Computerized Tomography Contrast Induced Nephropathy (CIN) among adult inpatients

Diogo, Luciano Passamani; Bahlis, Laura Fuchs; Carvalhal, Gustavo F.

doi:10.5935/0101-2800.20140064

Cited by 11 publications

(11 citation statements)

References 32 publications

(35 reference statements)

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“…In previous studies, Selistre et al [20] observed no association between fluid administration and CIN occurrence. Diogo et al [35] reported a low rate of prehydration therapy in Brazil.…”

Section: Survived N=48mentioning

confidence: 99%

Risk factors and outcomes of contrast-induced nephropathy in hospitalised South Africans

et al. 2016

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Despite preventive guidelines, iatrogenic contrast-induced nephropathy (CIN) ranks third as a cause of hospital-acquired AKI, impacts significantly on morbidity and mortality, and is associated with longer stays in hospitals, with higher medical costs. [1][2][3][4] The rates of CIN vary, depending on the study definitions employed and underlying risk factors, and range from 0.6% to 30% or higher among risk groups. [5][6][7][8] CIN is also associated with increased duration of hospitalisation and early and late mortality. In-hospital mortality due to CIN ranges from 7% to 22%. [9] McCullough et al. [9] reported early mortality of 1.1% in controls, 7.1% in CIN patients, and 35% in CIN patients that required dialysis. Owing to increased comorbidities, hospitalised patients have increased risk for developing CIN compared with ambulatory patients .[10]Inflammation and endothelial dysfunction, together with reactive oxygen species (ROS), are implicated in the pathogenesis of CIN. [8] Iodinated contrast media directly injures the renal tubular epithelium by producing ROS radicals that cause intra-renal vasoconstriction leading to ischaemia and death of tubular cells. [8,10,11] Serum albumin is an important antioxidant that reduces the formation of oxygen free radicals and is important in expanding intravascular volume. [12,13] However, the role of serum albumin in reducing the incidence of CIN remains unexplored.Sub-Saharan Africa has a dearth of data on rates of CIN. This study investigated the rates of CIN together with the influence of serum albumin, albuminuria, age, haemoglobin, and glomerular filtration rate (GFR) levels on CIN and patient outcomes. Methods Study design, setting and populationThis study was a prospective observational study conducted at Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa, from 1 July 2014 to 30 July 2015. Ethical approval was obtained from the human research ethics committee (HREC) of the University of the Witwatersrand and informed written consent was obtained from all patients. We consecutively recruited hospitalised patients undergoing computed tomography (CT) and angiography from the Divisions of Radiology and Cardiology, respectively. The following exclusion criteria were used: <18 years of age; evidence of pre-existing AKI (clinical or laboratory); end-stage renal disease (ESRD); renal replacement therapy (RRT); prior contrast media administration in the preceding 7 days; pregnancy; or incomplete data. Study proceduresThe study physician reviewed participants' medical records and examined the participants in order to determine pre-existing risk factors for CIN. The medical records were reviewed to determine patient duration of hospitalisation, dialysis requirements and mortality. Study phlebotomists collected blood samples prior to and post contrast media administration. Pre contrast, urine was collected and analysed for microalbuminuria using the Chemistrip Micral 30 immune assay test (Roche 11544039172). Serum creatinine was analysed using the Jaff...

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“…In previous studies, Selistre et al [20] observed no association between fluid administration and CIN occurrence. Diogo et al [35] reported a low rate of prehydration therapy in Brazil.…”

Section: Survived N=48mentioning

confidence: 99%

Risk factors and outcomes of contrast-induced nephropathy in hospitalised South Africans

et al. 2016

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“…Только 0,15-12% пациентов, у которых развивается КИН, требуют медицинского вмешательства [74]. У пациентов с высоким риском важно использовать минимальную дозу низко-или изоосмолярных КВ, необходимых для повышения качества диагностики, или применять альтернативные методы визуализации [22]. В течение многих лет в литературе, посвященной КИН, обсуждалось предположение, что большая часть острых почечных повреждений, которые по времени связаны с введением йодсодержащих КВ, должны рассматриваться как связанные собственно с самим КВ, а не с другими ранее существующими нефротоксичными факторам риска [75] [77] -час тота выявления пациентов, отвечающих критериям КИН после бесконтрастной КТ, похожа на ту, что наблюдали у пациентов после КТ с контрастным усилением.…”

