Estimation of the glomerular filtration rate (GFR), accepted as one of the earliest and most sensitive indicators of renal dysfunction, can be determined in horses using standard techniques In adult horses and foals, renal dysfunction can occur as a secondary complication to gastrointestinal disorders, dehydration, septicemia, endotoxemia and nephrotoxic drug administration. Measurement of renal function is an important feature not only in the diagnosis, but also in the prognosis and management of renal disease. Commonly used drugs such as phenylbutazone and gentamicin can be highly nephrotoxic under certain conditions. Of particular concern are those drugs, including the aminoglycoside antibiotics, that are eliminated almost exclusively by the kidney. Knowledge of a patients renal status prior to treatment would direct efforts at; 1) restoring kidney function prior to protracted therapy with potentially damaging drugs, 2) adjusting the dose of a life-saving drug based on the magnitude of dysfunction, or 3) selecting a drug that is not dependant on renal function for elimination. such as endogenous or exogenous renal creatinine clearance. Unfortunately, these techniques can be time consuming, dangerous to perform on fractious patients, require trained personnel and are subject to errors most often associated with improper or incomplete urine collection. Recently, tests using iohexol, a radiographic contrast agent, have been developed to estimate the GFR in human beings, dogs and cats with results that have been validated by traditional standards. Most testing protocols require a single bolus injection of iohexol, followed by 2 or 3 blood samples obtained over a few hours. Compared to traditional testing methods, samples are easily and rapidly obtained making the testing procedure less stressful for the patient. A simple method to measure GFR in horses that does not require urine collection, would allow veterinarians in a clinical setting the ability to determine a patient's renal status easily and safely. The objectives of this study were; 1) model the pharmacokinetic profile of iohexol in horse foals, 2) compare creatinine clearance, an accepted standard for GFR determination in patients, with iohexol clearance, and 3) develop sampling parameters and calculation methods for a practical test, based on iohexol clearance, that compares favorably with creatinine clearance in horse foals. Iohexol concentration time data were best described using a 3-compartment open model. Mean creatinine clearance (2.17 ml/min/kg) and mean iohexol clearance (2.15 ml/min/kg) showed good agreement. In addition, GFR values for all foals using either method were within published reference ranges for this species. The results of this study indicate that a single intravenous injection of iohexol at a dose of 150 mg/kg, followed by collection of 2 serum samples at 4 and 6 hours post injection can be used to estimate the GFR in healthy horse foals. Mean corrected GFR value (CLpredicted) for 10 foals in this study was 2.15 ml/min/kg. / Master of Science

In adult horses and foals, renal dysfunction can occur as a secondary complication to gastrointestinal disorders, dehydration, septicemia, endotoxemia and nephrotoxic drug administration. Measurement of renal function is an important feature not only in the diagnosis, but also in the prognosis and management of renal disease. Commonly used drugs such as phenylbutazone and gentamicin can be highly nephrotoxic under certain conditions. Estimation of the glomerular filtration rate (GFR), accepted as one of the earliest and most sensitive assessments of renal function, can be determined in horses using standard techniques such as endogenous or exogenous renal creatinine clearance. These techniques can be time consuming, dangerous to perform on fractious patients, require trained personnel and are subject to errors most often associated with improper or incomplete urine collection. Recently, tests using iohexol, a radiographic contrast agent, have been developed to estimate the GFR in human beings, pigs, sheep, dogs, cats and horse foals with results that have been validated by traditional standards. Serum clearance of a substance that is freely filtered by the kidneys without tubular secretion or reabsorption, that is not protein bound, and that is not metabolized, is a measurement of glomerular filtration rate. Iohexol meets all of these requirements and thus its clearance from serum should accurately estimate GFR. Utilization of serum clearance studies for estimation of GFR provides a clinically feasible and reproducible method in order to measure GFR in horses. Other commonly used methods to assess renal function in horses are fraught with inherent and operator error. Serum clearance