Methods and systems for reducing substance-induced renal damage

Abstract

Methods for reducing kidney damage induced by radiographic contrast medium or another nephrotoxic drug or substance administered to or generated by a patient include reducing the temperature of the patient by positioning an endovascular heat exchange device in a blood vessel of the patient and adjusting the temperature of the device to cause a reduction in the patient's temperature. The patient's temperature may be reduced prior to, during, and / or after, the administration of the contrast medium. The methods may also include administering an anti-shivering mechanism to the patient to reduce shivering caused by the reduction in the patient's temperature. The methods may also include disrupting the laminarity of blood flow around the device to enhance the temperature exchange between the device and the blood flowing around the device. The endovascular heat exchange device may be an endovascular heat exchange catheter. The device may be a component of a system, which includes a temperature controller in communication with the endovascular heat exchange device to reduce the temperature of the patient to reduce the temperature of the patient's kidneys.

Description

RELATED APPLICATIONS[0001]This application is a continuation of copending U.S. patent application Ser. No. 10 / 612,780 filed Jul. 1, 2003 which is a continuation of U.S. patent application Ser. No. 10 / 120,167 filed Apr. 10, 2002 and issued as U.S. Pat. No. 6,685,733, the entire disclosures of such applications being expressly incorporated herein by reference.FIELD OF THE INVENTION[0002]This invention relates generally to medical devices and methods, and more particularly to systems and methods for avoiding or reducing substance-induced renal damage.BACKGROUND OF THE INVENTION[0003]Numerous drugs and other substances are known to be nephrotoxic. For example, radiographic contrast media (e.g., “contrast agent” or “dye”), non-steroidal antiinflamatory drugs (NSAIDs), amphotericin, cisplatin, methotrexate, acyclovir, gentamicin, acetylcholinesterase inhibitiors, other nephrotoxic drugs, products of tumor lysis and products of rhabdomyolysis are known to cause damage to the kidneys.[0004]...

AI Technical Summary

Benefits of technology

[0014]The present invention provides methods and systems wherein an endovascular heat exchange device is used to cool all or a portion of the body of a human or veterinary patient to prevent the occurrence of, or to reduce the severity of, renal damage that may result from blood-borne nephrotoxic substances, such as; radiographic contrast media (e.g., “contrast agent” or “dye”), non-steroidal antiinflamatory drugs (NSAIDs), amphotericin, cisplatin, methotrexate, acyclovir, gentamicin, acetylcholinesterase inhibitiors, other nephrotoxic drugs, products of tumor lysis and products of rhabdomyolysis, etc. The method of the present invention is generally performed by inserting an endovascular heat exchange device into the vasculature of the patient and using such heat exchange device to cool all or a portion of the patient's body (e.g., at least the patient's kidneys) to a temperature at which the substance-induced renal damage is prevented or attenuated. The endovascular heat exchange device may be controlled by an automated controller that regulates the amount of heat exchanged by the heat exchanger to maintain the temperature of the renal parenchyma or kidney tissue (or the patient□s core body temperature) within a temperature range that is optimal for reducing or avoiding the substance-induced renal damage.

[0015]In accordance with one specific embodiment of the invention, there is provided a method of reducing kidney damage resulting from administration of radiographic contrast medium to a human or veterinary patient. This method generally comprises the steps of a) positioning an endovascular heat exchange device in a blood vessel of the patient, and b) using the endovascular temperature exchange device to lower the temperature of the patient's body or at least the patient's kidneys to a temperature at which the nephrotoxic effect of the radiographic contrast medium is lessened or eliminated.

[0016]In accordance with other specific embodiments of the invention, there are provided methods for preventing or reducing the renal damage that occurs due to an overdose of a nephrotoxic drug (e.g., NSAID overdose), administration of a nephrotoxic drug to a patient whose kidney function is already impaired or other ingestion, absorption, formation or exposure of / to a nephrotoxic substance. This method generally comprises the steps of a) positioning an endovascular heat exchange device in a blood vessel of the patient, and b) using the endovascular temperature exchange device to lower the temperature of the patient's body or at least the patient's kidneys to a temperature at which the nephrotoxic effect of drug or other nephrotoxic substance is lessened or eliminated.

Problems solved by technology

For example, radiographic contrast media (e.g., “contrast agent” or “dye”), non-steroidal antiinflamatory drugs (NSAIDs), amphotericin, cisplatin, methotrexate, acyclovir, gentamicin, acetylcholinesterase inhibitiors, other nephrotoxic drugs, products of tumor lysis and products of rhabdomyolysis are known to cause damage to the kidneys.

However, the use of radiographic contrast media may be associated with adverse side effects, including nephrotoxicity.

In particular, contrast medium-induced nephrotoxicity is known to be an iatrogenic cause of acute renal failure in some patients.

It has been reported that use of contrast media is the third most common cause of new onset renal failure in hospital patients.

Consequences may be dramatic and can lead to irreversible renal damage and dialysis.

For hospitalized, critically ill patients, these results carry a poor prognosis for the patient, especially if dialysis becomes necessary.

In addition, patients at high risk of developing renal failure, including those with endothelial dysfunction, may not be able to dilate the renal vasculature, and thus experience a prolonged vasoconstrictive response.

Patients with body temperatures below 27 degrees Celsius may be classified as severely hypothermic, and may be characterized by the cessation of voluntary movement, less than half normal cardiac output, and a significant risk of ventricular fibrillation.

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