Section: Discussionunclassified

“…Так, Diogo L.P. и соавт. [22] рекомендуют в среднем вводить 139,1 ± 31,2 мл КВ, а для корректировки объема они учитывают площадь поверхности тела (тогда объем КВ будет равен 81,0 ± 2,1 мл/м 2 ) [22].…”

Section: результатыunclassified

“…Факторы риска, связанные с пациентом, -это существовавшие ранее (до диагностической процедуры с введением КВ) нарушения функции почек, сахарный диабет, множественная миелома, преклонный возраст, застойная сердечная недостаточность, гемодинамическая нестабильность, гипертония, необходимость выполнения исследования в экстренных условиях, анемия, показатели фракции выброса левого желудочка <40%, нефротический синдром [9,24]. Недавно перечень факторов риска, связанных с пациентом, был обновлен и теперь включает также факторы, связанные с сердечно-сосудистой нестабильностью, такие как низкий уровень гематокрита, гипотензия на момент проведения исследования, недавно перенесенный инфаркт миокарда (<24 ч), а также использование интрааортальной баллонной помпы [22]. Хроническая болезнь почек (ХБП) со сниженной СКФ является наиболее важным предрасполагающим фактором.…”

Section: факторы риска развития кинunclassified

“…Diogo L.P. и соавт. (2014) [22] изучили побочные проявления введения КВ при КТ у 410 пациентов. У 35 (8,5%) из них развилась КИН.…”

Section: факторы риска развития кинunclassified

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Risk Factors and Pathophysiology of Contrast- Induced Nephropathy after Contrast Enhanced Multidetector Computed Tomography

Kаrmаzаnovsky¹,

Ревишвили

2017

Medicinskaâ vizualizaciâ

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Introduction.The number of contrast enhanced MDCT is growing everywhere. The risk adverse events after intravascular injection of contrast media increased also. One of these adverse events is an acute renal injury (known in the literature as a “contrast-induced nephropathy, CIN”). Literature data are often contradictory. We need an objective analysis of information on the incidence of CIN and evaluation of risk groups for MDCT-CIN.Theaimof the study: the evaluation of factors affecting the development of CIN, understanding of its pathophysiology, including patients with diabetes mellitus, at contrast-enhanced MDCT.Material and methods. 62 English-language scientific publications, the full text of which and bibliography is available for search in PubMed (2013–2016 years), were analyzed. Factors of pathophysiology of CIN were divided into groups and subgroups for critical analysis and understanding the contraindications to the use of contrast-enhanced MDCT in the diagnostic process.Results.Age older than 65 years, low baseline estimated glomerular filtration rate (eGFR), diabetes, low levels of serum albumin, hypertension predispose patients to CIN more often than the modified baseline serum creatinine. Intravenous injection of low osmolar CM is not a risk factor in patients with eGFR ≥45 ml /kg /1.73 m2. SCr levels may vary to levels greater than or less than 25% of baseline even without administration of iodinated CM and may not be a reliable diagnostic test.Conclusion.The introduction into the everyday practice of screening CIN such test as the eGFR, considering the risk of CIN threshold level lower than 45 mL/ min / 1.73 m2, will reduce the risk of misidentification of CIN in a large number of adult inpatients with a threshold level of serum creatinine (SCr) > 1,5 mg /dl.

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Magnetic Resonance Imaging Markers of Cerebral Small Vessel Disease in Hematoma Expansion of Intracerebral Hemorrhage

Suo

Chen

Pan

et al. 2018

Journal of Stroke and Cerebrovascular Diseases

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Computerized Tomography Contrast Induced Nephropathy (CIN) among adult inpatients

Cited by 11 publications

References 32 publications

Risk factors and outcomes of contrast-induced nephropathy in hospitalised South Africans

Risk factors and outcomes of contrast-induced nephropathy in hospitalised South Africans

Risk Factors and Pathophysiology of Contrast- Induced Nephropathy after Contrast Enhanced Multidetector Computed Tomography

Magnetic Resonance Imaging Markers of Cerebral Small Vessel Disease in Hematoma Expansion of Intracerebral Hemorrhage

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