Cyclosporine-Associated Nephrotoxicity

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To determine whether gadodiamide is a safe and useful angiographic contrast agent for help in diagnosis and percutaneous treatment of renal artery stenosis in patients with renal insufficiency. Diagnostic renal angiography and percutaneous renal interventions were performed by using gadodiamide (total dose, 0.3 mmol/kg) and CO2 as intraarterial contrast agents in 25 procedures in 24 patients with renal insufficiency. Serum creatinine levels were obtained within 24 hours before and at 24 and 48 hours after the procedure. Increases in serum creatinine of more than 44 mumol/L were considered clinically important. Gadodiamide-enhanced angiograms were compared with CO2-enhanced angiograms. In 23 (92%) of 25 procedures, there was no increase in serum creatinine level at 48 hours. One patient with acute and chronic rejection of a renal transplant and one with evidence of cholesterol embolization had a clinically important increase in serum creatinine level at 48 hours. No marked increase in creatinine level was observed in patients with relatively low baseline levels (n = 19). Gadodiamide-enhanced angiograms appeared to be better than CO2-enhanced angiograms for help in identifying renal artery occlusions, visualizing renal vessels incompletely filled with CO2, and determining the progress of intervention. Gadodiamide appears to be a safe and useful intraarterial contrast agent in patients with renal insufficiency and can be used to supplement or confirm CO2-enhanced angiographic findings.

Daily variation in serum creatinine and the effect of a protein load was studied in 18 patients with renal transplants and in 10 healthy controls. Serum creatinine was analyzed both with a standard Jaffé method and with a specific HPLC technique. Following a protein meal, a 30% increase in serum creatinine levels was noted in both groups, but the rise in absolute terms was more prominent among the transplanted patients. Urinary excretion of creatinine did not increase in the transplanted group, indicating a reduced ability to deal with the surplus creatinine in the protein meal. It is concluded that serum creatinine levels are diet-dependent and that this variation is more pronounced when renal function is reduced. Standardized blood sampling is important when following serum creatinine in renal transplant recipients from one day to the next.

BackgroundCreatine monohydrate is a widely used dietary supplement with proven benefits in athletic performance and potential therapeutic applications in clinical populations. However, concerns regarding its impact on renal function persist, largely due to elevated serum creatinine levels associated with creatine intake.MethodsA comprehensive literature search was conducted in PubMed, Scopus, Web of Science, and Google Scholar for studies published between January 2000 and March 2025. Primary outcomes were serum creatinine and glomerular filtration rate (GFR). Meta-analyses were performed using a random-effects model, with subgroup analysis by supplementation duration.ResultsTwenty-one studies were included in the systematic review, and 12 studies (177 participants in the creatine group and 263 in control) were eligible for meta-analysis of serum creatinine levels. Creatine supplementation was associated with a small but statistically significant increase in serum creatinine (MD: 0.07 µmol/L; 95% CI: 0.01 to 0.12; p = 0.03). Subgroup analysis of the creatinine outcome based on follow-up duration revealed that the intervention effect was significant in studies with a follow-up of ≤ 1 week (MD = 0.12; 95% CI: 0.03 to 0.21). However, no significant effect was observed in studies with a follow-up of 1 to 12 weeks (MD = 0.04; 95% CI: − 0.09 to 0.17). The effect became significant again in studies with a follow-up of more than 12 weeks. The meta-analysis revealed a non-statistically significant differences in GFR following creatine supplementation compared to control.ConclusionCreatine supplementation is associated with a modest, transient increase in serum creatinine levels, likely due to metabolic turnover rather than renal impairment. No significant changes were observed in GFR, suggesting preserved kidney function.Clinical trial numberNot applicable.Graphical Supplementary InformationThe online version contains supplementary material available at 10.1186/s12882-025-04558-6.

Zoledronic acid belongs to the new generation of bisphosphonates with demonstrated clinical benefit for the treatment of bone metastases from different kinds of neoplasms. Hypocalcemia and serum creatinine elevation are expected adverse events during this therapy. The monitoring of serum calcium and creatinine is therefore recommended. The primary aim of this study was to establish the actual incidence of hypocalcemia and serum creatinine elevation during treatment with zoledronic acid. Skeletal-related events and side effects were also assessed. Serum creatinine and calcium levels were evaluated in 240 consecutive patients (83 males, 157 females; mean age, 62 years) with metastatic bone lesions from different solid tumors treated with zoledronic acid. Overall, 93 of 240 patients (38.8%) developed hypocalcemia, which was grade (G)1 in 45 patients (48.4%), G2 in 37 patients (39.8%), G3 in 10 patients (10.8%), and G4 in one patient (1.1%). The median time to occurrence of hypocalcemia (any grade) was 2.3 months after the beginning of the treatment (range, 0-34.9 months). Increased serum creatinine was observed in 33 of 240 patients (13.7%), of whom 19 had G1 (57.6%), 11 had G2 (33.3%), and three had G3 (9.1%). The median time to serum creatinine increase (for any grade) was 4.7 months (range, 0-29.2 months). Our analysis shows a high incidence of hypocalcemia and increased serum creatinine level during treatment with zoledronic acid. These results strongly support the need for accurate monitoring of plasma calcium and creatinine levels.

