Radiographic contrast-induced nephropathy (RCIN), defined by a variable rise in serum creatinine, occurs in up to 40% of contrast radiologic procedures. A prospective, randomized double-blind study was done to determine whether misoprostol prevented or modified RCIN. Patients with a serum creatinine less-than-or-equal2.0 mg dl(minus sign1), who were scheduled to undergo a radiologic contrast procedure (N = 125), were randomized to receive placebo (N = 62) or misoprostol (N = 63) given at 200 &mgr;g Q.I.D. for 72 h prior to contrast and for 48 h after contrast. Contrast significantly decreased creatinine clearance, and misoprostol significantly diminished the dysfunction. The effect was more pronounced in patients with diabetes mellitus (N = 24) and patients on nonsteroidal anti-inflammatory drugs (NSAIDs) (N = 47). Our findings are consistent with a functional role of prostaglandins in the renal response to contrast. We conclude that short-term administration of misoprostol is a useful adjunct for contrast procedures, especially in patients with diabetes and patients on NSAIDs.
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