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What Do My Lab Test Reports Indicate?
Question: Hi Sir
My mom is 64years old on dialysis (Stage5=gfr<15), with an history of Hypertension and is on PD for 4 years.She was diagnosed with LV dysfunction and was advised angiogram and her DST report is negative. My question is what kind on impact will XXXXXXX have on kidney functioning post operation (Scr=8, Albumin:3). Im worried about occurrence of CIN(Contrast Induced Nephropathy). Thank you
My mom is 64years old on dialysis (Stage5=gfr<15), with an history of Hypertension and is on PD for 4 years.She was diagnosed with LV dysfunction and was advised angiogram and her DST report is negative. My question is what kind on impact will XXXXXXX have on kidney functioning post operation (Scr=8, Albumin:3). Im worried about occurrence of CIN(Contrast Induced Nephropathy). Thank you
Brief Answer:
please provide full form of DST and its report.
Detailed Answer:
Dear Sir
1. A patient with CKD stage V with history of hypertension with Coronary artery disease is definitely one of the higher risk groups for contrast induced nephropathy.
2. Any one who really requires an interventional cardiology procedure should not be denied it. The best people to decide regarding this are the cardiologist and nephrologist of the patient. They can really decide if harms of contrast exposure exceed the benefit of revascularization.
3. There are certain preventive measures recommended for such patients. These include nephrologist consultation prior to procedure, minimum use of contrast, possibly coronary angiogram and angioplasty in same sitting and use of non-iodonated iso-osmolar contrast agent. The volume expansion and immediate dialysis after the procedure are not mandatory for CKD-V patient on dialysis but will be best decided by nephologist.
4. What is meant by test DST. kindly elaborate on it. It is important in her management.
Waiting for your reply.
Sincerely
Sukhvinder
please provide full form of DST and its report.
Detailed Answer:
Dear Sir
1. A patient with CKD stage V with history of hypertension with Coronary artery disease is definitely one of the higher risk groups for contrast induced nephropathy.
2. Any one who really requires an interventional cardiology procedure should not be denied it. The best people to decide regarding this are the cardiologist and nephrologist of the patient. They can really decide if harms of contrast exposure exceed the benefit of revascularization.
3. There are certain preventive measures recommended for such patients. These include nephrologist consultation prior to procedure, minimum use of contrast, possibly coronary angiogram and angioplasty in same sitting and use of non-iodonated iso-osmolar contrast agent. The volume expansion and immediate dialysis after the procedure are not mandatory for CKD-V patient on dialysis but will be best decided by nephologist.
4. What is meant by test DST. kindly elaborate on it. It is important in her management.
Waiting for your reply.
Sincerely
Sukhvinder
Above answer was peer-reviewed by :
Dr. Veerisetty Shyamkumar
Dear Sir,
Thank you for taking my query. I'm elaborating on DST & also sharing a couple points which i missed previously.
DST test : Dobutamine Stress Test (Stress Myocardial Perfusion Scan): Test was done as a temporary measure (3 months back)(DST report enclosed below)
DST Report
Echo pointed :Global Hypokensia (with Ejection Fraction :37%) & ECG: NSR.
Report is as follows
Position :Supine
Rest HR:88 bpm
Endpoint: THR achieved
Symptoms : Palpitation
Scan Finding
Size of LV cavity: NORMAL
Overall Myocardial Uptake :NORMAL
Segmental Distribution of Tracer : NORMAL perfusion noted in all myocardial segments
IMPRESSION
Negative for inducible ischaemia with Dobutamine.
She doesn't report breathlessness or sweating while walking, though fatigue, and low BP are present (Takes Carnitor Injection:weekly once)
Sir,gfr rate in this case may be between 5-8% . As per my understanding, XXXXXXX once it enters the bloodstream can be filtered by only kidneys (please correct me if wrong). If so,
1. How effective will the RRT (Renal Replacement Therapy: Hemodialysis or Peritoneal Dialysis) be? Will XXXXXXX be entirely flushed out from the blood by RRT.
2. What will be the long term implications of such a radio contrast material in the body if any(6months or 1year).
3.Are there any alternate non-invasive methods which can mitigate risk of contrast material
4.What is the probability of CIN in the present case or any other complication.
Please let me know if you need any other information on the case
Thank you.
