Study the Effect of Modifiable Risk Factors on Incidence and Prognostic Impact of Contrast Induced Nephropathy Post Coronary Interventions in Patients Admitted at AL-Azhar University Hospital, New Damietta, Egypt

摘要

Background: Contrast-induced nephropathy (CIN) is defined as a relative (≥25%) or absolute (≥0.5 mg/dl; 44 μmol/l) increase in serum creatinine from baseline value. The aim of the work: Study the Incidence and the effect of Modifiable and non-modifiable risk factors for occurrence and prognostic impact of Contrast Induced Nephropathy post coronary interventions in patients admitted at AL-Azhar University Hospital, New Damietta, Egypt. Patients and methods: This study was conducted on 120 patients attended at the emergency unit, cardiac outpatient clinic and Internal medicine department of Al-Azhar university hospital New Damietta during the period from December 2014 and August 2015. They were presented by cardiac symptoms (chest pain, dyspnea, low cardiac output symptoms., acute coronary syndrome or chronic stable angina). They were subjected to coronary angiography and Percutaneous coronary Interventions after medical history taking, clinical examinations, and ECG findings suggestive of acute coronary syndrome, Basal serum creatinine before coronary angiography and percutaneous coronary Intervention Follow up serum creatinine 48 hours later and two weeks later, serum Na (meq/dl), serum K (meq/dl), serum uric acid (mg/dl), urine analysis, serum cholesterol, serum triglycerids, CBC, fasting and 2 hours post prandial blood glucose level, Hg A1 C. Results: 15 patients out of 120 patients developed contrast induced nephropathy (12.5%) 105 patients out of 120 patients didn’t develop contrast induced nephropathy (87.5%) so studied 120 patients divided into 2 groups: (group A) patients who developed contrast induced nephropathy (15 patients) and (group B) patients without contrast induced nephropathy (105) patients. There was a statistical significant increase of s. creatinine, follow up 48h s. creatinine after coronary interventions and follow up 2 weeks s. creatinine in group A in comparison to group B. There were statistically significant increase of D.M, HTN and congestive heart failure in group A in comparison to group B. Conclusion: Contrast nephropathy is a major cause of morbidity in patients undergoing coronary angiography or per cutaneous coronary interventions, risk factors for CIN such as diabetes mellitus, congestive heart failure, hypertension, and medications, high osmolality and high ionic content of contrast medium, large volume of contrast medium and recurrent contrast exposure all are included in increased incidence of occurrence of CIN and poor the prognosis. Proper selection of patients who undergo contrast imaging and pre-procedural preparations would be helpful to reduce the risk of CIN.