“Contrast nephropathy” in renal transplantation: Is it real?

Abstract

The risk of contrast-induced nephropathy (CIN) in renal transplant recipients is increased in diabetics, patients with impaired basal kidney function, patients in shock, patients presenting with acute emergency and in old age recipients. Approximately one-third of all hospitalized patients with acute kidney injury is attributed to CIN. In the United States, it is the third leading cause of hospital-acquired renal failure. Therefore, efforts should be directed to minimize CIN-related morbidity and mortality as well as to shorten hospital stay. While the role of peri-procedural prophylactic hydration with saline is unequivocal; the use of acetyl cysteine is not based on robust evidence. The utility of theophylline, aminophylline, calcium channel blockers, natriuretic peptide, and diuretics does not have proven role in attenuating CIN incidence. We aim to analyze the evidence for using various protocols in published literature to limit CIN-associated morbidity and mortality, particularly during surveillance of the renal allograft survival.

Contrast-Associated Acute Kidney Injury (CA-AKI) in Children: Special Considerations

“…A vast array of other forms of con genital kidney diseases, such as idiopathic nephrotic synd rome and hereditary tubulopathies, though rare individu ally, amount to a substantial number of children with CKD in specialist centers. Lastly, pediatric transplant recipients are another vulnerable cohort posing unique challenges 23) .…”

Endovascular treatment of cerebral aneurysm after renal transplantation in polycystic kidney disease

“…14 The stress with contrast in a transplanted patient with a single kidney definitely affects allograft function, since this solitary kidney has several hemodynamic changes and has been exposed to immunosuppressive agents. 13 While there is a high incidence of CIN in early transplant recipients, it is low in transplanted patients after 120 days, 15 as in our patient.…”

“…12 The risk of contrast-induced nephropathy (CIN) is increased in patients with diabetes mellitus, impaired renal function, shock, acute injuries, and in the elderly. 13 One-third of hospitalized patients with acute kidney injury are attributable to CIN. While prophylactic and transprocedural hydration is unequivocal, the use of N-acetylcysteine is not based on strong evidence.…”

“…13 Aminophylline, calcium channel blockers, natriuretic peptide, and diuretics have also not been shown to play a significant role in attenuating the incidence of CIN. 13 There is clear evidence that CIN does not occur if the patient undergoing contrast examination has normal renal function. 14 The stress with contrast in a transplanted patient with a single kidney definitely affects allograft function, since this solitary kidney has several hemodynamic changes and has been exposed to immunosuppressive agents.…”

“…While prophylactic and transprocedural hydration is unequivocal, the use of N-acetylcysteine ​​is not based on strong evidence. 13 Aminophylline, calcium channel blockers, natriuretic peptide, and diuretics have also not been shown to play a significant role in attenuating the incidence of CIN. 13 There is clear evidence that CIN does not occur if the patient undergoing contrast examination has normal renal function.…”