Contrast-induced nephropathy – a review of current literature and guidelines

Abstract

SummaryThe use of iodine-based contrast agents always entails the risk of contrast-induced nephropathy (CIN). The recently observed dramatic increase in the number of examinations and therapeutic procedures using iodine-based contrast media led us to conduct a thorough analysis of the growing number of scientific reports and collective works devoted to contrast-induced nephropathy, based on current definitions, epidemiology, pathophysiology, risk factors, successful prophylaxis and guidelines of the European Society of Urogenital Radiology (ESUR).Radiological contrast agents are the third most common cause of nephropathy among in-patients, accounting for 11–12% of cases. CIN is connected with some clinically significant consequences, including increased morbidity, prolonged hospitalisation, increased risk of complications, potential need for dialysis and increased mortality rate. A significant increase in the number of examinations applying iodine-based contrast media in the course of inpatient procedures requires close cooperation of the clinician and radiologist, supported by knowledge of all CIN issues. In order to protect patients from contrast-induced nephropathy, it is necessary to monitor their renal function, indentify patients with risk factors, refer patients for examinations in a responsible manner, and undertake successful preventive measures.

Pre-Procedural Risk Score of Contrast-Induced Nephropathy in Elderly Patients Undergoing Elective Coronary Angiography

“…Therefore, it is important to identify patients at high risk of CIN, which would enable the use of prophylactic interventions. 4) Several risk score models that present the cumulative risk of several peri-procedural predictors, such as the Mehran CIN score 5) and BMC2 CIN score, 6) have been established and proven useful for bedside clinical decision-making and risk assessment. However, these score models are mainly evaluated after contrast medium (CM) exposure, which cannot be accurately used to guide hydration protocols before the procedure.…”

Atorvastatin alleviates iodinated contrast media-induced cytotoxicity in human proximal renal tubular epithelial cells

“…Iodinated CM-induced nephropathy (CIN) is the third most common cause of hospital-acquired acute kidney injury, which is associated with a lengthened hospital stay, increased health care costs and higher risk of mortality (1)(2)(3). Therefore, it is of great importance to explore effective strategies to prevent CIN.…”

The preventive effect of Berberis vulgaris extract on contrastinduced acute kidney injury

“…Contrast media-induced nephropathy is defined as 25% increase in serum creatinine (Cr) from baseline 3 days after intravenous administration with contrast media (2). CI-AKI has been reported to occur in up to one fourth of patients who undergo coronary interventions (3).…”

“…Contrast media-induced acute kidney injury (AKI) is the cause of approximately 10% of the impairments of renal function leading to hospitalization (4). After being intravenously injected, contrast media rapidly circulates in body fluids and is excreted from the body only through glomerular filtration (2,4). If renal function is normal, contrast media is excreted from the body within 24 hours.…”