nidНефрология и диализNephrology and Dialysis1680-44222618-9801Российское диализное общество10.28996/2618-9801-2019-3-301-311nid-296Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESБиомаркеры контраст-индуцированного острого почечного повреждения после чрескожных коронарных вмешательствBiomarkers of contrast-induced acute kidney injury after percutaneous coronary interventionsХильчукА. А.KhilchukA. A.anton.khilchuk@gmail.comАбуговС. А.AbugovS. A.noemail@neicon.ruВласенкоС. В.VlasenkoS. V.noemail@neicon.ruЩербакС. Г.ScherbakS. G.noemail@neicon.ruСаранаА. М.SaranaA. M.noemail@neicon.ruАгарковМ. В.AgarkovM. V.noemail@neicon.ruКармазанашвилиЕ. Г.KarmazanashviliE. G.noemail@neicon.ruОтделение рентгенохирургических методов диагностики и лечения, СПб ГБУЗ "Городская больница № 40"; Медицинский факультет СПбГУ; Отдел рентгенохирургии и аритмологии, РНЦХ им. акад. Б.В. ПетровскогоРоссияDepartment of Interventional Radiology, City Hospital № 40; Medical Faculty, Saint-Petersburg State University; Endovascular and arrhythmology department, Russian National Research Center of Surgery named after academician B.V. PetrovskyRussian FederationОтдел рентгенохирургии и аритмологии, РНЦХ им. акад. Б.В. ПетровскогоРоссияEndovascular and arrhythmology department, Russian National Research Center of Surgery named after academician B.V. PetrovskyRussian FederationОтделение рентгенохирургических методов диагностики и лечения, СПб ГБУЗ "Городская больница № 40"; Медицинский факультет СПбГУРоссияDepartment of Interventional Radiology, City Hospital № 40; Medical Faculty, Saint-Petersburg State UniversityRussian FederationМедицинский факультет СПбГУРоссияMedical Faculty, Saint-Petersburg State UniversityRussian FederationОтделение рентгенохирургических методов диагностики и лечения, СПб ГБУЗ "Городская больница № 40"РоссияDepartment of Interventional Radiology, City Hospital № 40Russian FederationКафедра хирургии усовершенствования врачей № 1, ВМедА им. С.М. КироваРоссияPostgraduate surgical department № 1, S.M. Kirov Military Medical AcademyRussian Federation201907082024213301311Copyright © Хильчук А.А., Абугов С.А., Власенко С.В., Щербак С.Г., Сарана А.М., Агарков М.В., Кармазанашвили Е.Г., 20242024Хильчук А.А., Абугов С.А., Власенко С.В., Щербак С.Г., Сарана А.М., Агарков М.В., Кармазанашвили Е.Г.Khilchuk A.A., Abugov S.A., Vlasenko S.V., Scherbak S.G., Sarana A.M., Agarkov M.V., Karmazanashvili E.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephro.ru/jour/article/view/296

Современные достижения интервенционной кардиологии в лечении ишемической болезни сердца (ИБС) привели к значительному росту частоты выполняемых вмешательств с применением рентгеноконтрастных средств (РКС). КИ-ОПП представляет собой ятрогенное осложнение внутрисосудистого введения РКС, которое удовлетворяет одному из следующих критериев ОПП: повышение сывороточного креатинина (СКр) на 26,5 мкмоль/л в течение 48-72 часов или повышение СКр более чем в 1,5 раза в сравнении с его известным или предполагаемым уровнем за предшествующие 7 дней. Несмотря на известное токсическое воздействие РКС на эпителий почечных канальцев, безопасной замены им пока не найдено. При отсутствии ранней диагностики КИ-ОПП приводит к увеличению частоты осложнений со стороны сердечно-сосудистой системы, увеличению длительности госпитализации, в ряде случаев к необходимости в заместительной почечной терапии, а также связано с пятикратным увеличением внутрибольничной смертности. Возможности лечения уже возникшего КИ-ОПП ограничены, поэтому крайне важной является его адекватная профилактика с ранней стратификацией риска развития КИ-ОПП и отменой принимаемых пациентом нефротоксичных препаратов. Значимость проблемы и диагностические ограничения, связанные с определением СКр, требуют поиска клинически и диагностически значимых биомаркеров ОПП. В контексте коронарной ангиографии и чрескожных коронарных вмешательств было проведено несколько исследований клинической и диагностической значимости некоторых биомаркеров. Определенные биомаркеры ОПП доказали свою эффективность в нескольких исследованиях, но необходимо детальное изучение возможности их комбинирования с целью улучшения качества оказания медицинской помощи пациентам после чрескожных коронарных вмешательств (ЧКВ). Ятрогенная и предсказуемая природа КИ-ОПП делает исследования в области его ранней диагностики крайне актуальными. В данной статье дан краткий обзор современного представления о КИ-ОПП, а также раскрыта перспектива практического использования нейтрофильного желатиназа-ассоциированного липокалина (NGAL), печеночного протеина, связывающего жирные кислоты (L-FABP), молекулы повреждения почки-1 (KIM-1), цистатина С (CysC), интерлейкинов-6,8,18 (IL-6,8,18) в интервенционной кардиологии.

Modern achievements of interventional cardiology in treatment of coronary heart disease (CHD) have significantly increased the number of interventions with the use of contrast media (CM). Contrast-induced acute kidney injury (CIAKI) associated with CM administration is determined by increase in the serum creatinine (SCr) concentration up to 26.5 µmol/l within 48-72 hours or >1.5-fold increase in SCr concentration compared to its known or estimated level in previous 7 days. Despite toxic CM effects on the renal tubule epithelium, no safe replacement has been found yet. Treatment of existing CIAKI is complex and not very efficient. Effective therapeutic options are limited only to adequate prevention of renal injury. Without early diagnosis and prevention, CIAKI leads to higher cardiovascular morbidity, extended admission, rare but significant need of a renal replacement therapy and involves 5-fold rise of in-hospital mortality. Without effective disease management, prevention with early CIAKI risk stratification and cessation of nephrotoxic medications taken by patients are important. The significance of the problem and diagnostic limitations associated with the measurement of SCr level require the search for clinically and diagnostically significant AKI biomarkers. In terms of coronarography and percutaneous coronary interventions, several studies have been conducted to estimate the clinical and diagnostic significance of some biomarkers. Certain AKI biomarkers have proved their efficacy in several studies, but detailed studies of the effects of their combinability are necessary to improve the quality of medical care of patients after performed percutaneous coronary intervention (PCI). This article characterises and discloses prospective practical use of neutrophil gelatinase-associated lipocalin (NGAL), liver-type fatty acid binding protein (L-FABP), kidney injury molecule-1 (KIM-1), cystatin C (CysC) and interleukins-6,8,18 (IL-6,8,18) in interventional cardiology.

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The authors declare that there are no conflicts of interest present.