The incidence of contrastinduced nephropathy cin has been reported to range from 0% to 24%. Contrastinduced nephropathy is most commonly defined as acute renal failure occurring within 48 hr of exposure to intravascular radiographic contrast material that is not attributable to other causes. Contrast induced nephropathy cin is the 3rd most common cause of hospitalacquired acute renal failure. Oliguric acute renal failure requiring hemodialysis. Sep 01, 2014 contrast induced nephropathy cin is agenerally reversible form of acute kidney injury aki that occurs soon after the administration of radiocontrast media.
Sodium bicarbonate, nacetylcysteine, and saline for prevention of radiocontrastinduced nephropathy. Any child in the intensive care unit undergoing diagnostic imaging using contrast material should be considered to be at risk to develop contrast induced nephropathy cin. 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. A study showing similar rates of contrastinduced nephropathy with or without hydration challenges expert opinion. The serum creatinine level begins to rise within 24 hr of contrast administration, usually peaks within 35 days, and returns to baseline within 1014 days 11, 17. Contrastinduced nephropathy radiology reference article. Contrastinduced nephropathy cin is a significant problem resulting from the use of iodine contrast agents in computed tomography ct scans and cath lab angiography. An angiogram is one such imaging technique that uses contrast dye. The primary goal should be avoiding contrast media to prevent contrast induced nephropathy, if at all possible, and risk factors should be recognized. Risk assessment for contrast induced acute kidney injury ciaki. Contrast media cause acute kidney injury through two major mechanisms. May 15, 2012 contrast induced nephropathy cin is a significant problem resulting from the use of iodine contrast agents in computed tomography ct scans and cath lab angiography. O it has been shown that dialysis removes contrast o however earlier trials have not been able to show any benefit to dialyze patients after.
Contrast induced nephropathy cin is an iatrogenic acute renal failure arf occurring after the intravascular injection of iodinated radiographic contrast media. The number of patients undergoing examinations using radiocontrast is increasing, and the population at risk for cin is growing. Risk of contrast induced nephropathy risk of need for dialysis mehran r et al. Early highdose rosuvastatin for contrast induced nephropathy prevention in acute coronary syndrome. Any child in the intensive care unit undergoing diagnostic imaging using contrast material should be considered to be at risk to develop contrastinduced nephropathy cin. Acute renal failure from both ischemia and contrast are postulated to occur. This article outlines some of the key information on the agents themselves, possible methods of action and how to prevent and treat cin. Prevention of contrast induced nephropathy car canadian. Context contrastinduced nephropathy remains a common complication of radiographic procedures. Iatrogenic acute kidney injury aki associated with use of contrast media rise in creatinine serum of. Contrast induced nephropathy cin is a specific type of kidney disease that is caused by a routine medical procedure.
Patients with preexisting impaired renal function are especially susceptible. Contrastinduced nephropathy is a common cause of acute renal functional impairment and accounts forsignificant morbidity and mortality. Apr 01, 2014 contrast induced nephropathy is a common cause of acute renal functional impairment and accounts forsignificant morbidity and mortality. Several preventive strategies were evaluated in the past. A study showing similar rates of contrast induced nephropathy with or without hydration challenges expert opinion. Contrastinduced nephropathy cin is a form of kidney damage in which there has been recent exposure to medical imaging contrast material without another clear cause for the acute kidney injury. Acute kidney injury, aki, cin, contrast induced nephropathy, dogmalysis, renal april 6th, 2017 leave a comment intravenous iv iodinated contrast media is used routinely to improve the accuracy of computed tomography ct in the emergency department ed. Contrastinduced nephropathy cin is an iatrogenic acute renal failure arf occurring after the intravascular injection of iodinated radiographic contrast media. Prevention of contrastinduced nephropathy through a. Nov 18, 2005 contrastinduced nephropathy is usually defined as an increase of. Version 2020 of the acr manual on contrast media was published in january 2020 as a webbased product. Traditional risk factors do not adequately identify patients. In most cases, contrastinduced nephropathy cin is characterized by an elevation of creatinine within 24 to 48 hours following exposure, reaching a peak within 3 to 5 days, followed by a return to baseline within 7 to 10 days.
Ann emerg med 2017 aug 12 a large metaanalysis of observational studies finds no evidence of risk. Preventive measures requires knowledge of mechanisms of druginduced nephrotoxicity. Aug 25, 2017 more evidence that contrast induced nephropathy is not clinically important daniel j. Columbia university medical center interventional cardiology data base. Prevention of contrast induced acute kidney injury the renal. Mar 09, 2016 14 contrast induced nephropathy is a sudden deterioration is renal function within 48 to 72 hours of contrast administration in patients without other attributable factors for renal insufficiency. List of prevention of radiographic contrast nephropathy. Prospective study of the incidence of contrastinduced. We next look at markers of renal injury and what tests are used in clinical practice to define contrastinduced nephropathy cin. After injection of these contrast agents, a mild transient kidney function impairment can be detected by sensitive tests. You might think so because it has pathy in the name, but for all i can tell from what is written here, it does not have any significance to the patient.
