Contrast media is a group of medical drugs used to increase the visibility of internal organ structures by X-ray based imaging techniques, such as radiography and computed tomography (CT). This contrast media is indispensable in radiology practice for diagnostic and therapeutic. The most commonly used contrast media in Indonesia according to Formularium Nasional (Fornas) and Daftar Obat Esensial Nasional (DOEN) are iodinated contrast media, namely Iohexol and Iopamidol. Radiologists and other medical personnel involved with iodinated contrast media should be aware of the risk factors for a reaction to the contrast media. It needs vigilance and strategies to minimize, recognize, and manage the emergence of unwanted effects. The injected contrast media dilutes in the bloodstream and is immediately distributed throughout the extracellular fluid. This contrast media is not well bound to serum albumin, is freely filtered by the glomeruli, and excreted by the kidneys. The flow of this contrast media allows for side effects. Although it is generally safe to use, severe, life-threatening reactions can occur. The most important unwanted side effect of using contrast media is acute kidney injury (AKI), a sudden decrease in kidney function due to kidney damage. AKI that occurs after administration of contrast media is called contrast-induced AKI (CI-AKI) or Contrast-Induced Nephropathy (CIN).
Definisi CI-AKI yang paling umum saat ini adalah peningkatan level serum kreatinin (SCr) ≥25% atau peningkatan absolut sebesar 0.5 mg/dl (44.2 𝜇mol/L) dari nilai awal yang terjadi 48-72 jam setelah paparan bahan kontras. Istilah CI-AKI dirasa mencerminkan adanya tahap awal kerusakan ginjal. Ketika bahan kontras diinjeksi secara intravena atau intraarterial, hampir seluruhnya difiltrasi oleh glomerulus dan terkonsentrasi di dalam lumen tubulus selama proses pembuatan urine primer sehingga terjadi paparan antara sel epitel tubulus dengan peningkatan konsentrasi bahan kontras radiografi. Akibatnya terjadi kerusakan sel epitel tubulus yang menjadi tanda histopatologis pada CI-AKI.
CI-AKI is a common iatrogenic cause of AKI, so a particular study is needed to discuss the side effects of contrast media. There are still no studies that specifically address the differences in side effects of using Iohexol and Iopamidol. In this case, analysis is needed to see the histopathological differences and renal function (SCr and BUN) after intravascular injection of iodinated contrast media Iohexol and Iopamidol.
This research is a experimental laboratory with a post-test only control group design. The sample in this study was a white rat (Rattus norvegicus) male Wistar strain and observe renal histopathology in each sample group. Histopathology changes analyzed were tubular necrosis and proteinaceous casts. The blood samples taken were put into SST tubes then examined for SCr using the modified Jaffe’s kinetic method and BUN using the enzymatic UV. Method test by an automated analysis machine.
Kruskal-Wallis test (α= 0.05) on renal histopathology scores, both tubular necrosis and protein casts showed Asymp. Sig. value > 0.05, which means there is no significant difference between the groups (K, P1, and P2). Kruskal-Wallis test (α= 0.05) on SCr levels also showed the Asymp. Sig. value > 0.05 and One-Way ANOVA Comparative Test on BUN levels showed the Sig. value > 0.05 which means there is no significant difference in renal function between the groups. This study proved no difference in histopathology and renal function in Wistar rats after injection of iodinated contrast media Iohexol and Iopamidol so that their use is safe for renal.
Author: Abdurrahman Hasyim Asy’ari, Anny Setijo Rahaju, Arifa Mustika
Article title: Histopathology And Renal Function In Wistar Rats After Intravascular Injection Of Iodinated Contrast Media Iohexol And Iopamidol
Article Link: http://dx.doi.org/10.36418/syntax-literate.v7i1.5709
