scholarly journals The Pathophysiology and the Management of Radiocontrast-Induced Nephropathy

Diagnostics ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. 180
Author(s):  
Eunjung Cho ◽  
Gang-Jee Ko
Keyword(s):  
Interventional Procedure ◽  
Kidney Injury ◽  
The Elderly ◽  
Preventive Strategy ◽  
Iodinated Contrast Medium ◽  
Iodinated Contrast ◽  
Direct Cytotoxicity ◽  
Risk Patients ◽  
Associated Risk Factors ◽  
Hospital Acquired

Contrast-induced nephropathy (CIN) is an impairment of renal function that occurs after the administration of an iodinated contrast medium (CM). Kidney dysfunction in CIN is considered transient and reversible in most cases. However, it is the third most common cause of hospital-acquired acute kidney injury and is associated with increased morbidity and mortality, especially in high-risk patients. Diagnostic and interventional procedures that require intravascular CM are being used with increasing frequency, especially among the elderly, who can be particularly susceptible to CIN due to multiple comorbidities. Therefore, identifying the exact mechanisms of CIN and its associated risk factors is crucial not only to provide optimal preventive management for at-risk patients, but also to increase the feasibility of diagnostic and interventional procedure that use CM. CM induces kidney injury by impairing renal hemodynamics and increasing the generation of reactive oxygen species, in addition to direct cytotoxicity. Periprocedural hydration is the most widely accepted preventive strategy to date. Here, we review the latest research results on the pathophysiology and management of CIN.

scholarly journals Contrast-Induced Acute Kidney Injury: Definition, Epidemiology, and Outcome

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Felix G. Meinel ◽  
Carlo N. De Cecco ◽  
U. Joseph Schoepf ◽  
Richard Katzberg
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Renal Insufficiency ◽  
Time Window ◽  
Contrast Material ◽  
Kidney Injury ◽  
Preventive Strategy ◽  
Iodinated Contrast ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced

Contrast-induced acute kidney injury (CI-AKI) is commonly defined as a decline in kidney function occurring in a narrow time window after administration of iodinated contrast material. The incidence of AKI after contrast material administration greatly depends on the specific definition and cutoff values used. Although self-limiting in most cases, postcontrast AKI carries a risk of more permanent renal insufficiency, dialysis, and death. The risk of AKI from contrast material, in particular when administered intravenously for contrast-enhanced CT, has been exaggerated by older, noncontrolled studies due to background fluctuations in renal function. More recent evidence from controlled studies suggests that the risk is likely nonexistent in patients with normal renal function, but there may be a risk in patients with renal insufficiency. However, even in this patient population, the risk of CI-AKI is probably much smaller than traditionally assumed. Since volume expansion is the only preventive strategy with a convincing evidence base, liberal hydration should be encouraged to further minimize the risk. The benefits of the diagnostic information gained from contrast-enhanced examinations will still need to be balanced with the potential risk of CI-AKI for the individual patient and clinical scenario.

scholarly journals Iodinated contrast medium: Is there a re(n)al problem? A clinical vignette-based review

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Karim Lakhal ◽  
Stephan Ehrmann ◽  
Vincent Robert-Edan
Keyword(s):  
Acute Kidney Injury ◽  
Contrast Media ◽  
Kidney Injury ◽  
Case Vignette ◽  
Iodinated Contrast Media ◽  
Iodinated Contrast Medium ◽  
Iodinated Contrast ◽  
Prophylactic Measures ◽  
Indirect Consequence ◽  
Toxic Potential

Abstract As we were taught, for decades, that iodinated contrast-induced acute kidney injury should be dreaded, considerable efforts were made to find out effective measures in mitigating the renal risk of iodinated contrast media. Imaging procedures were frequently either downgraded (unenhanced imaging) or deferred as clinicians felt that the renal risk pertaining to contrast administration outweighed the benefits of an enhanced imaging. However, could we have missed the point? Among the abundant literature about iodinated contrast-associated acute kidney injury, recent meaningful advances may help sort out facts from false beliefs. Hence, there is increasing evidence that the nephrotoxicity directly attributable to modern iodinated CM has been exaggerated. Failure to demonstrate a clear benefit from most of the tested prophylactic measures might be an indirect consequence. However, the toxic potential of iodinated contrast media is well established experimentally and should not be overlooked completely when making clinical decisions. We herein review these advances in disease and pathophysiologic understanding and the associated clinical crossroads through a typical case vignette in the critical care setting.

scholarly journals Contrast-Induced Nephropathy in Patients Undergoing Percutaneous Coronary Intervention

