Objective:
Radiocontrast nephrotoxicity (RCN) is a common and important cause of hospital-acquired renal insufficiency and a well-recognized complication of cardiac angiography. RCN is generally mild and reversible but can lead to prolonged hospitalization, increased health care costs, and substantial morbidity and mortality. Neutrophil gelatinase-associated lipocalin (NGAL) is an early predictive biomarker of renal failure unlike serum creatinine levels.
Method:
We prospectively enrolled 46 children (age 0–16 years, median: 3 yrs) with congenital heart disease (9 cyanotic, 37 acyanotic) undergoing elective cardiac catheterization and angiography with non-ionic contrast (IOPROMID 769mg/ml) administration in our study. Serial urine and plasma samples (baseline, 4 hr, 24 hr, and 48 hr after the procedure) were analyzed for NGAL and creatinine.
Results:
The volume of contrast medium injected was 4.20±2.18cc/kg. (0,65-10,6cc/kg). RCN, defined as a 25% increase in serum creatinine from baseline, was found in 17 subjects (34%). However, in 36 patients (72%) serum NGAL levels were increased (in some up to 9 fold) after 4 hours of contrast administration. The volume of contrast medium injected between the patient group who had increased NGAL levels and who had not differed significantly (4,77±2,04 vs 3,00±2,01cc/kg, p<0,01).
Conclusion:
The dependency of creatinine to some factors like age, gender, muscle mass, muscle metabolism, medications, hydration status, and delayed response to renal function loss which make take several days are important disadvantages. According to the results of our study
plasma NGAL levels have emerged as sensitive, specific and highly predictive early biomarker of RCN in children.