LETTER TO THE EDITOR
Year : 2008 | Volume
: 19 | Issue : 6 | Page : 985--986
Protective effect of pentoxifylline on contrast induced nephropathy
Jamshid Roozbeh1, Alireza Hamidian Jahromi2, Maryam Sharifian1, Maryam Pakfetrat1, Raha Afshariani1, 1 Nemazee Hospital Organ Transplantation Unit, Shiraz University of Medical Sciences, Shiraz, Iran 2 Nemazee Hospital Organ Transplantation Unit, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Renal Transplant, St. Georges Hospital, London, UK
Correspondence Address:
Maryam Sharifian Nemazee Hospital Organ Transplantation Unit, Shiraz University of Medical Sciences, Shiraz, Iran
How to cite this article:
Roozbeh J, Jahromi AH, Sharifian M, Pakfetrat M, Afshariani R. Protective effect of pentoxifylline on contrast induced nephropathy.Saudi J Kidney Dis Transpl 2008;19:985-986
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How to cite this URL:
Roozbeh J, Jahromi AH, Sharifian M, Pakfetrat M, Afshariani R. Protective effect of pentoxifylline on contrast induced nephropathy. Saudi J Kidney Dis Transpl [serial online] 2008 [cited 2021 Jan 27 ];19:985-986
Available from: https://www.sjkdt.org/text.asp?2008/19/6/985/43480 |
Full Text
To the Editor,
Contrast Induced Nephropathy (CIN) is commonly defined as acute renal failure occurring within 48 hours of exposure to intravenous radiographic contrast that is not attributable to other causes. [1] It is the third most common cause of hospital-acquired acute renal failure, after surgery and hypotension. [2] In most cases it is preventable with sufficient fluid administration, however an irreversible damage to the kidney might occur.
Ideally, serial creatinine clearances should be measured, but is neither practical nor costeffective and therefore literature describes the use of isolated measurements of serum creatinine levels, even though less sensitive. Contrast induced acute renal failure has been variably defined as a minimum increase in serum creatinine level from baseline values of 25%-50% or an absolute increase from 0.5 mg/dL to 1.0 mg/dL. (44 to 88 µmol/L). [3]
The exact underlying mechanisms of CIN remain elusive. Experimental studies suggest combination of renal ischemia and direct tubular epithelial cell toxicity as its pathogenesis. Inhibition of renal prostaglandins and nitric oxide synthesis. [4],[5] and contrast media causing oxidative stress and free radical release as possible mechanisms responsible for CIN. [6]
Apart from general agreement on the value of adequate hydration prior to the contrast injection; conflicting and inconsistent reports exist as to the efficacy and safety of different pharmacologic interventions. In a recent metaanalysis, Kelly et al, reviewed effectiveness of different drugs for preventing CIN and could only show overall beneficial effects of Nacetylcysteine and theophylline [7] . They suggested, N-acetylcysteine to be more reno-protective than hydration alone.
Pentoxifylline (PTX) is a methyl-xanthine derivative with multiple haematologic properties. It is commonly used to treat peripheral vascular diseases. PTX improves oxygen delivery to ischemic tissues through effects of increasing intracellular cyclic-AMP in red blood cells, increasing cyclic-AMP in polymorph nuclear cells and decreasing oxygen free radicals production. [8],[9] There has been some evidence of PTX having free radical-scavenging properties besides limiting the inflammatory response with a reduction in cellular activation, phagocytosis and endothelium adhesion. There are evidences that PTX also reduces the nitric oxide destruction. [9]
Accordingly it could be hypothesized that PTX may have a protective effect on development of CIN.
References
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3 | Katzberg RW. Urography into 21st century: New contrast media, renal handling, imaging characteristics, and nephrotoxicity. Radiology 1997;204:297-312. |
4 | Gleeson TG, Bulugahapitiya S. Contrastinduced nephropathy. AJR Am J Roentgenol 2004;183:1673-89. |
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7 | Kelly AM, Dwamena B, Cronin P, Bernstein SJ, Carlos RC. Meta-analysis: Effectiveness of drugs for preventing contrast-induced nephropathy. Ann Intern Med 2008;148:284-94. |
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9 | Davila-Esqueda ME, Martinez-Morales F. Pentoxifylline diminishes the oxidative damage renal tissue induced by streptozotocin in the rat. Exp Diabetes Res 2004;5:245-51. |
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