The number of patients undergoing examinations using radiocontrast is increasing. Contrast nephropathy was defined in terms of small transient creatinine elevations, a definition which is sensitive but nonspecific. The major risk factor predicting cin is preexisting ckd, which can be predicted from glomerular filtration rate gfr. The rate of incidence of contrastinduced nephropathy as a complication of radiographic diagnostic and interventional studies varies markedly, depending on the definition used and on other variables such as the type of radiology procedure performed, the dose and type of contrast agent administered. Intravascular iodinated contrast has historically been considered a risk factor for acute kidney injury aki, particularly among individuals with underlying chronic kidney disease 1. Contrastinduced nephropathy most commonly manifests as a nonoliguric and asymptomatic transient decline in renal function. The use of contrast media in diagnostic procedures is a potential risk for the development of acute renal failure. O ciaki refers to an abrupt deterioration in renal function associated with the administration of iodinated contrast media o. Contrast induced nephropathy cin is a frequent and severe complication in subjects receiving iodinated contrast media for diagnostic or therapeutic purposes. The incidence of contrast induced nephropathy or radiocontrast nephropathy 3 of 7 comparable to previous reported incidence of cinrcn of 0. The canadian association of radiologists has developed these guidelines as a practical approach to risk stratification and prevention of cin. Clinical practice guideline on prevention of contrast induced. Traditional risk factors do not adequately identify patients at risk for contrast induced nephropathy in this population.
Followup of patients with contrastinduced nephropathy kidney. The occurrence of cin prolongs hospital length of stay an average of 2 days. The prevention of contrastinduced aki ciaki has been a longstanding subject of much interest 11, with a recent pubmed search for contrast nephropathy clinical trial yielding 1700 references. Cin is classically defined as a serum creatinine increase of at least 25% andor an absolute increase in serum creatinine of 0. Contrastinduced nephropathy an overview sciencedirect topics.
In this commentary, we argue that contrast material can often be safely used without increased risk of aki, even among individuals with underlying kidney disease. The clinical epidemiology of contrastinduced nephropathy. Recent studies, however, have suggested that incidence of contrast induced nephropathy cin may not be as frequent as previously thought 2,3. Contrastinduced nephropathy cin is defined as renal hypofunction with an increase in the serum creatinine scr concentration of 25% or more, or by 44. Development of contrastinduced nephropathy cin, ie, a rise in serum creatinine by either. Update on contrast induced nephropathy an article from the ejournal of the esc council for cardiology practice vol. A double blind comparison ofiodixanol and opamidol. Oct 03, 20 they are eliminated solely by glomerular filtration. Contrastinduced nephropathy in patients with chronic kidney disease undergoing computed tomography. Contrast induced nephropathy cin describes an association between intravenous or intraarterial contrast administration and renal impairment, but increasingly the evidence shows that contrast is not the cause of the renal impairment and that confounding factors such as sepsis are likely to be responsible. The increasing use of cm, an aging population and an increase in chronic kidney disease ckd will result in an increased incidence of contrast induced. Contrast induced nephropathy cin is a form of kidney damage in which there has been recent exposure to medical imaging contrast material without another clear cause for the acute kidney injury. Feb 21, 2020 contrastinduced nephropathy cin is defined as the impairment of renal function and is measured as either a 25% increase in serum creatinine scr from baseline or 0.
The pathophysiology of contrast induced nephropathy cin is based on three distinct but interacting mechanisms. Consensus guidelines for the prevention of contrast induced. Nonoliguric renal failure typically occurs within 2472 hours. Contrastinduced acute kidney injury is a common iatrogenic complication associated with increased health resource utilization and adverse outcomes, including short and longterm mortality and accelerated progression of preexisting renal insufficiency. This article describes the parameters of contrastinduced nephropathy, but it does not say that it is a problem. Contrastinduced nephropathy cin is a serious complication of angiographic procedures resulting from the administration of contrast media cm. Radiocontrastinduced nephropathy cin is the third most common cause of acute renal failure among inpatients. Although contrast nephropathy is intended to be a diagnosis of exclusion, studies attribute all elevations in creatinine to contrast nephropathy, causing contrast to be blamed for every renal insult. Consensus guidelines for the prevention of contrast. Druginduced renal disorders journal of renal injury prevention. It is a condition with impairment in renal function defined as an increase in scr by more than 25% within three days following intravenous.
Nacetylcysteine, sodium bicarbonate, and statins, among others to reduce the risk of contrast induced nephropathy cin, need for renal replacement therapy. More evidence that contrastinduced nephropathy is not clinically important daniel j. Contrastinduced nephropathy is usually defined as an increase of. Postcontrast acute kidney injury and contrast induced nephropathy in adults and nephrogenic systemic fibrosis. The incidence of contrast induced nephropathy complicated by severe renal failure and death after computed tomography of the pulmonary arteries may be higher than has been previously estimated. The primary goal should be avoiding contrast media to prevent contrastinduced nephropathy, if at all possible, and risk factors should be recognized. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Contrastinduced nephropathy cin is defined as the impairment of renal function and is measured as either a 25% increase in serum creatinine scr from baseline or 0. About prevention of radiographic contrast nephropathy. These guidelines represent a practical approach to identification and management of patients at risk for cin.
