Afin d'ajouter � la discussion, une �tude a �t� publi�e dans le "American Journal of Cardiology" en f�vrier dernier, encore une fois sur un petit nombre de patients mais on parviendra peut-�tre un jour � publier une "m�ta" sur le sujet...
"Diaz-Sandoval et al. Acetylcysteine to prevent angiography-related renal tissue injury (the APART trial). 2002, 1 f�vrier; 1;89(3):356-358. Jean Levasseur -----Message d'origine----- De�: J Levasseur [mailto:[EMAIL PROTECTED]] Envoy�: 13 mars, 2002 19:29 ��: '[EMAIL PROTECTED]' Objet�: RE : URG-L: acetyl cysteine et injection de produit de contraste Nous utilisons et le NAC et la th�ophylline selon le temps dont nous disposons pour "pr�parer" le patient, mais m�me si pas "EBM certified" nos n�phrologues et nos radiologues ont embarqu�... Cela fait-il vraiment une diff�rence ??? Je serais tent� de dire oui par le nombre moins important de patients en IRA suite � l'injection de produit de contraste, que j'ai pu remarquer dans ma pratique (urgence et soins intensifs). Voici une r�f�rence: : Intensive Care Med 2001 Jul;27(7):1200-9 Related Articles, Books, LinkOut Reduced incidence of radiocontrast-induced nephropathy in ICU patients under theophylline prophylaxis: a prospective comparison to series of patients at similar risk. Huber W, Jeschke B, Page M, Weiss W, Salmhofer H, Schweigart U, Ilgmann K, Reichenberger J, Neu B, Classen M. Department of Internal Medicine II, Klinikum Rechts der Isar, Technical University Munich, Germany. [EMAIL PROTECTED] OBJECTIVE: To investigate whether the adenosine-antagonist theophylline reduces the incidence of contrast-induced nephropathy (CIN). DESIGN AND SETTING: Prospective, comparison to series of patients at similar risk of CIN in a university hospital medical ICU. PATIENTS: 78 ICU patients with at least one risk factor for CIN undergoing 150 consecutive contrast examinations. INTERVENTIONS: Administration of 200 mg theophylline/70 kg BW intravenously 30 min before that of 100 ml or more low-osmolarity contrast medium (CM). MEASUREMENTS AND RESULTS: Concentrations of serum creatinine and blood urea nitrogen (BUN), urine volume, fluid balance, and the incidence of CIN [increase in creatinine > or =20.5 mg/dl (= 44.2 micromol/l) within 48 h] were monitored for 48 h. Despite the large number of risk factors (6.8 per patient) including a high dose of CM (169.4 ml), impaired renal function (51%), diabetes (38%), aminoglycosides (61%), vancomycin (53%), catecholamines (52%), creatinine concentrations were not increased 24 h (1.40+/-0.92 mg/dl) or 48 h (1.38+/-0.88 mg/dl) after CM [1.47+/-1.0 mg/dl (= 130+/-88 micromol/l)] vs. baseline. The fluid balance was not different before (+3 ml/h) and after CM (-9 ml/h). The urine volume slightly increased after CM and theophylline (184 ml/h vs. 164 ml/h). Only three patients (2%) developed CIN. The incidence was significantly lower than that of 14% (78/565) in the control series with patients at comparable risk of CIN (p < 0.0001). CONCLUSIONS: Using a theophylline prophylaxis the incidence of CIN in patients with increased risk of CIN is as low as 2%. Pour ce qui est du NAC il y a quelques �tudes en cours afin d'an clarifier le r�le en ce qui regarde le risque associ� � l'injection de produit de contraste et en p�ri op�ratoire. Salutations, Jean Levasseur M�decin � l'urgence de l'ICM et aux soins intensifs du CHRDL.
