Nephrotoxicity from contrast media: attenuation with theophylline

Area of Science:

• Nephrology
• Pharmacology
• Radiology

Background:

• Contrast-induced nephrotoxicity is a significant concern in patients undergoing radiological procedures.
• Theophylline, a xanthine derivative, has potential protective effects against kidney injury.

Purpose of the Study:

• To investigate the efficacy of theophylline in preventing the decline of creatinine clearance following contrast medium administration.
• To explore the role of intrarenal adenosine in contrast medium nephrotoxicity.

Main Methods:

• A randomized controlled trial involving 93 patients receiving either nonionic (iopamidol) or ionic (sodium diatrizoate) contrast media.
• Patients were pre-treated with either theophylline or a placebo.
• Creatinine clearance and urinary adenosine levels were measured pre- and post-angiography.

Main Results:

• Theophylline administration prevented the decrease in creatinine clearance observed with iopamidol and significantly reduced the decrease seen with sodium diatrizoate.
• Urinary adenosine levels increased significantly in theophylline-treated groups.
• A separate group receiving dipyridamole (adenosine-uptake inhibitor) with iopamidol also showed increased urinary adenosine and decreased creatinine clearance.

Conclusions:

• Intrarenal adenosine plays a role in the development of contrast medium-induced nephrotoxicity.
• Theophylline demonstrates a protective effect against contrast-induced nephrotoxicity, likely mediated through adenosine pathways.