Pathophysiology of Contrast-Induced Nephropathy

Tumlin, James A.; Stacul, Fulvio; Adam, Andy; Becker, Christoph R.; Davidson, Charles J.; Lameire, Norbert; McCullough, Peter A.

doi:10.1016/j.amjcard.2006.01.020

Cited by 330 publications

(221 citation statements)

References 77 publications

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“…4 The pathophysiology of CIN is poorly understood, although hemodynamic effects, direct tubular toxicity, and oxidative stress are considered to be amongst the most important factors. 5,6 The osmolality of the ICM, and hence the osmotic load delivered to the kidneys, is thought to play a critical role in the pathogenesis of CIN, 6,7 but it is not known whether this is a direct or indirect effect. 6 In vitro studies support the hypothesis that the toxicity is related to the osmolality of the ICM, as low-osmolal ICM (LOCM) have considerably less toxic effects than high-osmolal ICM (HOCM) on various cell types, with the observed toxicity being dose dependent.…”

Section: Introductionmentioning

confidence: 99%

“…5,6 The osmolality of the ICM, and hence the osmotic load delivered to the kidneys, is thought to play a critical role in the pathogenesis of CIN, 6,7 but it is not known whether this is a direct or indirect effect. 6 In vitro studies support the hypothesis that the toxicity is related to the osmolality of the ICM, as low-osmolal ICM (LOCM) have considerably less toxic effects than high-osmolal ICM (HOCM) on various cell types, with the observed toxicity being dose dependent. 8,9 The ionic force of the molecule seems to be irrelevant to the toxicity.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Effects of the Iodinated X-Ray Contrast Media Iodixanol, Iohexol, Iopromide, and Ioversol on the Rat Kidney Epithelial Cell Line NRK 52-E

et al. 2011

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Nephrotoxicity, associated with the administration of iodinated X-ray contrast media (ICM), continues to be a major side effect in a significant number of vulnerable patients undergoing diagnostic X-ray imaging procedures. The molecular mechanisms underlying these adverse effects on the kidneys are unclear despite several decades of investigation. Side effects are more common after exposure to high-osmolar compared with low-osmolar ICM, suggesting that osmolality may be an important physical-chemical property related to nephrotoxicity. This investigation in cultured NRK 52-E cells, a cell line of renal origin, compares the in vitro toxicity of the iso-osmolal ICM iodixanol with the lowosmolal ICM iohexol, iopromide, and ioversol. The cellular toxicity was evaluated with the trypan blue exclusion assay, the MTT assay, and incidences of cell death. A qualitative assessment of vacuolation of the cultured NRK 52-E cells was taken as a measure of intracellular uptake of ICM. A difference in cell death incidence was observed between the iso-osmolal iodixanol and the low-osmolal iohexol, iopromide, and ioversol contrast media, with the isoosmolal iodixanol having the least effect in each of the in vitro systems tested. The osmolality of the contrast media appeared to be the major cause for the observed in vitro toxicity.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Effects of the Iodinated X-Ray Contrast Media Iodixanol, Iohexol, Iopromide, and Ioversol on the Rat Kidney Epithelial Cell Line NRK 52-E

et al. 2011

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“…With increased usage of iodinated CM during radiological or interventional procedures, CIN has become one of the most prevalent causes of acute renal failure (ARF), especially in patients suffering from diabetes or cardiovascular pathology (5)(6)(7). The pathogenesis of CIN, however, is currently unclear (8) Previous research has used invasive laser-Doppler probe or Clark-type microelectrodes to demonstrate that the renal ischemia and anoxia plays an important role in the development of CIN (9). To date, a noninvasive technique for the investigation of functional alterations within the kidney has not been well established.…”

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confidence: 99%

Time course study on the effects of iodinated contrast medium on intrarenal water transport function using diffusion‐weighted MRI

