Pitfall in nephrology: contrast nephropathy has to be differentiated from renal damage due to atheroembolic disease

Abstract

In a setting regarding millions of patients and millions of dollars/year, in order to clarify the true renal damage directly related to CM, we ask for prospective studies differentiating cohorts receiving intravenous and intra-arterial, transradial and transfemoral injections, and clinically relevant renal outcomes, thus avoiding the dangers that can come from the idolatry of a surrogate end point such an asymptomatic 25% transient increase of serum creatinine. To avoid that, patients may lose the possibility of a more useful radiological diagnosis, because of an exaggerated suspicion of risk.

Guideline for the Diagnostic Pathway in Patients with Acute Abdominal Pain

“…However, this evidence is based on studies with intra-arterial contrast administration. More recent studies have demonstrated that the risk of CIN is minimal when the eGFR (glomerular filtration rate) is above 45 ml/min/1.73 m 2 [26,27,28,29]. Preventive measures such as pre-hydration can decrease the risk of CIN.…”

Frequency of Acute Kidney Injury Following Intravenous Contrast Medium Administration: A Systematic Review and Meta-Analysis

“…Although the existence of CIN appears to be supported by some animal model data and a myriad of medical literature, the causal association between the administration of IV iodinated contrast medium and CIN remains controversial for several reasons (11)(12)(13)(14)(15)(16). First, it has been proposed that the "multiple-insult animal model" has poor applicability to human renal disease because of the use of multiple exaggerated nephrotoxic insults (17,18).…”

“…Intraarterial administration of contrast medium, performed predominantly for angiocardiographic procedures, has been reported to be associated with a higher incidence of AKI, dialysis, and mortality, as compared with IV contrast medium administration (11,53). It is uncertain whether these higher incidences are attributable to the route of administration, differences in AKI susceptibility among patients who undergo procedures with intraarterial versus IV administration of contrast medium or to iatrogenic causes from the procedures themselves (13,16). Controlled studies comparing intraarterial contrast medium-exposed and contrast medium-unexposed patients are not possible, as contrast medium administration is inherent to these procedures, with the rare exception of CO 2 angiography.…”

“…Controlled studies comparing intraarterial contrast medium-exposed and contrast medium-unexposed patients are not possible, as contrast medium administration is inherent to these procedures, with the rare exception of CO 2 angiography. Accordingly, the true incidence including fluid restriction, hypotension, use of nephrotoxic medication, hemorrhage, as well as biologic variability in SCr level, probably contribute to contrast medium-independent increases in SCr level (13). These contrast mediumindependent sources of AKI may act as confounders for cases that are reported as CIN.…”

Serum Creatinine Level doesn’t Change much at 2nd Day after Percutaneous Coronary Intervention (PCI): Amount of Contrast Injected may be the Key Factor

“…Such as alteration in renal hemodynamic, rheological properties, endocrine and paracrine factors (adenosine, endothelin and reactive oxygen species), hyper-osmolar and hyperviscious alteration of intratubular fluids and direct cytotoxic effects on renal tubular cell. 18 Although, the eGFR is associated with higher risk of acute kidney injury as denned by Creatinine, this risk is independent or exposure to contrast material. 19 Iso-osmoler and Low-osmolar contrast media are less likely than other types of contrast to be associated with CIN.…”