Clin Exp Emerg Med.  2016 Dec;3(4):204-212. 10.15441/ceem.15.110.

Urine metabolomic analysis to detect metabolites associated with the development of contrast induced nephropathy

Affiliations
  • 1Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, TX, USA. Deborah.Diercks@utsouthwestern.edu
  • 2Department of Emergency Medicine, Davis Medical Center, University of California, Sacramento, CA, USA.
  • 3Indiana University, Indianapolis, IN, USA.

Abstract


OBJECTIVE
Contrast induced nephropathy (CIN) is a result of injury to the proximal tubules. The incidence of CIN is around 11% for imaging done in the acute care setting. We aim to analyze the metabolic patterns in the urine, before and after dosing with intravenous contrast for computed tomography (CT) imaging of the chest, to determine if metabolomic changes exist in patients who develop CIN.
METHODS
A convenience sample of high risk patients undergoing a chest CT with intravenous contrast were eligible for enrollment. Urine samples were collected prior to imaging and 4 to 6 hours post imaging. Samples underwent gas chromatography/mass spectrometry profiling. Peak metabolite values were measured and data was log transformed. Significance analysis of microarrays and partial least squares was used to determine the most significant metabolites prior to CT imaging and within subject. Analysis of variance was used to rank metabolites associated with temporal change and CIN. CIN was defined as an increase in serum creatinine level of ≥ 0.5 mg/dL or ≥ 25% above baseline within 48 hours after contrast administration.
RESULTS
We sampled paired urine samples from 63 subjects. The incidence of CIN was 6/63 (9.5%). Patients without CIN had elevated urinary citric acid and taurine concentrations in the pre-CT urine. Xylulose increased in the post CT sample in patients who developed CIN.
CONCLUSION
Differences in metabolomics patterns in patients who do and do not develop CIN exist. Metabolites may be potential early identifiers of CIN and identify patients at high-risk for developing this condition prior to imaging.

Keyword

Metabolomics; Contrast; Nephropathy

MeSH Terms

Citric Acid
Creatinine
Humans
Incidence
Least-Squares Analysis
Metabolomics*
Spectrum Analysis
Taurine
Thorax
Tomography, X-Ray Computed
Xylulose
Citric Acid
Creatinine
Taurine
Xylulose
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