Contrast media-induced nephropathy

Ide JM, Lancelot E, Pines E, Corot C. Prophylaxis of iodinated contrast media-induced nephropathy a pharmacological point of view. Invest Radiol 2004 39(3) 155-70. 

The use of iodinated contrast media (CM) continues to be a common cause of hospital-acquired acute renal failure (ARF) and its development increases the in-hospital mortality significantly [1, 2,3, 4] as well as increasing the length of hospital stay [5]. Contrast media-induced nephropathy (CMIN) is defined as an otherwise unexplained acute deterioration of renal function after intravascular administration of iodinated CM. Although the clinical features and the histopathological findings of CMIN have been well described [6-9], its pathogenesis, prevention and best treatment modality remain uncertain. 

Table 1. Risk factors for contrast media-induced nephropathy.

CMIN contrast media induced nephropathy DPCPX l,3-dipropyl-8-cyclopentylxan thine... 

CMIN contrast-media induced nephropathy FACS fluorescence-activated cell sorting... 

I 6 Bettmann MA, Contrast medium-induced nephropathy critical review of the existing clinical evidence, Nephrol Dial Transplant 2005 20(Suppl I ) i 12— 17. 

Thomsen HS and Morcos SK. Contrast-medium-induced nephropathy is there a new consensus A review of published guidelines. Eur Radiol 2006 16 1835-1840... 

Fleyman SN, Rosenberger C, Rosen S. Regional alterations in renal hemodynamics and oxygenation a role in contrast medium-induced nephropathy. Nephrol DialTranspI 2005 20(SI) i6-i11. 

Thomsen HS, Marckmann P, Logager VB (2007) Enhanced computed tomography or magnetic resonance imaging a choice between contrast medium-induced nephropathy and nephrogenic systemic fibrosis Acta Radiol 48 593-596... 

Baumgarten DA, EUis JH. Contrast-induced nephropathy contrast material not required AJR Am J Roentgenol August 2008 191(2) 383-6. Katzberg RW, Newhouse JH. Intravenous contrast medium-induced nephrotoxicity is the medical risk really as great as we have come to believe Radiology July 2010 256(l) 21-8. 

Barrett BJ, Parfrey PS. Clinical practice, Preventing nephropathy induced by contrast medium, N Engl J Med 2006 354 379-386. 

In patients with pre-existing renal impairment, hemodialysis did not influence the incidence or outcome of contrast-induced nephropathy, in spite of eliminating contrast agents effectively from the circulation. The same group has now confirmed their previous observation in a bigger study in 30 patients with pre-existing renal impairment (184). Hemodialysis did not influence the incidence or outcome of contrast-induced nephropathy, in spite of effective elimination of contrast medium from the circulation. The failure of hemodialysis to protect against the development of contrast nephropathy is due to the very rapid onset of renal injury after the administration of contrast medium. 

Langner S, Stumpe S, Kirsch M et al (2008) No increased risk for contrast-induced nephropathy after multiple CT perfusion studies of the brain with a nonionic, dimeric, iso-osmolal contrast medium. Am J Neuroradiol 29 1525-1529. 

Contrast-induced nephropathy (GIN) is defined as renal hypofunction with an increase in the serum creatinine (SCr) concentration of 25% or more or by 44 gmol/L (0.5 mg/dL) or more, developing within 3 days after injection of an intravascular contrast medium in the absence of other causes. 

---