Results from the pratoacs study protective effect of rosuvastatin and antiplatelet therapy on contrastinduced acute kidney injury and myocardial damage in patients with acute coronary syndrome. Contrast induced nephropathy cin is defined as impairment of renal function, an increase in serum creatinine levels by more than 25 percent or 0. Contrastinduced nephropathy an overview sciencedirect. The steadily increasing use of contrast media in radiological and interventional cardiac procedures has led to more research and well designed studies of prophylactic strategies for its leading life threatening side effect of contrast induced nephropathy cin. Contrastinduced nephropathy in interventional cardiology.
Results from the pratoacs study protective effect of rosuvastatin and antiplatelet therapy on contrast induced acute kidney injury and myocardial damage in patients with acute coronary syndrome. Contrastinduced acute kidney injury in the preserve trial. Contrast induced nephropathy is a form of acute renal failure that is caused by exposure to contrast media during imageguided cardiology and radiology procedures. Pathophysiologic mechanisms underlying this disorder are not fully understood, but it is currently believed that disturbances in renal hemodynamics and a direct effect of cm on renal tubules are involved. Prevention of contrastinduced nephropathy cin definition. Recent clinical studies and metaanalyses delivered some new aspects on preventive measures used in the past and present. The incidence of contrastinduced nephropathy or radiocontrast nephropathy 3 of 7 comparable to previous reported incidence of cinrcn of 0. The risk for cin is increased in children with preexisting renal dysfunction. Contrastinduced nephropathy effective health care program. Pretreatment with sodium bicarbonate is more protective than sodium chloride in animal models of acute ischemic renal failure. Contrastinduced nephropathy cin is a frequent and severe complication in subjects receiving iodinated contrast media for diagnostic or therapeutic purposes. This dye is called contrast dye and is used during xray procedures to help cardiologists gather images of the blood vessels. Many preventive measures have failed to show benefits in.
It occurs in % of nondiabetics, and in 20% of diabetics who received contrast. Prevention of contrastinduced nephropathy with sodium. Dr mandrola quotes a nephrologist who asks if we need to rethink cin entirely. The primary outcome, incidence of contrastinduced nephropathy, occurred in 2. Context contrast induced nephropathy remains a common complication of radiographic procedures. However, the field has been hindered by underpowered studies with heterogeneous inclusion. The incidence of contrastinduced nephropathy complicated by severe renal failure and death after computed tomography of the pulmonary arteries may be higher than has been previously estimated. In patients with normal renal function, cms are eliminated within 24 h. Ideally, the impairment of renal function should be measured by serial creatinine clearance, but because this step may be neither practical nor costeffective in many centers, most of the. Radiocontrast induced nephropathy cin is the third most common cause of acute renal failure among inpatients.
A comparison of 3 regimes for protecting contrastinduced nephropathy in patients undergoing coronary procedures. Contrastinduced nephropathy cin is the 3rd most common cause of hospitalacquired acute renal failure. It is uncommon in the general population, with an incidence of 12%, and occurs within 72 hours of receiving contrast media, usually recovering over the following five days. Contrast induced nephropathy in patients with chronic kidney disease undergoing computed tomography. Acetylcysteine to prevent acute contrastinduced nephropathy. Clinical practice guideline on prevention of contrast. In most cases, contrast induced nephropathy cin is characterized by an elevation of creatinine within 24 to 48 hours following exposure, reaching a peak within 3 to 5 days, followed by a return to baseline within 7 to 10 days. The canadian association of radiologists recognizes the pivotal role radiologists have in the prevention of contrast induced nephropathy cin in at risk groups. Contrastinduced nephropathy cin is the third most common reason for hospitalacquired acute kidney injury. To reduce the occurrence of contrast induced nephropathy, assessment and. Content changes may take place as a result of changes in technology, clinical treatment, or other evidence ba sed. Contrastinduced nephropathy is kidney damage caused by use of radioactive dye during medical procedures. The pathophysiology of contrastinduced nephropathy cin is based on three distinct but interacting mechanisms. Contrast induced nephropathy cin is a serious complication of angiographic procedures resulting from the administration of contrast media cm.
The contribution of each of these mechanisms to the development of cin in the individual patient remains unclear. Early highdose rosuvastatin for contrastinduced nephropathy prevention in acute coronary syndrome. Cin adversely affects the prognosis after interventional procedure and poses substantial extra burden on health care costs. More evidence that contrastinduced nephropathy is not. Contrastinduced nephropathy in interventional cardiology doron sudarsky, eugenia nikolskycardiology department, rambam health care campus and technionisrael institute of technology, haifa, israelabstract. This is an extreme presentation of a common iatrogenic problem. Columbia university medical center interventional cardiology data base hypotension systolic blood pressure nephropathy.