イオン性および非イオン性造影剤による静脈性尿路造影時の腎障害の比較検討

Abstract

1)正常血清Crの患者を対象として静脈性尿路造影を行い, イオン性diatrizoate (60%ウログラフィン(R), 100 ml)使用群30例と非イオン性iohexol(オムニパーク300(R), 100 ml)使用群30例に分けて造影剤による腎障害の程度を比較した.2)造影剤注入前と注入30分後に採尿し, 尿中ALB, γ-GTP, NAG, β2 MG, Crを測定し, 尿中Crの値で除した比の値を用いて推計学的に検討した.3)造影剤注入30分後にdiatrizoate群でγ-GTP, NAGとβ2 MGが有意に増加し, iohexol群ではγ-GTPとβ2 MGが有意に増加した.ALBはdiatrizoate群で増加傾向があった.4)各項目の前後の差の値は, いずれもdiatrizoate群のほうがiohexol群より有意に大きく, iohexolはdiatrizoateより腎障害が少ない結果がえられた.5)造影剤による副作用症状のあった症例が, 副作用症状のなかった症例に比べて腎障害が増強することはなかった.年齢別では造影後に高齢者ほど腎障害が増強することもなかった.6)尿中Crは造影剤注入後に2群とも有意に減少したが, 減少率はイオン性群の方が非イオン性群より有意に大きく, 静脈性尿路造影における腎障害はおもに造影剤の高浸透圧性によると考えられた

The effects on renal function of an ionic and hyperosmolaric contrast agent (diatrizoate) and a non-ionic and slightly hypertonic agent (iohexol) for drip infused urography were compared on 60 patients with normal renal function. Urine samples were collected before and 30 minutes after drip infusion of contrast agent, and analyzed for albumin (ALB), gamma-glutamyl transpeptidase (gamma-GTP), N-acetyl-beta-glucosaminidase (NAG), beta 2 microglobulin (beta 2MG) and creatinine (CRE). The urinary excretion of proteins and enzymes was compared with urinary CRE. gamma-GTP, NAG and beta 2MG increased significantly after infusion of diatrizoate. gamma-GTP and beta 2MG increased significantly after infusion of iohexol. Excretion of ALB, gamma-GTP, NAG and beta 2MG was significantly higher after infusion of diatrizoate than after iohexol. The urinary concentration of CRE was significantly lower after infusion of diatrizoate than after iohexol. The degree of renal damage after urography was no related to the appearance of allergy to the contrast agent or age of patient. Therefore, the non-ionic and slightly hyperosmolaric iohexol may be less toxic to the kidneys than the ionic and hypertonic diatrizoate. This nephrotoxicity after drip infused urography is thought to be related mainly to the osmolarity of contrast agent.