Background and Purpose: As endovascular therapy (EVT) occupies a growing role in the management of acute ischemic stroke (AIS), contrast-induced nephropathy (CIN) associated with consecutive contrast media administration for vascular imaging and distal subtraction angiography is an emerging concern. We investigated the incidence, risk factors and clinical outcome of CIN in AIS patients who underwent EVT. Methods: Multicenter data from the ASIAN KR registry collected between January 2011 and Mar 2016, on consecutive patients who received EVT for AIS, were analyzed. Diagnostic criteria for CIN were: an absolute increase in serum creatinine (SCr) by ≥0.3 mg/dL from baseline within 48 hours after EVT; or a relative increase in SCr levels by ≥50% from baseline. Results: Of 721 patients, 616 patients (85%) were eligible for this study. CIN was diagnosed in 47 (7.6%), and was more associated with history of hypertension (p=0.011), history of diabetes mellitus (DM) (p=0.002), and higher initial NIHSS score (16.6 vs. 18.7 p=0.006). In multivariable analysis, independent risk factors of CIN were hypertension history (OR 2.465, 95% CI 1.027-5.919, p=0.043), DM history (1.978, 1.023-3.822, p=0.042), initial NIHSS score (1.071, 1.014-1.132, p=0.014), initial SCr level (1.603, 1.159-2.217, p=0.004) and duration from puncture to final angiography (1.006 per minute, 1.000-1.012, p=0.045). In multiple logistic regression, CIN was an independent risk factor of poor clinical outcome (modified Rankin Scale at 3 months 4-6; 3.782, 1.770-8.083, p=0.001) after adjusting age, sex, initial NIHSS, hypertension history, DM history, onset to puncture time and successful reperfusion. Conclusions: CIN is not uncommon and associated with poor clinical outcome after EVT in AIS. Clinicians should be aware that key factors associated with an increased likelihood of CIN are hypertension history, DM history, abnormal SCr level, higher NIHSS score and longer procedure duration.

Background: CHA2DS2-VASC risk score (CVRS) is useful in predicting the occurrence of contrast induced nephropathy (CIN) among patients with Ischemic heart disease undergoing percutaneous coronary Intervention. CIN was defined an absolute increase in serum creatinine levels by ≥0.3 mg/dL from baseline, or a relative increase in serum creatinine by ≥50% from baseline, within 48 h after PCI, according to Acute kidney Injury Network (AKIN) definition. Objective: To evaluate CHA2DS2-VASC score as a predictor of contrast induced nephropathy (CIN) in patient with ischemic heart disease undergoing percutaneous coronary intervention (PCI). Patients and Methods: A total of 200 consecutive patients presenting to Cardiology Department, Almogama Alteby Hospital at Tanta city ,during the period from January 2019 to January 2020, diagnosed as IHD and underwent PCI, They were divided into two groups: Group I: Those who developed CIN 48h after PCI (28%) and Group II: Those who did not (72%). CHA2DS2-VASc score (age, sex, diabetes, hypertension, heart failure on admission, previous ischemic event, vascular event) was calculated for each patient. Serum creatinine level and estimated Glomerular Filtration Rate (eGFR) were estimated for all patient before and 48h after PCI. Results: CIN was reported in 56 patients (28%). Patients with CIN had a higher frequency of hypertension, diabetes mellitus, and had a lower left ventricular ejection fraction and baseline estimated glomerular filtration rate. The average CVRS in the CIN group was significantly higher than that in non-CIN group. CHADSVASC score cut off value was higher than 3 and the area under the ROC curve was equal to 0.906 which indicating that it is excellent predictor for contrast induced nephropathy cases. The sensitivity, Specificity, positive predictive value and negative predictive values of CHADSVASC score were 80.36, 89.58, 51.5, and 96.0 respectively. Conclusion: The CVRS can be used as a simple pre-procedural predictor of CIN among patients with IHD undergoing PCI.