of iohexol does not necessitate collection of urine and has been shown to be a safe, reproducible method using collection of timed blood samples to assess renal function in humans and animals. The objectives of this project were 1) to determine a method of estimation of GFR based on serum clearance of a substance that meets the requirements of a marker for GFR, and 2) to make the method clinically applicable by developing a method using two blood samples to derive clearance and thus GFR in normal adult horses. Results of this study showed good agreement between GFR derived by exogenous creatinine clearance and serum clearance of iohexol. In addition, GFR values for all horses using either method were within published reference ranges for this species. The results of this study indicate that a single intravenous injection of iohexol at a dose of 150 mg/kg, followed by collection of 2 serum samples at 3 and 4 hours post injection can be used to estimate the GFR in healthy horses. / Master of Science

En réanimation, il n’existe pas de gold standard pour estimer le débit de filtration glomérulaire (DFG). Nous avons mesuré la clairance du iohexol chez 20 patients en insuffisance circulatoire aiguë (injection de 5 mL de iohexol et cinétique riche sur 24h). Les clairances urinaire et plasmatique étaient équivalentes ; la clairance plasmatique n’était pas influencée par le remplissage. Nous avons étudié la distribution de la clairance du iohexol chez 85 patients en insuffisance circulatoire aiguë. Quarante-et-un patients (48%) avaient un DFG < 30 mL.min-1, 29 (34%) entre 30 et 60mL.min-1, 10 (12%) entre 60 et 90mL.min-1, 4 (5%) entre 90 et 130 mL.min-1 et 1 (1%) > 130 mL.min-1. Nous avons mesuré les biomarqueurs lésionnels [TIMP-2].[IGFBP-7] juste avant, 6h et 24 h après un scanner injecté en réanimation; il n’y a pas eu d’augmentation significative des biomarqueurs, confortant l’hypothèse d’une toxicité négligeable des produits de contraste iodés en réanimation. En conclusion, le iohexol peut être considéré comme un gold standard pour l’estimation du DFG chez des patients en insuffisance circulatoire aiguë en termes de faisabilité, fiabilité et sécurité. / There is no gold standard for glomerular filtration rate (GFR) estimation in intensive care unit. We measured iohexol clearance in 20 patients experiencing acute circulatory failure (5 mL iohexol bolus, urine and blood-sample collections over 24h). Urinary and plasma clearances were equivalent; rapid fluid infusion did not influence plasma clearance. We studied iohexol clearance repartition in 85 patients experiencing acute circulatory failure. Forty-one (48%) had a GFR < 30 mL.min-1, 29 (34%) between 30 and 60mL.min-1, 10 (12%) between 60 and 90mL.min-1, 4 (5%) between 90 and 130 mL.min-1 and 1 (1%) > 130 mL.min-1. We measured lesion biomarkers [TIMP-2].[IGFBP-7], before, 6h and 24h after an injected computed tomography scan; there was no significant raise in the biomarkers. This result supports the hypothesis that contrast media are armless in intensive care units. To conclude, iohexol can be considered as a gold standard for GFR estimation in acute-circulatory-failure patients regarding feasibility, reliability and safety.

Contrast media are commonly used as an enhancement in several diagnostic imaging methods, which in today’s healthcare often are combined with blood works in diagnostics and surgical preparations, as well as to follow up on the patient’s recovery. To save time and money for both the hospital and the patients themselves, the ability to carry out both the radiological examination and the blood works within the same hospital visit would be preferred. However, there have been indications of a potential interference from the contrast media used, and therefore a waiting period is in place. The aim of this study was therefore to see if that waiting period was warranted by testing if contrast media does cause a significant interference in the most common analyses. This was investigated by infusing pooled samples with either iohexol or gadoteric acid, the active components of the most common contrast agents, at either a full dosage or a half dosage. These samples were then run by standard protocol and the results compared to control samples. The results showed that while some analyses proved affected, others proved unaffected or only insignificantly so. Some of the affected analyses were sodium, activated partial thrombin time and hemoglobin. While some analyses such as prostate specific antigen and prothrombin time were unaffected. Analysis of more samples is necessary to confirm the results, but the overall consensus is that while most analyses are unaffected the effects are too large and uncertain to comfortably disregard the waiting time.

