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Original Article
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Korean J Med. 2007;73(4):361-367.
- 원저 : 신기능 저하 환자의 조영제 신독성 예방을 위한 N-acetylcysteine 복용과 수액요법의 비교
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서정숙.전혜정.구호석.이원동.강선우 김영훈.김양욱.이정녀.박성한.이준식.허 동, , , , , , , , , ,
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- Comparison of oral N-acetylcysteine(NAC) and prehydration for preventing contrast-induced nephropathy in patients with renal dysfunction
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Jeong Sook Seo, Hae Jung Jun, Ho Seok Koo, Won Dong Lee, Sun Woo Kang, Yeong Hoon Kim, Yang Wook Kim, Jeong Nyeo Lee, Sung Han Park, Jun Sik Lee, Dong Heo
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건양대학교 병원 내과학교실
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- Abstract
- Background : Contrast induced nephropathy (CIN) is an important cause of acute renal failure in patients with renal
dysfunction. We investigated whether oral NAC alone was sufficient to prevent CIN to the same extent as hydration in
patients with renal dysfunction, and whether these treatments resulted in diffierences in the urinary excretion of nitric
oxide, a vasodilator.
Methods : A total of 27 patients with renal dysfunction, who underwent radiographic examination with nonionic and
low osmolar contrast, were randomly assigned to receive either NAC (600 mg orally twice daily; N=11) or 0.45% saline
hydration (1 mL/kg/Hr; N=16) 12 hours prior to and 12 hours after the contrast procedure. We measured serum creatinine
(sCr), fractional excretion of sodium (FENa), creatinine clearance (CCr), and urinary nitrite before and after contrast
administration.
Results : The mean volume of contrast used was similar in the two groups (100.9±54.8 mL vs 114.7±38 mL; p=0.43),
as was baseline sCr in the two groups (2.31±1.59 mg/dL vs 2.18±1.41 mg/dL; p=0.98). Treatment did not significantly
affect the incidence of CIN, with 18.2% and 12.5% in the NAC group and hydration group, respectively (p=1.0). The
urinary nitrite/creatinine ratio (μmol/mg) was 1.26±0.57 and 1.43±0.64 at baseline and 48 hours after contrast exposure
in the NAC group, respectively, and 0.80±0.40 and 1.18±0.60 in the hydration group, respectively, which were not
significantly different. FENa increased significantly after contrast exposure in the NAC group compared with hydration
group (p=0.04)
Conclusions : NAC alone may prevent CIN. When bolus hydration is contraindicated in patients with renal
dysfunction, administration of NAC alone may be sufficient.(Korean J Med 73:361-367, 2007)
Keywords :Contrast induced nephropathy, N-acetylcysteine, Hydration
