STUDY OF SERUM NEOPTERIN, INTERLEUKIN-10 AND NEUTROPHIL TO LYMPHOCYTE RATIO IN CONTRAST INDUCED NEPHROPATHY

Abstract

Background: Recent improvements in radio-diagnostic procedures and in cardiovascular percutaneous
interventions, together with increased life expectancy, have resulted in the subjection of an increasing number of
patients to contrast medium-enhanced examinations or cardiac and angiographic procedure requiring iodinated
contrast medium injection.
 Subjects and methods: This study was carried out at Internal Medicine, Cardiology, Radiology and
Clinical Pathology departments, Zagazig University Hospitals. The study was approved by Institutional Review
Board (IRB) and included a total of 60 patients.
 Based on the development of contrast induced nephropathy after IV administration of high osmolar
contrast agent, Patients were classified into CIN and NO CIN groups. We measured serum neopterin and IL-10
and calculating neutrophil to lymphocyte ratio before contrast administration, 24 and 48 hours after in 45
patients underwent coronary angiography for diagnostic and therapeutic purposes and 15 patients underwent
renal angiography.
 Results: About 25 % of the present studied patients (14 patients) fulfilled the criteria of contrast
nephropathy with more cases in the percutaneous coronary angiography group (11 patients).This study revealed
that serum neopterin, IL 10 and neutrophil to lymphocyte ratio were higher in patients with CIN following IV
contrast media at 24 & 48 hours compared to patients without CIN. In our study; we found increased pre
procedural and post-procedural CRP, ESR and uric acid levels at 48 hours in patients with CIN. We found a
decreased basal serum total bilirubin level in patients with CIN following IV contrast media compared to
patients without CIN.
 Conclusion: Serum neopterin, IL 10 and neutrophil to lymphocyte ratio proved that they can be used as
early biomarkers of contrast induced nephropathy instead of serum creatinine as they rise 24 hours before any
change in the serum creatinine. Decreased serum total bilirubin levels had a higher incidence of CIN after the
use of contrast media. Measuring ESR & CRP levels at admission may offer additional assistance in predicting
the development of CIN. Elevated serum uric acid level is independently associated with an increased risk of
CIN.
 Abbreviations: CIN = Contrast induced nephropathy, AKI = Acute kidney injury, CRP = C-reactive
protein, NLR= Neutrophil to lymphocyte ratio, ESR = Erythrocyte sedimentation rate, UA = Uric acid, eGFR =
estimated glomerular filtration rate.
 Keywords: Contrast induced nephropathy; Neopterin; IL-10; Neutrophil to lymphocyte ratio.