzene rings), its viscosity is higher than that of
other CB. And viscosity, according to some data, negatively affects renal function and the
toxic effect on the kidneys is higher in more viscous KB (Schwab S.J., et al. 1989, Cigarroa
R.G. et al. 1989, Lautin E.M. et al. 1991). Unfortunately, both low-osmolar and isoosmolar
KB cause renal dysfunction (RD) in a certain category of patients. The ideal non-ionic KB,
combining isoosmolarity with low viscosity and providing high-quality visualization, has
not yet been synthesized.
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