COMPARATIVE EVALUATION OF DIATRIZOATE MEGLUMINE AND IOPROMIDE AS CONTRAST AGENTS FOR NON - SELECTIVE INTRA - ARTERIAL DIGITAL SUBTRACTION ANGIOGRAPHY OF KIDNEYS IN DOGS (Canis domestica)
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Date
2004
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AAU, Anand
Abstract
An experimental study on non-selective renal angiography using ionic contrast media Diatrizoate Meglumine (Group I, n=I2) and nonionic contrast media lopromide (Group II, n=5) as contrast agents by intra-arterial digital subtraction angiography technique was conducted in 17 clinically healthy dogs of either sex to compare their efficacy, safety and tolerance. The angiography procedure was carried out under general anaesthesia using mixture of ketamine hydrochloride @ 10 mg/kg b.wt. and diazepam 0.5 mg/kg b.wt. IV given 30 minutes after mild sedation with acepromazine hydrochloride @ 0.05 mg/kg b.wt. IM. The non-selective renal angiography was performed by introducing pig-tail catheter using transfemoral approach. The aortographic flush was brought by intra-arterial injection of Diatrizoate Meglumine and lopromide @ 2 ml/kg b.wt. at the speed of 15 ml/sec in animals of groups I and II, respectively. Preangiography, immediate postangiography and 48 hrs postangiography arterial blood and urine samples were obtained from animals of both the groups for biochemical study and urinalysis. Clinical observation and aortographic image quality were recorded following angiography in both the groups. No clinical adverse effects were seen with use of either of the CM under study. The image quality was almost similar in both the groups with regards to opacity of the renal vascular system, however, few minor details were more prominent with longer duration of sharp delineation visualized with lopromide as compared to Diatrizoate Meglumine. Optimum visualization upto inter-lobular branches was noticed alongwith the capillary phase in nephrograms. In postangiography clinical observation, general health, appetite, water intake and urination were found to be normal with postangiography haematoma (2-5 cm diameter) noticed in 7 animals which vanished within 48 hrs. The arterial blood sample was subjected to the gaseous parameter study viz., partial pressure of oxygen (Pa02) and carbon dioxide (PaC02), total carbon dioxide (TCO2), haemoglobin oxygen saturation (Sa02 %) and pH. A nonsignificant decrease and increase in Pa02 and Sa02 was observed in animals of group I and II respectively whereas, PaC02 showed a significant increase and a nonsignificant decrease in groups I and II respectively. A nonsignificant and significant decrease in TCO2 were seen in groups I and II, respectively. The pH significantly decreased in group I, while, in group II it showed nonsignificant fluctuations with the value remaining almost constant throughout the period of study up to 48 hrs. Diatrizoate Meglumine showed marginal nonsignificant fluctuations in the BUN and SCr levels, whereas, the SCr value remained unaltered with nonsignificant decrease in BUN in animals of lopromide group, however, extent of decrease in SCr and BUN were more in Diatrizoate Meglumine group than lopromide group. The plasma electrolytes such as plasma bicarbonate, potassium, sodium and chloride were determined. Group I showed nonsignificant transient decrease in concentration of all the electrolytes immediately after the angiography except for plasma sodium which showed significant decrease. Significant decrease in all the electrolytes concentration was seen in group II with peak decrease seen at 48 hrs, except for nonsignificant decrease in plasma potassium. The urine properties (urine pH - UpH and urine specific gravity - USG), the urine components (urine protein, urine creatinine and urine sodium) and the urinary derived parameters (Fractional Excretion of Sodium - FENa and the urine protein to creatinine ratio - UPr/Cr) were observed to be nonsignificant and showed fluctuation in both the groups. Overall, the fluctuating changes showed decreasing trend in animals of both the groups. A significant increase in enzymuria was seen. The urinary N-Acetylbeta- D-Glucosaminidase significantly increased in both the groups and urinary gamma glutamyl transferase and alanine-aminopeptidase significant ly increased in animals of groups I and II respectively were noted. Significant changes were observed at 48 hrs postangiography except for NAG in group I. The present study concludes that under non-selective intra-arterial DSA, delineation of renal vacular anatomy was adequate using both Diatrazoate Meglumine and lopromide. On comparative basis, superior quality aortograms were obtained using lopromide and the renal injury produced was less pronounced, hence, can be advocated especially in dogs with high risk renal failure.
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VETERINARY SURGERY, EVALUATION