Os meios de contraste iodados são substâncias radiopacas utilizadas em mielografias e, muito embora o iohexol e o iopamidol sejam considerados seguros na rotina mielográfica de humanos e animais, eventos adversos são relacionados ao seu uso. O iobitridol foi desenvolvido mais recentemente, sendo seu desenho molecular obtido após pesquisas sobre a conformação, distribuição e natureza permanente da estrutura hidrofílica; no entanto, estudos referentes à neurotoxicidade do iobitridol com administração subaracnóide são escassos e inconclusivos. O objetivo do presente trabalho foi comparar a neurotoxicidade do iobitridol com a do iohexol, por via intracisternal em ratos Wistar, como avaliação pré-clínica da utilização deste como agente mielográfico. Foram utilizados 75 animais divididos em três grupos experimentais de 25 animais: iobitridol, iohexol e NaCl 0,9% (grupo controle), e; estes subdivididos em cinco subgrupos com cinco animais cada, com doses distintas de 200, 400, 600, 800 e 1000 mg I/kg, sendo utilizado no grupo controle o volume equivalente aos meios de contraste testados. Os animais foram avaliados no momento da aplicação do iohexol e iobitridol quanto a alterações do trato respiratório, e posteriormente, aos 5, 15, 30, 60, 120, 180 e 240 minutos após este procedimento, quanto a sinais de depressão e excitação, reflexos tátil de agarramento palmar, flexor, extensor, palpebral, pupilar e da pina, reação de endireitamento e posicionamento e resposta auditiva. Nos sete dias subseqüentes, foram avaliados diariamente quanto a estes parâmetros, e ainda mensurados o peso e a ingestão de ração e de água. Não foram observadas diferenças estatisticamente significativas entre os grupos testados com meios de contraste, em nenhum dos parâmetros avaliados. Nesse modelo animal o iobitridol demonstrou baixa neurotoxicidade, comparável a observada com o iohexol, tornando-o uma possibilidade alternativa para utilização pela via subaracnóidea para realização de mielografias. / The iodinated contrast agents are radiopaque substances used in myelography, and although the iohexol and iopamidol are considered safe in human and animal myelographic routine, adverse events are related to their use. The iobitridol was recently developed, and its molecular designs obtained after research on the configuration, distribution and permanent nature of hydrophilic structure; however, neurotoxicologic studies of iobitridol in subarachnoid administration are scarce and inconclusive. The purpose of this study was to compare the neurotoxicity of iobitridol with iohexol, by intracisternal administration in Wistar rats, as pre-clinical evaluation of the use of this substance as myelographic agent. Seventy five animals were used, divided into three experimental groups with twenty five animals: iobitridol, iohexol and NaCl 0,9% (control group); and they are divided into five subgroups of five animals each, with different doses of 200, 400, 600, 800 and 1000 mg I/kg, while the control group received the equivalent volume of contrast media tested. The animals were evaluated during injection of iohexol and iobitridol on changes of respiratory tract, and subsequently at 5, 15, 30, 60, 120, 180 and 240 minutes after this procedure, for signs of depression and excitement, tactile palmar grasp, flexor, extensor, palpebral, papillary and pinna reflexes, surface righting and placing reactions, and auditory startle test. The evaluations were assessed daily for seven days these parameters, and the body weight and food and water intake were also measured. There were no statistically significant differences between groups tested with respect to any of the evaluated parameters, in other words, in this animal model, the iobitridol demonstred low neurotoxicologic potential, comparable to the observed with iohexol. In conclusion, iobitridol should be a safe alternative to myelography.

