ENDOTHELIN (ET-1) IS INVOLVED IN THE CONTRAST-MEDIA INDUCED NEPHROTOXICITY IN CHILDREN WITH CONGENITAL HEART-DISEASE

In 77 children with congenital heart disease urinary endothelin-1 (ET- 1), an indicator of intrarenal endothelin release, was compared to uri nary excretion of total protein, albumin, immunoglobuline G (IgG), alp ha(1)-microglobuline (alpha(1)-MG), N-acetyl-beta-D-glucosaminidase (N AG) and villin. Urine samples were collected the day before and immedi ately after cardiac angiography with high (Conray 70; n = 56; CON) or low osmolality contrast media (Solutrast 300; n = 21; SOL) to assess t he relationship between urinary endothelin and glomerular and tubular nephrotoxicity of contrast media. The children were further subdivided according to age: less than 1 year - CON 1 (n = 20); SOL 1 (n = 12) a nd 1 - 18 years CON 2 (n = 36); SOL 2 (n = 9). Results (median): 1. Th ere are no significant changes in total protein-, albumin- and IgG-exc retion as parameters of glomerular toxicity. 2. Tubular toxicity of co ntrast media is shown by significant increase of alpha(1)-MG-(10.0 to 23.2 mg/g Crea; p < 0.001), NAG-(5.9 to 9.6 mg/g Crea; p < 0.001) and Villin-excretion (1.0 to 2.0 STS, p < 0.001) in all children. 3. Endot helin excretion (101.0 to 163.0 ng/g Crea, p < 0.001) and concentratio n (42.5 to 56.0 pg/ml; p < 0.001) were elevated after angiography in a ll children. 4. The changes in endothelin excretion are correlated to the changes in alpha(1)-MG (r = 0.65; p < 0.001) and NAG (r = 0.43, p < 0.001) in all children. Particular in children less than 1 year high er correlation coefficiants to alpha(1)-MG are shown (CON 1: r = 0.65; p < 0.01 and SOL 1: r = 0.86; p < 0.001). 5. Regarding the tubular to xicity there was no difference between high or low osmolar contrast me dia. 6. Tubular damage was not correlated to dosage of contrast media.