Iodine serum creatinine, increased

All patients admitted to a hospital during 6 months who had taken at least one dose of metformin were retrospectively evaluated for susceptibility factors for metformin-associated lactic acidosis (8). There were 263 hospitalizations in 204 patients. In 71 admissions there was at least one contraindication, such as renal or liver disease, renal dysfunction, congestive cardiac failure, metabolic acidosis, or an intravenous iodinated contrast medium given within 48 hours of metformin. In 29 (41%) metformin was continued despite the contraindication. The most frequent contraindication was a raised serum creatinine, but in only eight of the 32 admissions was metformin withdrawn. Of nine patients using metformin who died (not necessarily directly related to metformin), six had an absolute contraindication. In two patients who died and in one who survived, blood lactate was increased and this was temporally related to the use of metformin. 

Contrast-induced nephropathy has been defined as an increase in serum creatinine of at least 25% or an absolute increase in serum creatinine of at least 0.5 mg/dL within 48 to 72 hours of iodinated contrast administration and is associated with significant morbidity and mortality (75). Important risk factors include diabetes mellitus, chronic renal insufficiency, administration of large volumes of high osmolar contrast agents, and intravascular volume depletion. Numerous pharmacologic preventive measures have been studied, but consistent benefits have not been demonstrated. In a recent large retrospective study, preprocedural statin therapy was independently associated with a lower risk of contrast nephropathy and nephropathy requiring dialysis (76). 

The clinical and biological tolerance of iobitridol (Xenetix, a non-ionic medium, osmolality 915 mosmol/ kg at an iodine concentration of 350 mg/ml) has been assessed in a placebo-controlled study in 21 patients with chronic renal insufficiency (glomerular filtration rate less than 60 ml/minute) (170). Serum creatinine and creatinine clearance remained stable 24 and 48 hours after the procedure. No patient had a nephrotoxic reaction or acute oliguria. Only one patient given iobitridol had an increase in serum creatinine of more than 15% from baseline the serum creatinine normalized within 4 days of contrast administration. One patient given placebo had... 

More recently referred to as contrast-induced acute kidney injury (CIAKI), contrast medium-induced nephrotoxicity can occur after intravascular administration of iodinated contrast media. It is the third leading cause of acute kidney failure in hospitalized patients in the USA and Europe [11 ]. It leads to prolonged hospital stay and is associated with increased long-term morbidity and mortality. Traditionally it has been defined as an acute rise in serum creatinine by at least 44 pmoUl (0.5 mg/dl) or at least 25% above baseline within 48-72 hours of administration. The incidence is 5-50% [125], depending on the... 

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