Waiting for your reply.
Your sincerely,
XXXX
Thank you for taking my query. I'm elaborating on DST & also sharing a couple points which i missed previously.
DST test : Dobutamine Stress Test (Stress Myocardial Perfusion Scan): Test was done as a temporary measure (3 months back)(DST report enclosed below)
DST Report
Echo pointed :Global Hypokensia (with Ejection Fraction :37%) & ECG: NSR.
Report is as follows
Position :Supine
Rest HR:88 bpm
Endpoint: THR achieved
Symptoms : Palpitation
Scan Finding
Size of LV cavity: NORMAL
Overall Myocardial Uptake :NORMAL
Segmental Distribution of Tracer : NORMAL perfusion noted in all myocardial segments
IMPRESSION
Negative for inducible ischaemia with Dobutamine.
She doesn't report breathlessness or sweating while walking, though fatigue, and low BP are present (Takes Carnitor Injection:weekly once)
Sir,gfr rate in this case may be between 5-8% . As per my understanding, XXXXXXX once it enters the bloodstream can be filtered by only kidneys (please correct me if wrong). If so,
1. How effective will the RRT (Renal Replacement Therapy: Hemodialysis or Peritoneal Dialysis) be? Will XXXXXXX be entirely flushed out from the blood by RRT.
2. What will be the long term implications of such a radio contrast material in the body if any(6months or 1year).
3.Are there any alternate non-invasive methods which can mitigate risk of contrast material
4.What is the probability of CIN in the present case or any other complication.
Please let me know if you need any other information on the case
Thank you.
Waiting for your reply.
Your sincerely,
XXXX
Brief Answer:
please see details
Detailed Answer:
Dear Sir
1. If Dobutamine stress test is negative in a patient, I normally do not go for coronary angiogram. You can talk to your cardiologist about the pressing indication of angiogram in such a case or seek a second opinion on the issue.
2. Yes, I have already stated the fact that a patient with high blood pressure, CKD stage V with a coronary procedure is one of the higher risk categories for CIN. The risk is more because number of remaining nephrons is less, contrast load per nephron is higher and exposure time (for tubular cells) is also higher.
3. Renal replacement therapy in association with other measures for prevention of CIN may be helpful in certain high risk patients but it is not a definitive answer. As hemodialysis removed 70-80% of contrast agent in 4 hours session but could not reduce the peak concentration of contrast in blood (one of the studies). Once the CIN occurs in such a patient, prognosis is relatively bad. It has to be treated with RRT only. Long term prognosis in such patients is relatively poor due to various reasons.
4. Non-invasive methods N acetyl-cysteine etc has not provided much benefit. Volume expansion has a definite role but mostly in patients who have normal renal function or those who have CKD but do not require RRT. As I told you earlier that literature do no recommend their use in a patient who is already on RRT. Still individual practices prevail at different centers.
Sincerely
Sukhvinder
please see details
Detailed Answer:
Dear Sir
1. If Dobutamine stress test is negative in a patient, I normally do not go for coronary angiogram. You can talk to your cardiologist about the pressing indication of angiogram in such a case or seek a second opinion on the issue.
2. Yes, I have already stated the fact that a patient with high blood pressure, CKD stage V with a coronary procedure is one of the higher risk categories for CIN. The risk is more because number of remaining nephrons is less, contrast load per nephron is higher and exposure time (for tubular cells) is also higher.
3. Renal replacement therapy in association with other measures for prevention of CIN may be helpful in certain high risk patients but it is not a definitive answer. As hemodialysis removed 70-80% of contrast agent in 4 hours session but could not reduce the peak concentration of contrast in blood (one of the studies). Once the CIN occurs in such a patient, prognosis is relatively bad. It has to be treated with RRT only. Long term prognosis in such patients is relatively poor due to various reasons.
4. Non-invasive methods N acetyl-cysteine etc has not provided much benefit. Volume expansion has a definite role but mostly in patients who have normal renal function or those who have CKD but do not require RRT. As I told you earlier that literature do no recommend their use in a patient who is already on RRT. Still individual practices prevail at different centers.
