Contrast-induced nephropathy: Difference between revisions
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*Isotonic hydration with Normal Saline 1-1.5L (15ml/kg) prior to the contrast load in patients with impaired renal function <ref>Mueller C. et al. Prevention of contrast media-associated nephropathy: randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty. Arch Intern Med. 2002;162(3):329</ref><ref>Bertrand Dussol. et al. A randomized trial of saline hydration to prevent contrast nephropathy in chronic renal failure patients. Nephrol. Dial. Transplant. 2006. 21 (8): 2120-2126</ref> | *Isotonic hydration with Normal Saline 1-1.5L (15ml/kg) prior to the contrast load in patients with impaired renal function <ref>Mueller C. et al. Prevention of contrast media-associated nephropathy: randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty. Arch Intern Med. 2002;162(3):329</ref><ref>Bertrand Dussol. et al. A randomized trial of saline hydration to prevent contrast nephropathy in chronic renal failure patients. Nephrol. Dial. Transplant. 2006. 21 (8): 2120-2126</ref> | ||
===N-acetylcysteine=== | ===N-acetylcysteine=== | ||
*'''Is not useful for preventing CIN'''<ref>ACT Investigators. Acetylcysteine for prevention of renal outcomes in patients undergoing coronary and peripheral vascular angiography: main results from the randomized Acetylcysteine for Contrast-induced nephropathy Trial (ACT). Circulation. 2011 Sep 13;124(11):1250-9 [http://circ.ahajournals.org/content/124/11/1250.full.pdf PDF]<ref> | *'''Is not useful for preventing CIN'''<ref>ACT Investigators. Acetylcysteine for prevention of renal outcomes in patients undergoing coronary and peripheral vascular angiography: main results from the randomized Acetylcysteine for Contrast-induced nephropathy Trial (ACT). Circulation. 2011 Sep 13;124(11):1250-9 [http://circ.ahajournals.org/content/124/11/1250.full.pdf PDF]</ref> | ||
==See Also== | ==See Also== | ||
Revision as of 00:54, 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
- Isotonic hydration with Normal Saline 1-1.5L (15ml/kg) prior to the contrast load in patients with impaired renal function [5][6]
N-acetylcysteine
- Is not useful for preventing CIN[7]
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
- ↑ 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
- ↑ Mueller C. et al. Prevention of contrast media-associated nephropathy: randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty. Arch Intern Med. 2002;162(3):329
- ↑ Bertrand Dussol. et al. A randomized trial of saline hydration to prevent contrast nephropathy in chronic renal failure patients. Nephrol. Dial. Transplant. 2006. 21 (8): 2120-2126
- ↑ ACT Investigators. Acetylcysteine for prevention of renal outcomes in patients undergoing coronary and peripheral vascular angiography: main results from the randomized Acetylcysteine for Contrast-induced nephropathy Trial (ACT). Circulation. 2011 Sep 13;124(11):1250-9 PDF