Key result
Iopromide exposure resulted in a significantly higher average percent increase in serum NGAL at 24 hours compared to Gd-DTPA (62.23% vs. 36.44%, p=0.002) in pediatric patients.
Why the study?
Does exposure to iodinated-based versus gadolinium-based contrast media cause different rates of subclinical nephrotoxicity as measured by NGAL and KIM-1 in pediatric patients with normal kidney function?
Cohort (n=123)
Does exposure to iodinated-based versus gadolinium-based contrast media cause different rates of subclinical nephrotoxicity as measured by NGAL and KIM-1 in pediatric patients with normal kidney function?
Absolute Event Rate: 32.6% vs 25.45%
p-value: p=0.002
Both iodinated and gadolinium-based contrast media can cause subclinical nephrotoxicity in children with normal renal function, which can be detected early using serum NGAL and urinary KIM-1.
Both contrasts may induce subclinical nephrotoxicity detectable by NGAL/KIM-1 in children with normal renal function; leaves open clinical relevance and need for prospective validation.
BACKGROUND New renal biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) show promise in early diagnosis of contrast media induced acute kidney injury (CI-AKI). The purpose of our study was to compare the subclinical nephrotoxicity (a condition without changes in standard renal biomarkers) of gadolinium-based contrast media (Gd-DTPA, gadopentetate dimeglumine) and iodinated-based contrast media (iopromide) in pediatric patients with normal kidney function. MATERIAL AND METHODS The first group (n=58) of patients included in the study were undergoing angiography with iopromide, and the second group (n=65) were undergoing magnetic resonance (MR) angiography/urography with Gd-DTPA administration. The concentrations of NGAL and KIM-1 were measured four times in the urine (pre-contrast, then at four hours, 24 hours, and 48 hours after contrast administration), and serum NGAL was measured at 0 (baseline), 24 hours, and 48 hours after contrast exposure. RESULTS After 24 hours, serum NGAL increase of ≥25% was noticed in 32.6% of the patients in the iopromide group and in 25.45% of the patients in the gadolinium group, with significantly higher average percent of this increase in first group (62.23% vs. 36.44%, p=0.002). In the Gd-DTPA group, we observed a statistically significant increase in urinary KIM-1 24 hours after the procedure. Normalized urinary KIM-1, 24 hours after contrast exposure, was a better predictive factor for CI-AKI than other biomarkers (AUC 0.757, cut off 214 pg/mg, sensitivity 83.3%, specificity 54.2%, p=0.035). CONCLUSIONS In children with normal renal function, exposure to iodinated-based and gadolinium-based media might lead to subclinical nephrotoxicity, which could be detected using serum NGAL and urinary KIM-1.
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Spasojević et al. (2017) conducted a cohort in Normal kidney function requiring contrast media (n=123). Iopromide (iodinated-based contrast media) vs. Gd-DTPA (gadolinium-based contrast media) was evaluated on Serum NGAL increase of ≥25% at 24 hours (p=0.002). Iopromide exposure resulted in a significantly higher average percent increase in serum NGAL at 24 hours compared to Gd-DTPA (62.23% vs. 36.44%, p=0.002) in pediatric patients.
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