Os meios de contraste iodados são substâncias radiopacas utilizadas em mielografias e, muito embora o iohexol e o iopamidol sejam considerados seguros na rotina mielográfica de humanos e animais, eventos adversos são relacionados ao seu uso. O iobitridol foi desenvolvido mais recentemente, sendo seu desenho molecular obtido após pesquisas sobre a conformação, distribuição e natureza permanente da estrutura hidrofílica; no entanto, estudos referentes à neurotoxicidade do iobitridol com administração subaracnóide são escassos e inconclusivos. O objetivo do presente trabalho foi comparar a neurotoxicidade do iobitridol com a do iohexol, por via intracisternal em ratos Wistar, como avaliação pré-clínica da utilização deste como agente mielográfico. Foram utilizados 75 animais divididos em três grupos experimentais de 25 animais: iobitridol, iohexol e NaCl 0,9% (grupo controle), e; estes subdivididos em cinco subgrupos com cinco animais cada, com doses distintas de 200, 400, 600, 800 e 1000 mg I/kg, sendo utilizado no grupo controle o volume equivalente aos meios de contraste testados. Os animais foram avaliados no momento da aplicação do iohexol e iobitridol quanto a alterações do trato respiratório, e posteriormente, aos 5, 15, 30, 60, 120, 180 e 240 minutos após este procedimento, quanto a sinais de depressão e excitação, reflexos tátil de agarramento palmar, flexor, extensor, palpebral, pupilar e da pina, reação de endireitamento e posicionamento e resposta auditiva. Nos sete dias subseqüentes, foram avaliados diariamente quanto a estes parâmetros, e ainda mensurados o peso e a ingestão de ração e de água. Não foram observadas diferenças estatisticamente significativas entre os grupos testados com meios de contraste, em nenhum dos parâmetros avaliados. Nesse modelo animal o iobitridol demonstrou baixa neurotoxicidade, comparável a observada com o iohexol, tornando-o uma possibilidade alternativa para utilização pela via subaracnóidea para realização de mielografias. / The iodinated contrast agents are radiopaque substances used in myelography, and although the iohexol and iopamidol are considered safe in human and animal myelographic routine, adverse events are related to their use. The iobitridol was recently developed, and its molecular designs obtained after research on the configuration, distribution and permanent nature of hydrophilic structure; however, neurotoxicologic studies of iobitridol in subarachnoid administration are scarce and inconclusive. The purpose of this study was to compare the neurotoxicity of iobitridol with iohexol, by intracisternal administration in Wistar rats, as pre-clinical evaluation of the use of this substance as myelographic agent. Seventy five animals were used, divided into three experimental groups with twenty five animals: iobitridol, iohexol and NaCl 0,9% (control group); and they are divided into five subgroups of five animals each, with different doses of 200, 400, 600, 800 and 1000 mg I/kg, while the control group received the equivalent volume of contrast media tested. The animals were evaluated during injection of iohexol and iobitridol on changes of respiratory tract, and subsequently at 5, 15, 30, 60, 120, 180 and 240 minutes after this procedure, for signs of depression and excitement, tactile palmar grasp, flexor, extensor, palpebral, papillary and pinna reflexes, surface righting and placing reactions, and auditory startle test. The evaluations were assessed daily for seven days these parameters, and the body weight and food and water intake were also measured. There were no statistically significant differences between groups tested with respect to any of the evaluated parameters, in other words, in this animal model, the iobitridol demonstred low neurotoxicologic potential, comparable to the observed with iohexol. In conclusion, iobitridol should be a safe alternative to myelography.