Wang

Zhang

Yang

et al. 2012

Magnetic Resonance Imaging

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Purpose: To assess the effects of intravenous-injected iodinated contrast medium (CM) on intrarenal water diffusion using noninvasive diffusion-weighted MRI (DW-MRI). Materials and Methods:Ten New Zealand White rabbits were randomized to receive a 6 mL/kg body weight intravenous injection of clinically used iopamidol-370 (n ¼ 7) or an equivalent amount of 0.9% physiological saline (n ¼ 3). A sequential DW-MRI was performed to estimate the intrarenal apparent diffusion coefficient (ADC) at 24 h before and 1 h, 24 h, 48 h, and 72 h after administration.Results: Iopamidol produced a progressive ADC reduction in inner stripes of the renal outer medulla (IS) by 13.92% (P ¼ 0.05) at 1 h, 17.52% (P ¼ 0.02) at 24 h, 20.23% (P ¼ 0.01) at 48 h and 16.31% (P ¼ 0.04) at 72 h after injection. Cortical ADC was decreased by 14.14% (P ¼ 0.01) at 48 h and 14.12% (P ¼ 0.01) at 72 h after injection. Iopamidol produced slight decrease of ADCs in outer stripes of the outer medulla (OS) and inner medulla (IM) of kidney but without statistical difference. In control group, no significant ADC changes was observed in each anatomic compartment due to saline injection (P > 0.05). Conclusion:As demonstrated by DW-MRI, intravenous iopamidol injection resulted in a successive reduction of intrarenal water diffusion, particularly in IS of kidney. This MR technique may be used as a noninvasive tool to perform a time course study of the pathogenesis associated with contrast-induced nephropathy (CIN).

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“…High osmolar contrast media may induce intense and prolonged vasoconstriction at the corticomedullary junction of the kidneys and directly impair the autoregulatory ability of the kidney through a loss of nitric oxide production. [20][21][22][23] A sepsis-related decrease in renal blood flow and an increase in reactive oxygen species expression may increase renal injury in patients given Gd-CM. Therefore, Gd-CM and sepsis appear to synergistically interact in rapid GFR decline.…”

Section: Discussionmentioning

confidence: 99%

Risk of Acute Kidney Injury after Exposure to Gadolinium-Based Contrast in Patients with Renal Impairment

Chien

Wang

et al. 2011

Renal Failure

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Objectives: Gadolinium-based contrast media (Gd-CM) are reported to induce acute kidney injury (AKI) in a high-risk population group at the usual dose for magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) examinations. We assessed gadolinium-induced nephropathy in patients with renal impairment who underwent MRI or MRA examinations, and evaluated the risk factors. Materials and methods: In this retrospective study, 238 patients with baseline renal impairment, who received MRI or MRA examinations with Gd-CM, were recruited. After all other AKI causes-liver decompensation, severe heart failure, all kinds of shock, and severe sepsis-and patients on dialysis were excluded, 158 patients were enrolled. AKI was defined as a decrease in glomerular filtration rate (GFR) >10% of baseline data within 3 days after administration of Gd-CM. Regression analysis was used to find independent risk factors for gadolinium-induced AKI (Gd-AKI). Results: Twenty-six of the 158 patients (16.5%) developed Gd-AKI. There were no significant differences in gender, age, or baseline GFR between those who did and who did not develop AKI. Comorbid coronary artery disease, liver cirrhosis, diabetes mellitus, and hypertension were not significantly associated with the development of Gd-AKI. However, sepsis was an independent risk factor for Gd-AKI after multivariate regression analysis (adjusted odds ratio: 4.417; 95% confidence interval: 1.671-11.676, p = 0.03). Conclusions: It is potential AKI after administration of Gd-CM under sepsis condition at the dose for MRI and MRA examinations in patients with renal impairment. It is important to identify high-risk patients and closely monitor renal function after administration of Gd-CM.

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Pathophysiology of Contrast-Induced Nephropathy

Cited by 330 publications

References 77 publications

The Effects of the Iodinated X-Ray Contrast Media Iodixanol, Iohexol, Iopromide, and Ioversol on the Rat Kidney Epithelial Cell Line NRK 52-E

The Effects of the Iodinated X-Ray Contrast Media Iodixanol, Iohexol, Iopromide, and Ioversol on the Rat Kidney Epithelial Cell Line NRK 52-E

Time course study on the effects of iodinated contrast medium on intrarenal water transport function using diffusion‐weighted MRI

Risk of Acute Kidney Injury after Exposure to Gadolinium-Based Contrast in Patients with Renal Impairment

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