Sincerely
Sukhvinder
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Thank you very sir, for the detailed reply.Sir, angiogram has been performed and as indicated by DST there are no blocks except mild LAD.My top concern is nephrotoxicity and contrast used is Revelon (20 ml). My questions are as follows
1. How safe is the contrast medium used and quantity administered.
2. Are there any physical symptoms associated with the onset of CIN, as no serum creatinine tests were conducted post angio and no immediate dialysis (HD) was prescribed. Mom was told to be on normal PD exchange after 5 hours.
3. Gfr rate is 5-6%, how detrimental is losing remaining percent of Kidney function and its implication for heart.Will kidneys filter the above contrast quantity.
4.Can CIN be considered as a single independent predictor for CKD related mortality.
5. Can you please suggest me any website where i can get accurate info on diet related to heart and Kidney,there is too much info on this. very confusing.
Thank you very much sir, for taking up my case and answering patiently in the hour crisis.Thanks a ton.
Yours Sincerely
XXXX
1. How safe is the contrast medium used and quantity administered.
2. Are there any physical symptoms associated with the onset of CIN, as no serum creatinine tests were conducted post angio and no immediate dialysis (HD) was prescribed. Mom was told to be on normal PD exchange after 5 hours.
3. Gfr rate is 5-6%, how detrimental is losing remaining percent of Kidney function and its implication for heart.Will kidneys filter the above contrast quantity.
4.Can CIN be considered as a single independent predictor for CKD related mortality.
5. Can you please suggest me any website where i can get accurate info on diet related to heart and Kidney,there is too much info on this. very confusing.
Thank you very much sir, for taking up my case and answering patiently in the hour crisis.Thanks a ton.
Yours Sincerely
XXXX
Brief Answer:
Please see detailed reply.
Detailed Answer:
Dear Sir
1. I regret that I could not understand that which contrast media was administrated by name of REVELON. If you can provide me with pharamacological name of the agent, I will throw light on it.
2. Physical symptoms of Uremia may be there in a given case of Contrast induced nephropathy (CIN). However , there may not be any marked symptom especially when patient is already on RRT for CKD. CIN is usually non-oligouric, i.e. Urine output do not markedly decrease in most patients. As I told in my previous answers too, Patients on RRT may not require urgent dialysis post-procedure. It is best determined by treating nephrologist. Serum creatinine may not give better idea of CIN as compared to calculation of GFR and serum Cystatin C levels.
3. As I told you previously also, the chances of CIN are more in patients with CKD undergoing cardiac procedures. This may be deterimental to remaining nephrons as detailed in my previous answer.
4. CIN is a predictor of bad prognosis in any patient irrespective of presence of CKD or not. However, It can not be said that it is a single predictor nor its role in outcome of a single patient be quatified. Because data comes from populations and is applicable to populations. It can not be applied to predict outcome in a single patient.
5. The confusion about websites is because they provide only general information, While a given paitent has unique subset of problems. My adivse is to consult a good dietician for same.
Feel free to discuss further.
Sincerely
Sukhvinder
Sincerely
Sukhvinder
Please see detailed reply.
Detailed Answer:
Dear Sir
1. I regret that I could not understand that which contrast media was administrated by name of REVELON. If you can provide me with pharamacological name of the agent, I will throw light on it.
2. Physical symptoms of Uremia may be there in a given case of Contrast induced nephropathy (CIN). However , there may not be any marked symptom especially when patient is already on RRT for CKD. CIN is usually non-oligouric, i.e. Urine output do not markedly decrease in most patients. As I told in my previous answers too, Patients on RRT may not require urgent dialysis post-procedure. It is best determined by treating nephrologist. Serum creatinine may not give better idea of CIN as compared to calculation of GFR and serum Cystatin C levels.
3. As I told you previously also, the chances of CIN are more in patients with CKD undergoing cardiac procedures. This may be deterimental to remaining nephrons as detailed in my previous answer.
4. CIN is a predictor of bad prognosis in any patient irrespective of presence of CKD or not. However, It can not be said that it is a single predictor nor its role in outcome of a single patient be quatified. Because data comes from populations and is applicable to populations. It can not be applied to predict outcome in a single patient.
5. The confusion about websites is because they provide only general information, While a given paitent has unique subset of problems. My adivse is to consult a good dietician for same.
Feel free to discuss further.
Sincerely
Sukhvinder
Sincerely
Sukhvinder
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Priyanka G Raj
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