Saudi Journal of Kidney Diseases and Transplantation

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


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

1Barrett BJ, Parfrey PS. Prevention of nephro­toxicity induced by radio-contrast agents. N Engl J Med 1994;331:1449-50.
2Tublin ME, Murphy ME, Tessler FN. Current concepts in contrast media-induced nephro­pathy. AJR Am J Roentgenol 1998;171(4): 933-9.
3Katzberg RW. Urography into 21st century: New contrast media, renal handling, imaging characteristics, and nephrotoxicity. Radiology 1997;204:297-312.
4Gleeson TG, Bulugahapitiya S. Contrast­induced nephropathy. AJR Am J Roentgenol 2004;183:1673-89.
5Yokomaku Y, Sugimoto T, Kume S, et al. Asialoerythropoietin prevents contrast-induced nephropathy. J Am Soc Nephrol 2008;19:321-8.
6Jo SH, Koo BK, Park JS, et al. Prevention of radio contrast medium-induced nephropathy using short-term high-dose simvastatin in patients with renal insufficiency undergoing coronary angiography (PROMISS) trial-a ran­domized controlled study. Am Heart J 2008; 155:499.
7Kelly 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.
8Stafford-Smith M. Evidence-based renal protection in cardiac surgery. Semin Cardiothorac Vasc Anesth 2005;9:65-76.
9Davila-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.