The study standardized the glycerol induced (intra-peritoneal and intra-muscular) acute renal failure (ARF) models in Sprague-Dawley rats and validated its potential to predict the change in pharmacokinetics of the selected probe drugs in renal impairment. We assessed the induction of ARF by measuring the serum creatinine and blood-urea-nitrogen (BUN) levels at different time points (baseline, 6 h, 12 h, 24 h, 48 h and 72 h). Glycerol administrations via both intra-peritoneal and intra-muscular routes caused a significant increase in serum creatinine and BUN levels in rats at 6 h; however, the levels decreased within 24 h with intra-peritoneal administration. In contrast, with intra-muscular administration, a sustained increase in serum creatinine and BUN levels was observed up to 72 h post glycerol treatment demonstrating a sustained ARF like condition in rats that was suitable to evaluate the pharmacokinetics of drugs. Therefore, intra-muscular glycerol administration model was used to evaluate the pharmacokinetics of selected probe drugs including metformin, digoxin, atorvastatin and linezolid. The pharmacokinetics of metformin and digoxin were significantly altered in ARF versus control rats with increase in plasma exposure, prolonged elimination half-life and decreased systemic clearance. However, the pharmacokinetics of atorvastatin and linezolid did not show significant differences between ARF and control rats. These results demonstrated the utility of the ARF model in rats in predicting pharmacokinetic changes in patients with renal impairment. Such models may prove useful in early discovery work to screen and prioritize compounds requiring dose adjustment in patients with renal impairment.

A low ankle-brachial index (ABI) predicts risk of cardiovascular death, myocardial infarction, peripheral arterial disease events, and stroke. However, it is unknown whether a low ABI also predicts a decline in renal function. We examined the association between ABI and change in serum creatinine level over time among 13 655 participants in the Atherosclerosis Risk in Communities (ARIC) study who underwent serum creatinine and ABI measurement at baseline and also underwent serum creatinine measurement 3 years later at the second study visit. The study outcome was a 50% rise in serum creatinine level from baseline to the second study visit. Overall, 0.48% of participants with an ABI of 1 or higher, 0.9% of participants with an ABI between 0.9 and 0.99, and 2.16% of participants with an ABI lower than 0.9 experienced a 50% or greater increase in serum creatinine level. In multivariate analysis, participants with an ABI lower than 0.9 were still more than twice as likely as those in the referent category (ABI > or = 1) to experience an increase in serum creatinine level (odds ratio 2.5; 95% confidence interval, 1.1-5.7) (P = .04), and a linear trend in the incidence of worsening renal function was noted across ABI categories (P = .02). Analyses excluding participants with renal insufficiency, diabetes, and hypertension at baseline all produced similar results. In addition to known associations of the ABI with stroke, myocardial infarction, peripheral arterial disease events, and cardiovascular death, a low ABI also predicts an increase in serum creatinine level over time.

Ischemia-reperfusion injury (IRI) is the major cause of delayed graft function in renal allografts. The present study was performed to investigate the validity of serum creatinine (SCr) level as an indicator of postischemic renal dysfunction in mice. Renal IRI or sham surgery was induced in C57BL/6 mice, and SCr level and inulin clearance (Cin) were measured between 24 hr and 7 days after ischemia. Cin in IRI mice was reduced 75% at 72 hr after ischemia in association with a nearly threefold increase in SCr level. Cin in IRI mice did not recover between 72 hr and 7 days after ischemia, even though SCr level at 7 days was not different between control and IRI mice. In IRI mice, SCr level measured at 24, 48, and 72 hr after ischemia correlated inversely with Cin measured at 72 hr, but not 7 days, after ischemia. SCr level in the early postischemic period (24-72 hr) seems to be a valid indicator of early postischemic renal dysfunction, and that renal function remains markedly depressed at 7 days despite suggestion from the SCr value that renal function is improving.

To assess the safety of high-dose nonionic contrast media (CM) during a single radiologic procedure. From November 1991 to August 1995, 255 high-dose angiographic procedures were performed in 228 patients with normal serum creatinine (SCr) levels (< or = 1.6 mg/dL [141 mumol/L]). All patients received 250-800 mL low-osmolarity CM (300 mg iodine per milliliter). Pre- and postprocedure SCr levels were assessed. Urine output was measured daily in the 75 patients who received more than 400 mL CM. With linear regression analysis, a dose-related elevation in SCr levels was calculated. No patient developed abnormal SCr levels (> 1.6 mg/dL [141 mumol/L]) as a result of the CM. Among the patients who received more than 400 mL, none developed oliguria over the first 36 hours. With follow-up up to 3 years, no patient experienced delayed clinical renal failure. In 11 (4.3%) patients, the SCr levels increased more than 25%, but all increases were within expected limits (chi 2 analysis). Linear regression analysis revealed a 0.015 mg/dL (1 mumol/L) increase in SCr levels per 100 mL CM. Intravenous administration of high-dose low-osmolarity iodinated CM appears safe in patients without renal dysfunction or other underlying risk factors, in doses as large as 800 mL (300 mg iodine per milliliter).

