THE EFFECTS OF CONTRAST-MEDIA ON RENAL-FUNCTION IN CHILDREN - COMPARISON OF IONIC AND NONIONIC AGENTS

Nephrotoxicity is a common side effect of intravascular contrast media (CM). Although nephrotoxicity of ionic CM has been widely demonstrate d, recent studies suggest that newer and more costly non-ionic agents are no less nephrotoxic.We studied the hemodynamic, hematologic and ne phrotoxic effects of CM prospectively in 38 patients (ages six months- 16 years) with or without risk factors predisposing to nephropathy and compared ionic and non-ionic CM. We performed intravenous urography ( IU) with an ionic CM, sodium meglumine diatrizoate (n = 18) and a non- ionic CM, iohexol (n = 20). The patients were divided into three group s according to glomerular filtration rate (GFR) [GFR less than or equa l to 50 (n = 9), 50-80 (n = 13), greater than or equal to 80 ml/min/1. 73m(2) (n = 26)]. Eleven patients had risk factors for nephropathy. Bl ood pressure, heart rate, EGG, urine and blood samples were obtained 2 4 hours and one hour before as well as one, 24, and 48 hours after CM infusion. Although a significant increase was found in urine specific gravity, protein/creatinine ratios and serum Na and creatinine levels, the increased levels were within normal limits. We observed a signifi cant reduction in Hb and Htc and urinary prostaglandin E(1) levels. Ma ny of the changes observed in the urine and serum values after the use of CM were minor, insignificant and transient, later returning to the ir initial values. The GFR levels, the presence of risk factors and th e use of ionic vs. non-ionic CM had no effect on the results. The elev ated urinary basal beta-2-microglobulin levels further increased after CM infusion in patients with low GFRs. It was concluded that non-ioni c CM was not superior to ionic CM in patients with GFRs greater than 5 0 ml/min regardless of predisposing risk factors. One of the non-invas ive radiological methods is advised instead of IU in patients with low GFRs.