2010 ◽  
Vol 2010 ◽  
pp. 1-12 ◽  
Author(s):  
Sana Shoukat ◽  
Saqib A. Gowani ◽  
Asif Jafferani ◽  
Sajid H. Dhakam
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Renal Tissue ◽  
Therapeutic Interventions ◽  
Contrast Induced Nephropathy ◽  
Iodinated Contrast ◽  
Percutaneous Coronary ◽  
Direct Cytotoxicity ◽  
Risk Patients ◽  
Radiological Procedures

Contrast Induced Nephropathy (CIN) is a feared complication of numerous radiological procedures that expose patients to contrast media. The most notorious of these procedures is percutaneous coronary intervention (PCI). Not only is this a leading cause of morbidity and mortality, but it also adds to increased costs in high risk patients undergoing PCI. It is thought to result from direct cytotoxicity and hemodynamic challenge to renal tissue. CIN is defined as an increase in serum creatinine by either 0.5 mg/dL or by 25% from baseline within the first 2-3 days after contrast administration, after other causes of renal impairment have been excluded. The incidence is considerably higher in diabetics, elderly and patients with pre-existing renal disease when compared to the general population. The nephrotoxic potential of various contrast agents must be evaluated completely, with prevention as the mainstay of focus as no effective treatment exists. The purpose of this article is to examine the pathophysiology, risk factors, and clinical course of CIN, as well as the most recent studies dealing with its prevention and potential therapeutic interventions, especially during PCI. The role of gadolinium as an alternative to iodinated contrast is also discussed.

Hospital-acquired acute kidney injury in the elderly

2010 ◽  
Vol 6 (3) ◽  
pp. 141-149 ◽  
Author(s):  
Alexandra Chronopoulos ◽  
Dinna N. Cruz ◽  
Claudio Ronco
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
The Elderly ◽  
Hospital Acquired

Contrast and the Kidney

2019 ◽  
pp. 241-252
Author(s):  
Ayub Akbari ◽  
Swapnil Hiremath
Keyword(s):  
Acute Kidney Injury ◽  
High Risk ◽  
Isotonic Saline ◽  
Kidney Injury ◽  
Disease Status ◽  
Acute Injury ◽  
Risk Scores ◽  
Iodinated Contrast ◽  
Risk Patients ◽  
High Risk Populations

Iodinated contrast has revolutionized diagnosis and therapy but carries the risk of adverse effects, specifically acute kidney injury, in select high risk populations. This risk is substantially lower with the current generation of low- and iso-osmolar contrast media. Acute kidney injury in most cases is mild with favorable prognostic implications, and severe acute injury requiring dialysis is rare. Risk scores, typically including level of kidney function, diabetes, and cardiovascular disease status, can identify patients at high risk of developing acute kidney injury after contrast-enhanced procedures. Volume expansion with isotonic saline remains the most robust method of preventing acute kidney injury in select high risk patients.

scholarly journals Risk factors and incidence of contrast-induced acute kidney injury associated with diagnostic or interventional coronary angiography

2020 ◽  
Vol 9 (1) ◽  
pp. 21-24
Author(s):  
Abhishek Maskey ◽  
Ram Chandra Kafle ◽  
Sudip Lamsal
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Coronary Angiography ◽  
Statistical Tests ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Cross Sectional ◽  
Iodinated Contrast ◽  
Percutaneous Coronary ◽  
Hospital Acquired

Background and Aims: Coronary angiography/ interventions depend on iodinated contrast media (CM) and consequently pose risk of contrast-induced acute kidney injury (CI-AKI). This is an important complication that accounts for a significant number of cases of hospital-acquired kidney injury, with adverse effects on prognosis and health care. This study aimed to assess incidence and evaluate risk factor CI-AKI associated with diagnostic or interventional coronary angiography. Methods: A prospective cross sectional observational hospital based study was conducted. All patients undergoing percutaneous coronary angiography in Manipal Teaching Hospital from May 1, 2019 to April 31, 2020 were included in this study. Appropriate statistical tests were used to analyse results and P <0.05 was considered statistically significant. Results: We evaluated a total of 155 patients. Among them, 90 (58%) were male and 65 (42%) female. The mean age of patients was 62.74 ± 13.9 years. Overall incidence of contrast induced acute kidney injury was 15.48%. CI-AKI was observed to be more common in patient with advance age and diabetes. Apart from advance age and diabetes, none of the other conventional risk factors such as hypertension, anaemia, volume of contrast, baseline chronic kidney disease found to have a significant association with incidence of CI-AKI. None of the patients in our study required renal replacement therapy, and there was no mortality. Conclusion: The overall incidence of CI-AKI after coronary intervention in this study is high. Patients with advance age and diabetes were at high risk of CI-AKI.

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