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.

1 . A method of preventing or reducing the severity of substance-induced renal damage in a human or veterinary patient, the method comprising the step of cooling at least the patient's kidneys to a temperature at which the substance-induced renal damage is prevented or reduced in severity. 
   
   
       2 . A method according to  claim 1  wherein the cooling is effected by placing an endovascular heat exchange device within the patient's vasculature and using the endovascular heat exchange device to cool blood flowing through the patient's vasculature thereby resulting in cooling of at least the patient's kidneys to a temperature at which the substance-induced renal damage is prevented or reduced in severity. 
   
   
       3 . A method according to  claim 2  wherein the endovascular heat exchange device comprises a catheter having a heat exchange balloon through which heat exchange fluid is circulated. 
   
   
       4 . A method according to  claim 3  wherein the heat exchange balloon is in a collapsed configuration when inserted into the vasculature and subsequently assumes an expanded configuration when heat exchange fluid is circulated therethrough. 
   
   
       5 . A method according to  claim 2  wherein the endovascular heat exchange device comprises a heat exchange region that is metallic. 
   
   
       6 . A method according to  claim 2  further comprising a step of disrupting laminarity of blood flow around the endovascular heat exchange device. 
   
   
       7 . A method according to  claim 2  wherein the endovascular heat exchange device is positioned proximate the patient's heart to cause a reduction in the temperature of the blood flowing through the patient's heart. 
   
   
       8 . A method according to  claim 1  wherein the cooling is performed before the substance enters the patient's body. 
   
   
       9 . A method according to  claim 1  wherein the patient's entire body is cooled. 
   
   
       10 . A method according to  claim 9  wherein the patient's body temperature is reduced below 37 degrees Celsius. 
   
   
       11 . A method according to  claim 9  wherein the patient's body temperature is reduced to a temperature between 32 degrees Celsius and 37 degrees Celsius. 
   
   
       12 . A method according to  claim 1  further comprising a step of administering an anti-shivering treatment to the patient to reduce shivering caused by reducing the temperature of the endovascular heat exchange device. 
   
   
       13 . The method of  claim 12 , wherein the anti-shivering treatment comprises a blanket. 
   
   
       14 . The method of  claim 12 , wherein the anti-shivering treatment comprises administering to the patient a therapeutically effective amount of an agent that deters shivering. 
   
   
       15 . A method according to  claim 1  wherein the substance comprises radiographic contrast medium. 
   
   
       16 . A method according to  claim 1  wherein the substance is an endogenously produced substance that results from an infection or other disease of the patient. 
   
   
       17 . A method according to  claim 1  wherein the substance is selected from the group consisting of non-steroidal antiinflamatory drugs, amphotericin, cisplatin, methotrexate, acyclovir, gentamicin, acetylcholinesterase inhibitiors, other nephrotoxic drugs, products of tumor lysis, products of sepsis, products of infection, and products of rhabdomyolysis. 
   
   
       18 . A method according to  claim 2  further comprising:
 positioning a first endovascular heat exchange device in a first blood vessel of the patient through which blood flows to at least one of the patient's kidneys;   positioning a second endovascular heat exchange device in a second blood vessel of the patient through which blood flows from at least one of the patient's kidneys;   using the first endovascular heat exchange device to cool blood flowing to at least one of the patient's kidneys; and,   using the second endovascular heat exchange device to warm blood flowing from at least one of the patient's kidneys.   
   
   
       19 . A method according to  claim 2  further comprising:
 positioning a first endovascular heat exchange device in the patient's aorta upstream of the location at which a renal artery branches from the aorta;   positioning a second endovascular heat exchange device in the aorta downstream of said location at which a renal artery branches from the aorta;   using the first endovascular heat exchange device to cool blood flowing through the aorta, a portion of which flows into the renal artery; and,   using the second endovascular heat exchange device to warm the remaining blood flowing through the aorta after the portion has flowed into the renal artery.   
   
   
       20 . A method according to  claim 1  further comprising a step of monitoring the temperature of the patient. 
   
   
       21 . A method according to  claim 14  wherein the agent is selected from the group consisting of: dopamine receptor blockers; dopamine receptor agonists; kappa opioid receptor agonists; opioid agonist-antagonist analgesics; serotonin 5HT1a receptor agonists; and their pharmaceutically acceptable salts.