Contrast-induced nephropathy: Difference between revisions
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*Golshahi, J, Hasri H, Gharipour M. Contrast-induced nephropathy; A literature review. J Nephropathol. 2014;3(2):51-56. | *Golshahi, J, Hasri H, Gharipour M. Contrast-induced nephropathy; A literature review. J Nephropathol. 2014;3(2):51-56. | ||
*Persson PB, Hansell P, Liss P. Pathophysiology of contrast medium induced nephropathy. Kidney Int. 2005;68:14–22 | *Persson PB, Hansell P, Liss P. Pathophysiology of contrast medium induced nephropathy. Kidney Int. 2005;68:14–22 | ||
</references> | |||
Revision as of 00:43, 13 June 2014
Background
- Often defined as creatinine rise of more than 0.5 mg/dL or ≥25% above baseline[1]
- Vasoconstriction leading to ischemia in the deeper portion of the outer medulla
- Toxic to kidney tubular cells, inducing vacuolization, change in mitochondrial function, and apoptosis
- Less likely to occur with low and iso-osmolar contrast agents
Healthy Patients
Impaired Renal Function
- Administration should follow your local hospital protocols
- Less likely to occur in iso-osmolar contrast agents (iodixanol/Visipaque) and possibly not even an occurrence if the serum creatinine is greater than 2.0 mg/dL. [4]
Clinical Features
- 0.5mg/dl absolute or >25% relative increase in serum creatinine 48-72hrs after contrast exposure
Differential Diagnosis
- Poor renal perfusion
- Nephrotoxic medications
Workup
- Same for AKI
Management
- Hydration
- N-acetylcysteine
See Also
Sources
- Golshahi, J, Hasri H, Gharipour M. Contrast-induced nephropathy; A literature review. J Nephropathol. 2014;3(2):51-56.
- Persson PB, Hansell P, Liss P. Pathophysiology of contrast medium induced nephropathy. Kidney Int. 2005;68:14–22
</references>
- ↑ Goldfarb, S. et al. Contrast-Induced Acute Kidney Injury: Specialty-Specific Protocols for Interventional Radiology, Diagnostic Computed Tomography Radiology, and Interventional Cardiology. Mayo Clin Proc. Feb 2009; 84(2): 170–179 Text
- ↑ Davenport MS. et al. Contrast material-induced nephrotoxicity and intravenous low-osmolality iodinated contrast material. Radiology. 2013 Apr;267(1):94-105
- ↑ Sinert R, Brandler E, et al. Acad Emerg Med2012;19(11):1261
- ↑ McDonald RJ, McDonald JS, et al. Radiology. 2013;267(1):106