scholarly journals Acute kidney injury from contrast-enhanced CT procedures in patients with cancer: white paper to highlight its clinical relevance and discuss applicable preventive strategies

ESMO Open ◽  
2020 ◽  
Vol 5 (2) ◽  
pp. e000618 ◽  
Author(s):  
Laura Cosmai ◽  
Camillo Porta ◽  
Carmelo Privitera ◽  
Loreto Gesualdo ◽  
Giuseppe Procopio ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Primary Care Physicians ◽  
Kidney Injury ◽  
The Elderly ◽  
White Paper ◽  
Post Contrast ◽  
Patients With Cancer ◽  
Contrast Enhanced Ct ◽  
Enhanced Ct ◽  
Medical Radiology

Patients with cancer are subjected to several imaging examinations which frequently require the administration of contrast medium (CM). However, it has been estimated that acute kidney injury (AKI) due to the injection of iodinated CM accounts for 11% of all cases of AKI, and it is reported in up to 2% of all computed tomography (CT) examinations. Remarkably, the risks of developing AKI are increased in the elderly, in patients with chronic kidney disease or diabetes, and with dehydration or administration of nephrotoxic chemotherapeutics. Given the common occurrence of post-contrast acute kidney injury (PC-AKI) in clinical practice, primary care physicians and all specialists involved in managing patients with cancer should be aware of the strategies to reduce the risk of this event. In 2018, a panel of five experts from the specialties of radiology, oncology and nephrology were speakers at the annual meeting of the Italian Society of Medical Radiology (Società Italiana di Radiologia Medica e Interventistica), with the aim of commenting on existing evidence and providing their experience on the incidence and management of PC-AKI in patients with cancer. The discussion represented the basis for this white paper, which is intended to be a practical guide organised by statements describing methods to reduce renal injury risks related to CM-enhanced CT examinations in patients with cancer.

scholarly journals Post-Contrast Acute Kidney Injury in Patients with Various Stages of Chronic Kidney Disease—Is Fear Justified?

Toxins ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 395
Author(s):  
Inga Chomicka ◽  
Marlena Kwiatkowska ◽  
Alicja Lesniak ◽  
Jolanta Malyszko
Keyword(s):  
Computed Tomography ◽  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Creatinine Concentration ◽  
Post Contrast ◽  
Iodinated Contrast ◽  
Contrast Enhanced Ct ◽  
Enhanced Ct

Post-contrast acute kidney injury (PC-AKI) is one of the side effects of iodinated contrast media, including those used in computed tomography. Its incidence seems exaggerated, and thus we decided to try estimate that number and investigate its significance in our clinical practice. We analyzed all computed tomographies performed in our clinic in 2019, including data about the patient and the procedure. In each case, we recorded the parameters of kidney function (serum creatinine concentration and eGFR) in four time intervals: before the test, immediately after the test, 14–28 days after the test, and over 28 days after the test. Patients who did not have a follow-up after computed tomography were excluded. After reviewing 706 CT scans performed in 2019, we included 284 patients undergoing contrast-enhanced CT and 67 non-enhanced CT in the final analysis. On this basis, we created two comparable groups in terms of age, gender, the severity of chronic kidney disease, and the number of comorbidities. We found that AKI was more common in the non-enhanced CT population (25.4% vs. 17.9%). In terms of our experience, it seems that PC-AKI is not a great risk for patients, even those with chronic kidney disease. Consequently, the fear of using contrast agents is not justified.

Acute kidney injury in patients with nephrotic syndrome undergoing contrast-enhanced CT for suspected venous thromboembolism: a propensity score-matched retrospective cohort study

2017 ◽  
Vol 28 (4) ◽  
pp. 1585-1593 ◽  
Author(s):  
Shu Min Tao ◽  
Xiang Kong ◽  
U. Joseph Schoepf ◽  
Julian L. Wichmann ◽  
Darby C. Shuler ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Nephrotic Syndrome ◽  
Cohort Study ◽  
Venous Thromboembolism ◽  
Propensity Score ◽  
Retrospective Cohort ◽  
Kidney Injury ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct

scholarly journals Is the Presence of a Solitary Kidney an Independent Risk Factor for Acute Kidney Injury after Contrast-enhanced CT?

