Acute Renal Failure Caused by Low-Osmolar Radiographic Contrast Media in Patients with Diabetic Nephropathy

Contrast-induced nephropathy (CIN) is an iatrogenic acute renal failure (ARF) occurring after the intravascular injection of iodinated radiographic contrast media. During the past several years, in many patients undergoing computed tomography, iodinated contrast media have not been used for the fear of ARF, thereby compromising the diagnostic procedure. But recent studies have demonstrated that CIN is rarely occurring in patients with normal renal function and that preexisting chronic renal failure and/or diabetes mellitus represent(s) predisposing condition(s) for its occurrence. After the description of CIN and its epidemiology and pathophysiology, underlying the important role played by dehydration and salt depletion, precautions for prevention of CIN are listed, suggested, and discussed. Maximum priority has to be given to adequate hydration and volume expansion prior to radiographic procedures. Other important precautions include the need for monitoring renal function before, during, and after contrast media injection, discontinuation of potentially nephrotoxic drugs, use of either iodixanol or iopamidol at the lowest dosage possible, and administration of antioxidants. A long list of references is provided that will enable readers a deep evaluation of the topic.

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Using Acetylcysteine to Prevent Radiographic-Contrast-Media-Induced Nephropathy in a Patient with Chronic Renal Failure

Hospital Pharmacy ◽

10.1177/001857870103600715 ◽

2001 ◽

Vol 36 (7) ◽

pp. 795-797

Author(s):

Kevin E. Burns

Keyword(s):

Renal Failure ◽

Chronic Renal Failure ◽

Serum Creatinine ◽

Contrast Media ◽

Stress Test ◽

Chronic Hypertension ◽

Baseline Serum ◽

Radiographic Contrast ◽

Radiographic Contrast Media ◽

History Of

Clinical Pearls Each of these special features conveys an idea, concept, or fact that may be useful in your pharmaceutical practice, but may not be widely known, published, or taught. An 84-year-old male with a history of chronic renal failure secondary to nephrectomy and chronic hypertension was admitted for elective coronary angiography following complaints of midsternal chest pain and an abnormal thallium stress test. The patient was found to have other risk factors for radiographic-contrast-media-induced nephropathy, including hyponatremia and hypoalbuminemia. Mild volume expansion was initiated and acetylcysteine 600 mg was administered orally every 12 hours on the day before the procedure. The patient's baseline serum creatinine was found to be 2 mg/dL. A total of 125 mL of nonionic, low-osmolality contrast media was infused during the procedure. An additional two doses of acetylcysteine 600 mg were administered on the day of the procedure. The patient's recovery was uneventful and he was discharged. The postprocedure serum creatinine was stable at 2 mg/dL 48 hours after the procedure. It appears that orally administered acetylcysteine can prevent radiographic-contrast-media-induced nephropathy.

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Plasma D Dimer: A Useful Marker of Fibrin Breakdown in Renal Failure

Thrombosis and Haemostasis ◽

10.1055/s-0038-1646627 ◽

1989 ◽

Vol 61 (03) ◽

pp. 522-525 ◽

Cited By ~ 32

Author(s):

M P Gordge ◽

R W Faint ◽

P B Rylance ◽

H Ireland ◽

D A Lane ◽

...

Keyword(s):

Renal Failure ◽

Renal Function ◽

Acute Renal Failure ◽

Monoclonal Antibodies ◽

Diabetic Nephropathy ◽

Renal Disease ◽

Plasma Concentrations ◽

Significant Negative Correlation ◽

Healthy Controls ◽

D Dimer

SummaryD dimer and other large fragments produced during the breakdown of crosslinked fibrin may be measured by enzyme immunoassay using monoclonal antibodies. In 91 patients with renal disease and varying degrees of renal dysfunction, plasma D dimer showed no correlation with renal function, whereas FgE antigen, a fibrinogen derivative which is known to be cleared in part by the kidney, showed a significant negative correlation with creatinine clearance. Plasma concentrations of D dimer were, however, increased in patients with chronic renal failure (244 ± 3l ng/ml) (mean ± SEM) and diabetic nephropathy (308 ± 74 ng/ml), when compared with healthy controls (96 ± 13 ng/ml), and grossly elevated in patients with acute renal failure (2,451 ± 1,007 ng/ml). The results indicate an increase in fibrin formation and lysis, and not simply reduced elimination of D dimer by the kidneys, and are further evidence of activated coagulation in renal disease. D dimer appears to be a useful marker of fibrin breakdown in renal failure.

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Faculty Opinions recommendation of Renal function-based contrast dosing to define safe limits of radiographic contrast media in patients undergoing percutaneous coronary interventions.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.13200026.14542186 ◽

2011 ◽

Author(s):

John Ambrose

Keyword(s):

Renal Function ◽

Contrast Media ◽

Percutaneous Coronary Interventions ◽

Coronary Interventions ◽

Percutaneous Coronary ◽

Radiographic Contrast ◽

Radiographic Contrast Media ◽

Safe Limits

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Adverse Drug Reactions to Radiographic Contrast Media in a Teaching Hospital in North India: An Observational Study

Current Drug Safety ◽

10.2174/1574886314666190122095702 ◽

2019 ◽

Vol 14 (2) ◽

pp. 122-126

Author(s):

Deepti Chopra ◽

Abhinav Jain ◽

Richa Garg ◽

Shreya Dhingra

Keyword(s):

Observational Study ◽

Contrast Media ◽

Adverse Drug Reactions ◽

Teaching Hospital ◽

Adverse Reactions ◽

North India ◽

Drug Reactions ◽

Iodinated Contrast ◽

Radiographic Contrast ◽

Radiographic Contrast Media

Background: Radiocontrast media are used extensively nowadays to visualize internal organs. Currently, non-ionic iodinated contrast media are used which are generally considered to be safe but some adverse reactions have been reported. Thus, the present study was carried out to analyze the nature and incidence of adverse drug reactions (ADRs) to radiographic contrast media in a teaching hospital. Methods:An observational study carried out for a period of six months in a teaching hospital. Contrast media induced adverse reactions were analyzed in terms of affected organs, rate, causality assessment, severity and preventability. The treatment and outcomes of adverse events were also recorded. Naranjo Probability Scale was used to evaluate the relationship between the contrast agent used and the suspected ADR. The severity of the suspected ADRs was determined using Hartwig Scale and preventability was assessed using modified Schumock and Thornton criterion. Results:A total of 15 suspected ADRs occurred in 11 patients with an incidence of 1.4%. It included 5 (45.4%) males and 6 (54.5%) females (p < 05). The highest percentage (72.7 %) of ADRs was seen in adult patients, the mean age being 40.8 years. Vomiting (33.3%) was the most common ADR noted followed by severe nausea and rashes. 64.7 % of ADRs were categorized as probable and 35.3 % were possible. Adverse reactions required treatment in 46.6% patients. There was no fatality reported. Conclusion:The reactions observed were mild to moderate in severity and occurred within 30 minutes of the administration of the contrast.

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