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Radiographic contrast media induced nephropathy: experimental observations and the protective effect of calcium channel blockers

¹Department of Radiology, Rui Jin Hospital, Shanghai Second Medical University, Shanghai, China, ²College of Pharmacy, Shanghai Medical University, Shanghai, China and ³Department of Diagnostic Imaging, Northern General Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield S5 7AU, UK

Correspondence: Dr S K Morcos

Combined acute inhibition of the synthesis of nitric oxide with L-nitroarginine methyl ester (L-NAME) and of prostacycline synthesis with indomethacin predisposes rats to severe renal injury from radiographic contrast media. The reliability of this pharmacological manipulation in the study of radiographic contrast medium induced nephropathy (RCMN) was investigated. Adult male Sprague–Dawley rats were injected with iv L-NAME (10 mg kg^-1) and iv indomethacin (10 mg kg^-1) 15 min apart and prior to injection of RCM or normal saline (control group). A dose-dependent reduction in renal function was observed after intravascular injection of the high osmolar RCM diatrizoate (Angiografin, 306 mgI ml^-1). A significant (p<0.01) increase in serum creatinine (Cr) (from 54.66±8.39 µmol l^-1 to 171.96±24.49 µmol l^-1 and from 80.95±6.73 µmol l^-1 to 204.76±16.73 µmol ^-1, n=5 per group) was observed 24 h after injection of 6 ml and 8 ml of diatrizoate, respectively. The increase in serum Cr after injection of 8 ml of diatrizoate recovered spontaneously to 80.87±8.70 µmol l^-1 7 days after injection. No significant change in renal function was observed in the control group (n=5) receiving 8 ml kg^-1 of normal saline or after injection of 4 ml of diatrizoate (serum Cr 69.84±5.5 µmol l^-1 pre contrast injection and 66.67±13.47 µmol l^-1 24 h post contrast injection, n=5). The increase in serum Cr observed with 6 ml of diatrizoate was significantly higher (p<0.01) than the rise induced by equivolume of the low osmolar non-ionic monomer iopromide (Ultravist, 300 mgI ml^-1) (serum CR 68.47±8.39 µmol l^-1 pre contrast injection and 143.59±32.03 µmol l^-1 24 h post contrast injection, n=5). The calcium channel blocker diltiazem (10 mg kg^-1 injected intraperitoneally 30 min prior to RCM injection) prevented the rise in serum Cr observed with 6 ml of diatrizoate (serum Cr pre contrast injection 70.31±7.28 µmol^-1 and 78.21±17.81 µmol^-1 24 h post contrast injection in animals pre-treated with diltiazem, n=5). The protective effect against RCM-induced reduction in renal function was less with lower doses of diltiazem. In conclusion, the animal model used is reliable and reproduced previously established observations in the field of RCMN. The protective effect of a calcium channel blocker at the appropriate dose against RCMN has also been shown. The clinical effectiveness of this class of drugs in preventing RCMN requires further evaluation.