Radiology ◽  
2016 ◽  
Vol 278 (1) ◽  
pp. 74-81 ◽  
Author(s):  
Jennifer S. McDonald ◽  
Richard W. Katzberg ◽  
Robert J. McDonald ◽  
Eric E. Williamson ◽  
David F. Kallmes
Keyword(s):  
Acute Kidney Injury ◽  
Risk Factor ◽  
Independent Risk Factor ◽  
Kidney Injury ◽  
Solitary Kidney ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct

scholarly journals Giant bladder stone resulting in acute kidney injury; a case report and review of literature

2022 ◽  
Author(s):  
Feysel Hassen Issack ◽  
Kaleab Habtemichael Gebresellasie ◽  
Fitsum Gebreegziabher Gebrehiwot ◽  
Mubarek Bargicho Adem ◽  
Ferid Ousman Mummed ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Wound Care ◽  
Kidney Injury ◽  
Bladder Stone ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Urinary Tract Symptoms ◽  
Lower Urinary

Abstract A giant bladder stone is very rare in adults. We report a case of giant bladder stone causing acute kidney injury in a 23-year-old male, who presented with lower urinary tract symptoms (LUTS) characterized by both irritative and obstructive LUTS. In addition, he also had episodes of reddish urine for the past decade. A non-contrast-enhanced CT scan was used for the diagnosis. Open cystolithotomy was performed and a 500g weighing stone was removed. He developed a superficial surgical site infection which was treated with wound care. He was discharged improved. Improvement in symptoms and serum creatinine was noted on follow-up.

scholarly journals Acute kidney injury after contrast-enhanced examination among elderly

2014 ◽  
Vol 22 (4) ◽  
pp. 637-644 ◽  
Author(s):  
Beatriz Bonadio Aoki ◽  
Dayana Fram ◽  
Mônica Taminato ◽  
Ruth Ester Sayad Batista ◽  
Angélica Belasco ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Kidney Injury ◽  
The Elderly ◽  
Post Contrast ◽  
Hospitalized Elderly ◽  
Contrast Enhanced ◽  
Before And After ◽  
N 93 ◽  
Enhanced Computed Tomography

OBJECTIVES: to assess renal function in elderly patients undergoing contrast-enhanced computed tomography and identify the preventive measures of acute kidney injury in the period before and after the examination.METHOD: longitudinal cohort study conducted at the Federal University of São Paulo Hospital, from March 2011 to March 2013. All hospitalized elderly, of both sexes, aged 60 years and above, who performed the examination, were included (n=93). We collected sociodemographic data, data related to the examination and to the care provided, and creatinine values prior and post exam.RESULTS: an alteration in renal function was observed in 51 patients (54%) with a statistically significant increase of creatinine values (p<0.04), and two patients (4.0%) required hemodialysis.CONCLUSION: There is an urgent need for protocols prior to and post contrast-enhanced examination in the elderly, and other studies to verify the prognosis of this population.

scholarly journals Risk of Acute Kidney Injury Following Contrast-enhanced CT in Hospitalized Pediatric Patients: A Propensity Score Analysis

Radiology ◽  
2020 ◽  
Vol 294 (3) ◽  
pp. 548-556 ◽  
Author(s):  
Leah A. Gilligan ◽  
Matthew S. Davenport ◽  
Andrew T. Trout ◽  
Weizhe Su ◽  
Bin Zhang ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Propensity Score ◽  
Pediatric Patients ◽  
Propensity Score Analysis ◽  
Kidney Injury ◽  
Contrast Enhanced Ct ◽  
Score Analysis ◽  
Contrast Enhanced ◽  
Enhanced Ct

scholarly journals Intravenous iodinated contrast is not associated with acute kidney injury in adult patients with nephrotic syndrome

