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University of Geneva Hospital Geneva, Switzerland

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I thank Dr. Schultz and colleagues [1] for their interest in our article. They address one of the major issues of the controversial protective action of N-acetylcysteine (NAC) toward adverse effects of iodinated contrast media. Almost all prior series that have evaluated the nephroprotective role of NAC were based solely on the serum creatinine level to assess the renal function, despite the wide recognition that creatinine is an imperfect marker of glomerular filtration rate, especially in acute renal failure.

In 2002 when we were designing our study, we did postulate that serum cystatin C might be more sensitive than creatinine for revealing minute impairment of renal function after administration of contrast media, which was of major interest when dealing with small numbers of patients. The article by Hoffmann et al. [2], published in the meantime (2004), brought a plausible explanation to our results: the observed reduction in the creatinine level in patients who received NAC might only reflect a direct metabolic action of NAC on creatinine metabolism, hiding an effective (minor) impairment of the renal function. Thus the study stresses the importance of using additional markers of the renal function in further series.

However, no other conclusion can be drawn from our study results, especially whether NAC is effective or not against radiocontrast nephrotoxicity because our study analyzed only a limited aspect of the problem. One practical consequence of our study in our center is that hydration remains the only preventive action we systematically recommend immediately before performing emergency CT in a patient with renal failure. We do no consider NAC useful in this setting until proven otherwise.

References

1. Schultz MJ, Royakkers AANM, Bouman CSC. Of hypes and hopes: N-acetylcysteine and cystatin C. (letter) AJR2008; 190:[web]W224
2. Hoffmann U, Fischereder M, Kruger B, Drobnik W, Kramer BK. The value of N-acetylcysteine in the prevention of radiocontrast agent–induced nephropathy seems questionable. J Am Soc Nephrol 2004; 15:407 –410[Abstract/Free Full Text]

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Poletti, P.-A. Search for Related Content PubMed Articles by Poletti, P.-A. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?