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IV N-Acetylcysteine and Emergency CT: Use of Serum Creatinine and Cystatin C as Markers of Radiocontrast Nephrotoxicity

¹ Department of Radiology, University Hospital of Geneva, 24, rue Micheli-du-Crest, 1211 Genève 14, Switzerland.
² Service of Nephrology, University Hospital of Geneva, Geneva, Switzerland.
³ Service of Clinical Pharmacology and Pharmacy, University Hospital of Geneva, Geneva, Switzerland.
⁴ Emergency Center, University Hospital of Geneva, Geneva, Switzerland.

OBJECTIVE. The purpose of this study was to assess the effect of IV administration of N-acetylcysteine (NAC) on serum levels of creatinine and cystatin C, two markers of renal function, in patients with renal insufficiency who undergo emergency contrast-enhanced CT.

SUBJECTS AND METHODS. Eighty-seven adult patients with renal insufficiency who underwent emergency CT were randomized to two groups. In the first group, in addition to hydration, patients received a 900-mg injection of NAC 1 hour before and another immediately after injection of iodine contrast medium. Patients in the second group received hydration only. Serum levels of creatinine and cystatin C were measured at admission and on days 2 and 4 after CT. Nephrotoxicity was defined as a 25% or greater increase in serum creatinine or cystatin C concentration from baseline value.

RESULTS. A 25% or greater increase in serum creatinine concentration was found in nine (21%) of 43 patients in the control group and in two (5%) of 44 patients in the NAC group (p = 0.026). A 25% or greater increase in serum cystatin C concentration was found in nine (22%) of 40 patients in the control group and in seven (17%) of 41 patients in the NAC group (p = 0.59).

CONCLUSION. On the basis of serum creatinine concentration only, IV administration of NAC appears protective against the nephrotoxicity of contrast medium. No effect is found when serum cystatin C concentration is used to assess renal function. The effect of NAC on serum creatinine level remains unclear and may not be related to a renoprotective action.

Keywords: contrast media • CT • emergency radiology • N-acetylcysteine • nephrotoxicity

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