2019 ◽  
Vol 5 (2) ◽  
Author(s):  
Andrew Bacyinski
Keyword(s):  
Acute Kidney Injury ◽  
Nephrotic Syndrome ◽  
Retrospective Cohort ◽  
Critical Appraisal ◽  
Kidney Injury ◽  
European Radiology ◽  
Iodinated Contrast ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct

<p>A critical appraisal and clinical application of Tao SM, Kong X, Schoepf UJ, et al. Acute kidney injury in patients with nephrotic syndrome undergoing contrast-enhanced CT for suspected venous thromboembolism: a propensity score-matched retrospective cohort study. <em>European Radiology</em>. 2018;28(4):1585-1593. doi: <a href="https://doi.org/10.1007/s00330-017-5109-0">10.1007/s00330-017-5109-0</a></p>

Abstract 504: Cystatin-C Risk-Stratifies Patients for Acute Kidney Injury and 1-Year Major Vascular Events Following Contrast -Enhanced CT Imaging in the Emergency Care Setting

2015 ◽  
Vol 35 (suppl_1) ◽  
Author(s):  
Alice M Mitchell ◽  
Jeffrey A Kline ◽  
Roxanne Y Williams ◽  
David P Basile ◽  
Shawn D Teague ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cystatin C ◽  
Emergency Care ◽  
Care Setting ◽  
Kidney Injury ◽  
Ct Imaging ◽  
Vascular Events ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct

Background: Despite poor sensitivity in acutely ill patients, serum creatinine (and estimated glomerular filtration rate [eGFR SCR ]) remains the sole means of risk-stratifying patients for acute kidney injury (AKI) prior to contrast-enhanced CT imaging (CECT). Hypothesis: We hypothesized that an acute phase marker of renal dysfunction, cystatin-C (expressed as eGFR CYS ), would more accurately predict contrast-induced nephropathy (CIN) than eGFR SCR . Given the risk of arterial vascular events subsequent to AKI, we also evaluated eGFR CYS in risk-stratifying patients for major adverse events (MAE) within 1 year of CECT. Methods: We followed 462 consecutive adults, without end-stage renal disease, undergoing CECT (any indication) in the outpatient, emergency care setting for CIN and 1-year MAE: death, renal failure, myocardial infarction, stroke, and/or peripheral vascular event requiring intervention (blinded, adjudicated outcome). We excluded patients with life-threatening CECT indications and collected serum for eGFR SCR and eGFR CYS prior to CECT. Predictive accuracy was defined as the area under the receiver operating characteristic curve (AUROC) and likelihood ratios (LR+ and LR-). A threshold of ≤60 ml/min/m 2 defined an abnormal eGFR SCR or eGFR CYS . Results: CIN occurred in 14% and a MAE in 17% (low observer variability, κ>0.9) of our heterogeneous population: mean age 50 yrs (±16 yrs), 51% discharged after CECT, 16% with diabetes mellitus (DM), and only 16% with eGFR SCR ≤60ml/min/m 2 . CIN was associated with 1-year MAE: RR 2.4 (1.5-4.0) after adjusting for age and existing co-morbidities (active malignancy, CHF, DM, and CAD). The AUROC, LR+ and LR- for eGFR SCR were 0.55 (0.47-0.63), 0.9 (0.4-2.1) and 1.0 (0.9-1.1). In comparison, the AUROC, LR+, and LR- for eGFR CYS were 0.79 (0.62-0.96), 5.5 (3.9-7.6) and 0.43 (0.31-0.57), respectively. The MAE rate did not differ in patients with normal (13%) or abnormal (15%, p=0.5) pre-CECT eGFR SCR . Whereas, an abnormal eGFR SCR was associated with a 29% (p<0.01) increase in MAE. Conclusions: In patients undergoing CECT in the outpatient setting, eGFR CYS more accurately predicted CIN and more effectively risk-stratified patients for 1-year MAE than eGFR SCR . These findings warrant prospective validation.

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