2007 ESTIMATED GFR AS A BIOMARKER OF EFFICACY IN PATIENTS WITH METASTATIC RENAL CELL CARCINOMA TREATED WITH SUNITINIB

Sepsis-induced acute kidney injury (AKI) is difficult to prevent because most patients are diagnosed after they develop it. Standard serum and urine creatinine levels are insensitive and nonspecific for detecting kidney injury in its early stages. Glutathione S-transferase (GST) has received little attention as a biomarker in AKI. This study included 65 adult patients with sepsis who developed oliguria within 72 h of admission. Baseline serum creatinine values were recorded at least 1 month before or after intensive care unit (ICU) admission. The clinical endpoints were defined as the occurrence of advanced AKI stages 2 or 3 according to the KDIGO classification. Serum creatinine and urinary GST levels were measured every 6 h from admission until 72 h postoliguria development. The primary objective was to assess the correlation between urinary GST and serum creatinine levels in patients with sepsis-induced AKI. Among the 65 patients, 13 (20%) progressed to AKI Grade I, while 52 (80%) progressed to AKI Grade II or III. Both groups exhibited an increasing trend in serum creatinine and urinary GST levels up to 72 h. Significant mean differences between the two AKI groups were observed at 48 and 72 h for serum creatinine (P = 0.021 and P = 0.007, respectively) and at 18 h for urinary GST levels (P = 0.044). Urinary GST levels demonstrated an earlier elevation than serum creatinine levels in critically ill sepsis patients, underscoring their utility as a valuable tool for the early diagnosis and predicting AKI following admission to the ICU.

Increasing Overnight Fluid Intake and Kidney Function During Ramadan Fasting: A Randomized Controlled Trial

The nature of the relationship between high blood pressure and kidney damage is controversial. There is a view that essential non-malignant hypertension does not cause renal damage in patients with normal renal function and no proteinuria at first presentation. In contrast, patients with malignant hypertension (MHT) not due to underlying renal disease often exhibit progressive renal impairment, although there can be a dissociation between short-term changes in renal function and the long-term renal outcome. It has been established that the association of MHT and renal impairment is associated with a grave prognosis. To investigate further the changes in renal function after diagnosis of MHT. We studied the clinical features, renal function and survival of patients on the West Birmingham MHT Register. Patients presenting with no or only mild-to-moderate renal impairment (defined as an initial serum creatinine level < 300 micromol/L) were categorized as group 1 patients. Patients with severely impaired renal function, defined as a serum creatinine level > or = 300 micromol/l at presentation, were categorized as group 2 patients. Patients who subsequently suffered a deterioration in renal function were defined as those whose serum creatinine level had risen at follow-up (group A). Patients with an invariant or improving renal function at follow-up were those whose serum creatinine level neither rose nor fell (group B). Clinical characteristics and survival of patients in group 1 were therefore compared with those of patients in group 2; features of patients in group A were compared with those of patients in group B. We studied a total of 169 patients with MHT [107 men, aged 49.4 +/- 13.3 years (mean +/- SD)]. Of these, 136 (80.5%) patients had an initial serum creatinine level < 300 micromol/l (group 1). After a median follow-up of 53 months (interquartile range 15-103), the serum creatinine level of 56.8% (96 of 169) patients had risen (group A). Patients with MHT with only mild-to-moderate renal impairment at presentation (creatinine level < 300 micromol/l, group 1) had lower serum urea, creatinine and blood pressure levels at follow-up compared with those of patients with initially impaired renal function. Although there was no significant change in follow-up serum urea and creatinine levels compared with initial levels in patients in group 2 (paired Wilcoxon test, NS), there was a significant deterioration in renal function in patients in group 1 (P = 0.001). Group 2 patients had a shorter median survival time than did group 1 patients (15 versus 59 months, Lee-Desu statistic 15.4, P = 0.0001). Patients whose serum creatinine level had risen (group A) had significantly higher initial serum urea and creatinine levels and follow-up blood pressures than did those whose renal function had remained invariant or improved (group B). However, there was no significant difference between the median survival times of patients in groups A and B (51 versus 58 months, Lee-Desu statistic 0.377, P = 0.54). We suggest that renal function continues to deteriorate in some patients with MHT, despite a good degree of control of their blood pressures having been achieved at follow-up. However, the renal function of 16 of the 33 patients with severe renal impairment at presentation either remained invariant or was found to have improved at follow-up. There was no evidence that those cases whose renal function remained invariant were confined to those who had presented with less renal impairment. The severity of MHT at presentation and the amount of renal impairment did not predict the outcome. In contrast the quality of control of the blood pressure that had been obtained at follow-up did predict the outcome. Careful monitoring of renal functioning and effective treatment of the blood pressure is mandatory in patients with MHT.