Contrast-induced nephropathy

Background

• Often defined as creatinine rise of more than 0.5 mg/dL or ≥25% above baseline

• 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

• CIN not likely to occur in patients with a Cr<1.5 or a GFR >60ml/min

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.

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

• Contrast with Renal Dysfunction
• Creatinine Screening for CT with Contrast
• MRI Contraindications

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

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