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Home > The Role of Inflammation in Contrast Induced Nephropathy

The Role of Inflammation in Contrast Induced Nephropathy

Thesis Info

Author

Kwasa, Elijah A.

Department

Imaging and Diagnostic Radiology (East Africa)

Program

MMed

Institute

Aga Khan University

Institute Type

Private

City

Karachi

Province

Sindh

Country

Pakistan

Thesis Completing Year

2013

Thesis Completion Status

Completed

Subject

Medicine

Language

English

Added

2021-02-17 19:49:13

Modified

2024-03-24 20:25:49

ARI ID

1676728072914

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Background: Intravenously administered iodinated contrast media are widely and liberally used in daily diagnostic radiological investigations. Contrast-induced nephropathy (CIN) is notable as the third commonest cause of hospital-acquired renal injury. Justification: The global prevalence of CIN from various studies ranges from 2-5% but an incidence of CIN of 12-14% in Kenya was highlighted by a recent study without an explanation for the markedly increased incidence. Intravascular contrast has been demonstrated to commonly cause renal vasoconstriction. However, the low incidence of CIN in the general population infers that contrast alone cannot be a causative insult. This study proposes that inflammatory states, which are prothrombotic, when coupled with renal vasoconstriction may confer a higher relative risk for development of CIN. Objective: To determine the risk of developing CIN given the presence of an inflammatory state in patients presenting to a private university hospital in Kenya. Study design: Prospective cohort study of patients undergoing a contrast- enhanced CT scan (CECT) in Aga Khan University Hospital, Nairobi (AKUHN) Radiology department and who have no known risk factors for CIN. Methodology: A total of 423 patients were recruited over a period of 4 months. The patients were grouped into those without inflammation (unexposed) having serum C-reactive protein (CRP) levels ≤5mg/dL and those with inflammation(exposed) having CRP levels >5mg/dl. Serum creatinine (SCr) was measured before the CECT and 48 hours following the CECT with CIN diagnosed when there was an increase of >25% in the SCr from the baseline value. Relative risk was determined and multiple logistic regression analysis performed on the biophysical variables (age, weight, sex) and contrast volume to assess their effect on development of CIN. Results: CIN was present in 42 (9.92%) patients. Of the exposed group (elevated CRP), 29 out of 215 patients (13.5%) developed CIN. In the unexposed group, 13 out of 208 patients (6.25%) developed CIN. This gave arelative risk of developing CIN of 2.16(1.15 to 4.04, P=0.016).The attributable risk percentage is 7.24% (1.1% to 12.2%). No statistically significant association was seen between the biophysical variables and volume of contrast and development of CIN. Conclusion: Inflammation doubles the likelihood of development of CIN. Therefore a patient presenting with inflammation and any other risk factor for CIN should have a risk-benefit analysis to assess the need for administration of iodinated intravenous contrast.
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مولانا آزاد سبحانی

مولانا آزاد سبحانی
افسوس ہے پچھلے دنوں مولانا آزاد سبحانی کا۷۵ برس کی عمر میں گورکھ پور میں انتقال ہوگیا۔مرحوم کااصل نام عبدالقادر اوروطن سکندر پور ضلع بَلیاتھا۔ادھر ایک مدت سے گمنامی کی زندگی بسر کررہے تھے۔ورنہ تحریکِ خلافت کے زمانہ میں پورے ہندوستان میں ان کی شہرت کاطوطی بولتا تھا۔فلسفہ والٰہیات کے فاضل تھے۔ خطابت وتقریرمیں بعض حیثیتوں سے اپنا جواب نہیں رکھتے تھے۔ شاعر بھی تھے۔مرحوم کی ایک غزل بچپن میں کبھی پڑھی تھی جواب تک یاد ہے:
پیام آیا ہے پیمانِ جفا کا
یجہ کھل گیا جوشِ وفا کا
نِکل آؤ ذرا پردہ سے باہر
عقیدہ مٹ رہا ہے اب خدا کا
مزاجِ لااُبالی اور جوانی
خدا حافظ ہے ناموسِ حیا کا
خدا پر چھوڑ دو انجامِ کشتی
قدم کیوں درمیاں ہو ناخدا کا
حدیثِ ضبط پروانہ ہے بے وقت
زمانہ ہے فغانِ برمَلا کا
ترا آزادؔ پھر پابندِ غم ہے
ہ پھر محتاج ہے لطف و عطا کا
لیکن افسوس ہے اپنی صلاحیتوں اورکمالات سے اسلام اور مسلمانوں کو جو فائدہ پہنچا سکتے تھے اپنی طبیعت کے عدم استقلال اور تلون کی وجہ سے نہ پہنچا سکے۔ بحیثیت مجموعی بڑی خوبیوں کے انسان تھے۔الّٰلھم اغفرلہ وارحمہ ۔
[اگست ۱۹۵۷ء]

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