Os meios de contraste iodados são substâncias radiopacas utilizadas em mielografias e, muito embora o iohexol e o iopamidol sejam considerados seguros na rotina mielográfica de humanos e animais, eventos adversos são relacionados ao seu uso. O iobitridol foi desenvolvido mais recentemente, sendo seu desenho molecular obtido após pesquisas sobre a conformação, distribuição e natureza permanente da estrutura hidrofílica; no entanto, estudos referentes à neurotoxicidade do iobitridol com administração subaracnóide são escassos e inconclusivos. O objetivo do presente trabalho foi comparar a neurotoxicidade do iobitridol com a do iohexol, por via intracisternal em ratos Wistar, como avaliação pré-clínica da utilização deste como agente mielográfico. Foram utilizados 75 animais divididos em três grupos experimentais de 25 animais: iobitridol, iohexol e NaCl 0,9% (grupo controle), e; estes subdivididos em cinco subgrupos com cinco animais cada, com doses distintas de 200, 400, 600, 800 e 1000 mg I/kg, sendo utilizado no grupo controle o volume equivalente aos meios de contraste testados. Os animais foram avaliados no momento da aplicação do iohexol e iobitridol quanto a alterações do trato respiratório, e posteriormente, aos 5, 15, 30, 60, 120, 180 e 240 minutos após este procedimento, quanto a sinais de depressão e excitação, reflexos tátil de agarramento palmar, flexor, extensor, palpebral, pupilar e da pina, reação de endireitamento e posicionamento e resposta auditiva. Nos sete dias subseqüentes, foram avaliados diariamente quanto a estes parâmetros, e ainda mensurados o peso e a ingestão de ração e de água. Não foram observadas diferenças estatisticamente significativas entre os grupos testados com meios de contraste, em nenhum dos parâmetros avaliados. Nesse modelo animal o iobitridol demonstrou baixa neurotoxicidade, comparável a observada com o iohexol, tornando-o uma possibilidade alternativa para utilização pela via subaracnóidea para realização de mielografias. / The iodinated contrast agents are radiopaque substances used in myelography, and although the iohexol and iopamidol are considered safe in human and animal myelographic routine, adverse events are related to their use. The iobitridol was recently developed, and its molecular designs obtained after research on the configuration, distribution and permanent nature of hydrophilic structure; however, neurotoxicologic studies of iobitridol in subarachnoid administration are scarce and inconclusive. The purpose of this study was to compare the neurotoxicity of iobitridol with iohexol, by intracisternal administration in Wistar rats, as pre-clinical evaluation of the use of this substance as myelographic agent. Seventy five animals were used, divided into three experimental groups with twenty five animals: iobitridol, iohexol and NaCl 0,9% (control group); and they are divided into five subgroups of five animals each, with different doses of 200, 400, 600, 800 and 1000 mg I/kg, while the control group received the equivalent volume of contrast media tested. The animals were evaluated during injection of iohexol and iobitridol on changes of respiratory tract, and subsequently at 5, 15, 30, 60, 120, 180 and 240 minutes after this procedure, for signs of depression and excitement, tactile palmar grasp, flexor, extensor, palpebral, papillary and pinna reflexes, surface righting and placing reactions, and auditory startle test. The evaluations were assessed daily for seven days these parameters, and the body weight and food and water intake were also measured. There were no statistically significant differences between groups tested with respect to any of the evaluated parameters, in other words, in this animal model, the iobitridol demonstred low neurotoxicologic potential, comparable to the observed with iohexol. In conclusion, iobitridol should be a safe alternative to myelography.

Background: Glomerular filtration rate (GFR) is a clinically important measurement of kidney function and estimating the GFR is of great importance in healthcare. Methods available today either lack in precision or are overly time consuming. Proenkephalin (PENK) has been shown to correlate well with the GFR and has therefore been proposed as a novel biomarker for kidney function. Aim: To evaluate a new point-of-care test for measuring PENK in blood and to assess its correlation to GFR measured by iohexol plasma clearance (mGFRiohexol). Materials and methods: Blood was collected from 21 patients with varying indications for the iohexol plasma clearance test. PENK was measured with IB10 Sphingotest penKid in whole blood, plasma and serum respectively. The concentration was correlated to the mGFRiohexol and results were compared to those from measurement of the routine markers for kidney function, i.e. creatinine and cystatin C. Results: Fourteen men and seven women were included. The median age was 57 years. PENK in plasma correlated weakly with mGFRiohexol (R2=0.22, p=0.042). No significant correlation was shown for PENK in whole blood or serum. Creatinine also showed a weak correlation with mGFRiohexol (R2=0.35, p=0.0046). In contrast, cystatin C was strongly correlated with mGFRiohexol (R2= 0.87, p&lt;0.0001). Conclusion: Our results indicate that PENK is a biomarker of low clinical value for estimating the GFR. However, further studies are needed before this can be assured. Cystatin C, on the contrary, seems to be an accurate biomarker for estimating the GFR.