THE EFFECT OF THE NONIONIC CONTRAST-MEDIUM LOHEXOL ON GLOMERULAR AND TUBULAR FUNCTION IN DIABETIC-PATIENTS

The effect of the non-ionic contrast medium iohexol (Omnipaque(R)) on renal function was investigated in diabetic patients with signs of per ipheral ischaemia. Forty-six patients, 70 +/- 11 years (mean +/- SD) o ld, age at diabetes diagnosis 53 +/- 17 years, and with varying degree s of diabetic nephropathy were studied before, 1, 2, and 30 days after aortobifemoral arteriography. Serum creatinine, creatinine clearance, urinary excretion of immunoglobulin G, albumin, collagen IV (NC1), ka ppa and lambda chains, alpha-1-microglobulin and Tamm-Horsfall protein were evaluated. Within 1 month before and 30 days after arteriography , the glomerular filtration rate was measured by clearance of iohexol. The acute effect of the radiocontrast medium was an increase in the s erum creatinine level in 41 (89 %) patients, with a more than 25 % inc rease in 12 (26 %) patients. The excretion rates of immunoglobulin C a nd albumin decreased, whereas the proximal and distal tubular function and the excretion of collagen IV did not change. The increment in ser um creatinine was associated with the preangiographic renal function ( p < 0.05), a history of heart failure (p < 0.01), but not with age, du ration and type of diabetes, gender, systolic or diastolic blood press ure, glycated haemoglobin (HbA(1c)) or blood glucose levels. The incre ase of serum creatinine was associated with a pre-existing proximal tu bular dysfunction and a worsening of distal tubular function. No chang es in the parameters measured persisted 30 days after angiography. In summary, a transient increment in serum creatinine level after arterio graphy occurred in 89 % of diabetic patients. It was associated with t he preangiographic renal function, a history of heart failure and sign s of preexisting proximal tubular dysfunction and worsening of distal tubular function. However, these changes were reversible.