الفهرس 
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Abstract
Contrast induced nephropathy (CIN) is the third leading cause of hospital acquired renal failure and is associated with significant morbidity and mortality (Gupta et al., 2004). Contrast induced nephropathy (CIN), is defined as a worsening of renal function after radiographic contrast media (RCM) administration. The medical literature varies in the definition of CIN, typically using a change in serum creatinine (SCr) over baseline by 48 hr, such as ≥25% above baseline or an absolute increase of >0.25 or 0.5 mg/dl (King et al., 2004). The pathogenesis of CIN is still not completely understood, (Barrett et al., 2006) although it is clear that the root concept is medullary hypoxia-induced renal tubular damage. Whereas an interaction of various mechanisms has been shown to cause CIN, (Persson et al., 2006) a reduction in renal perfusion and toxic effects on the tubular cells caused by direct and indirect effects of the CM on the kidneys are generally recognized as important mechanisms (Wong et al., 2012). Several predictive algorithms have been proposed to estimate the risk for CIN. These algorithms generally include intraprocedural factors limiting their use prior to the procedure with none prospectively validation. Mehran developed a risk score for predicting CIN that includes congestive heart failure, hypotension, age >75 years, anemia, diabetes, RCM volume, and CKD defined as a SCr >1.5 mg/dl or an eGFR of <60/ml/ min/1.7 m2. Of note, the risk of CIN increases in a graded fashion as the eGFR decreases from <60/ml/min/1.7 m2 to <20/ml/min/1.7 m2 (Mehran et al., 2004).Scheme to define contrast-induced nephropathy (CIN) risk score. Anemia = baseline hematocrit value <39% for men and <36% for women; CHF = congestive heart failure class III/IV by New York Heart Association classification and/or history of pulmonary edema;.eGFR = estimated glomerular filtration rate; hypotension = systolic blood pressure <80 mm Hg for at least 1 h requiring inotropic support with medications or intra-aortic balloon pump (IABP) within 24 h periprocedurally. The development of CIN is strongly associated with significant morbidity and mortality. Among hospital survivors who undergo percutaneous coronary intervention (PCI), patients who develop CIN are at an increased risk of death or myocardial infarction (MI) at 6 months, 1 year, and 5 years (McCullough et al., 1997).
Rihal reported an in-hospital mortality of 22% in the 254 patients who developed CIN following PCI, from a patient population of 7,586. Acute hemodialysis was uncommon except in patients with severe CKD, especially when diabetes was present (Rihal et al., 2002). Diabetic nephropathy (DN) is the major cause of end-stage renal disease (ESRD) worldwide and is associated with increased cardiovascular risk and infections related complications. Diabetic nephropathy is defined as progressive decline in glomerular filtration rate (GFR) in context of long-standing diabetes and is usually accompanied by nephrotic range proteinuria and other end-organ complications, such as retinopathy (O’Connor and Schelling, 2005). Diabetic nephropathy is also known as Kimmelstiel Wilson syndrome and it was discovered in 1936 by Clifford Wilson and Paul Kimmelstiel. Diabetic nephropathy occurs because of an interaction between hemodynamic and metabolic factors (Cooper, 2001). The purpose of this study is to examine the effect of Ascorbic acid in the prevention of contrast-induced kidney disease in diabetic patients undergoing coronary angiography. 90 diabetic patients were admitted in our survey, 70 patients of them (15 females and 55 males) would receive 3g of ascorbic acid supplied in chewable tablets at least 2 hours before the beginning of the procedure, followed by 2 g of ascorbic acid at the night and the morning after. 20 patients others (8 females and 12 males) were given placebo. All the people were subjected to: Full history taking, Physical examination, 12-lead ECG, Echocardiographic examination involving
2D, M-mode, conventional Doppler used to assess left atrium, aortic root diameter, left ventricular systolic and diastolic dimensions, Mitral annular diameter, anterior mitral leaflet length and heaviness. Laboratory investigations which were done by removing 4 ml of venous blood from all patients, and renal function (urea, creatinine) before and after 3 days of the procedure, fasting and postprandial blood were done. This study showed that: - As regards to a number of risk factors, there was statistically important - Ascorbic acid has no role in the prophylaxis of CIN.