U-M: Pill Protects Kidneys During CT Scans and Angiograms
Most cancer patients undergo at least one CT scan during the diagnosis, treatment, or follow-up phases of their disease.
A new study conducted by the University of Michigan Health System indicates many of those patients should be taking an inexpensive prescription tablet called N-Acetylcysteine before their scan to protect their kidneys from potentially serious damage.
CT scans and angiograms are valuable imaging tools doctors use to detect and treat cancer, heart disease and other serious medical conditions, but these tests often use iodine-containing dyes called contrast agents which can cause kidney damage.
Kidney damage caused by contrast dyes, a condition known as contrast-induced nephropathy or CIN, has been a growing problem as the popularity of CT scans and x-ray guided procedures like angioplasty has increased.
High-risk patients who have vulnerable kidneys due to chronic conditions like diabetes or coronary disease are the most likely to experience kidney damage from contrast agents. One in four high-risk people plus up to 10 percent of people with normal kidney function experience mild to moderate kidney damage during a CT scan. Some cases of acute kidney failure have also been reported.
Hospitals currently use a wide variety of medications to protect patients against contrast-induced nephropathy so the team from University of Michigan (U-M) decided to compare the various medicines to find out which were the most effective. To arrive at their conclusion, they analyzed 41 randomized controlled studies and found N-Acetylcysteine – which costs about 25 cents for a 500 mg pill — clearly offered the most protection against kidney damage. U-M also noted that over-the counter forms of the pill should not be used to for pre-scan kidney protection.
According to U-M’s findings, other agents used to protect the kidneys did not reduce risk significantly, and furosemide actually raised the risk of kidney damage during a CT.
The U-M team hopes this new information will prove valuable to both clinicians and patients considering a CT. As one of the study’s authors explained,
“Millions of people receive contrast agent each year, including most heart patients who have angioplasties and stents, as well as those having a CT scan. Contrast agent helps physicians see the things they need to see, but it also does post a hazard to some people. This drug, which is quick, convenient, inexpensive and widely available, with no major side effects, appears to be the best choice to protect those whose kidneys are most at risk.”
Aine Kelly, MD, MS
Department of Radiology, U-M Medical School
Dr Kelly recommends that patients who know they have impaired renal function speak up when their doctor orders a CT, an angiogram or angioplasty, to make sure they get an N-acetylcysteine tablet before the procedure. Patients can also discuss the option of using new, more expensive low-iodine or iodine-free agents made for people allergic to iodine.
And since kidney problems often offer no symptoms, other patients and providers planning imaging with contrast dyes may consider reducing potential risks by testing creatinine levels prior to the CT scan to ensure the patient’s kidneys are operating efficiently.
If you’d like to learn more about this research, results have been published in the February 19, 2008, issue of the journal Annals of Internal Medicine. For your convenience, a link to the Annal’s audio summary of the work is also available in our related podcast section below.
Source: University of Michigan Health System Newsroom
Related Links: cbc.ca; scientistlive.com; United Press International; medicalimagingmag.com
Related Podcast: Audio Summary from the Annals of Internal Medicine
Tags: NIH-funded; NCI-funded; RCIN; GE AUR Radiology Research Academic Fellowship; internal medicine; patient safety; radiotherapy; Ann Arbor, MI; IVP
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