尿中逸脱酵素・蛋白に関する研究 第4報 : 腎機能障害を有する高齢者におよぼす非イオン性造影剤の影響について

Abstract

1) 55歳以上の尿潜血反応陽性18名をGFR 60ml/min以下と以上の2群に分け検討した。2)尿中排泄が造影後有意に増加したのは, 尿中γ-GTPは両群とも, 尿中ALBとNAGは腎機能正常群のみに認められた。近位尿細管β2-MG再吸収能は腎機能障害群のみ造影4日目まで一過性に低下傾向を示したが, 6日目には軽快していた

We assessed the nephrotoxicity of a non-ionic contrast medium, Iohexol, in 18 elderly patients. They were divided into two groups. Group 1 consisted of 12 patients with glomerular flow rate (GFR) above 60 ml/min/1.73 m2 (range 69-136; average 96) and group 2 consisted of 6 patients with GFR below 60 ml/min/1.73 m2 (range 38-59; average 49). Urine samples, collected before, immediately after, and on the third and sixth days after drip infused pyeloureterography (DIP) were analyzed for gamma-glutamyl transpeptidase (gamma-GTP), N-acetyl-beta-D-glucosaminidase (NAG), beta 2-microglobulin (beta 2-MG) and albumin. In group 1, immediately after DIP, the urinary excretion of albumin, gamma-GTP and NAG were significantly increased (p < 0.01, p < 0.01, p < 0.01). In group 2, immediately after DIP, the urinary excretion of gamma-GTP and beta 2-MG were significantly increased (p < 0.01, p < 0.1). The gamma-GTP and NAG values in both groups suggest that the damage of proximal tubules cells will not continue for more than 4 days. However, as for the reabsorption of beta 2-MG on proximal tubules, in group 2 the value did not return to the pre DIP level until 6 days after DIP. We believe it is important to postpone injection of non-ionic contrast medium within 6 days of its last usage.