Radiocontrast-Induced Acute Kidney Injury

Abstract

Many radiographic studies and procedures use iodinated contrast media and consequently pose the risk of contrast-induced acute kidney injury (AKI). This is an important complication, which accounts for a significant number of cases of hospital-acquired renal failure associated increased hospital length of stay and increased mortality. Sustained reductions in renal blood flow, hypoxic injury, direct cellular toxicity by the contrast media, and superimposed organ injury are all believed to play a role in this form of AKI. Avoidance of dehydration and multimodality prevention measures may reduce rates of this problem in patients at risk. Contrast-induced AKI is likely to remain a significant challenge for specialists in the future since the patient population is aging, chronic kidney disease and diabetes are coming more common, and use of iodinated contrast is growing.

Aging Male Spontaneously Hypertensive Rat as an Animal Model for the Evaluation of the Interplay between Contrast-Induced Acute Kidney Injury and Cardiorenal Syndrome in Humans

“…Type 1 CRS is defined as an acute worsening of heart function leading to acute kidney injury (AKI) [2][3][4] . In patients with acute myocardial infarction and acute heart failure who have left or right heart catheterization, the administration of contrast media can contribute to contrast-induced AKI (CI-AKI) [5] . Type 3 CRS is defined as acute worsening of kidney function leading to acute cardiac dysfunction [1,4] .…”

Is Endovascular Aneurysm Repair a Relative Contraindication for Patients with Preoperative Renal Dysfunction?

“…10) In patients with renal dysfunction, such as CKD3, the use of isosmotic or hyposmotic contrast media at volumes of less than 30 cc for diagnosis and less than 100 cc for treatment are recommended. 11) In patients requiring limited volumes of contrast media, concomitant intravascular ultrasonography and carbon dioxide have demonstrated utility during EVAR. In the present study, the mean volume of contrast medium administered was 90.6 ± 30 cc, which may have been appropriate, and no significant association was observed between the preoperative renal function and the volume of contrast medium administered.…”

Coronary Angiography Before and After Renal Transplantation

“…41 In the setting of severely reduced renal filtration, the risk of sustained intrarenal vasoconstriction, tubular and peritubular stasis of contrast agents, cellular toxicity and permanent loss of functioning nephrons are greatly increased. 42 Because coronary events are a major cause of perioperative risk and postoperative morbidity in patients considered for renal transplantation, coronary angiography is frequently performed prior to transplantation, particularly in patients with a history of angina or provocable myocardial ischemia on stress testing. 43 If coronary disease becomes a concern after renal transplantation, the intravascular administration of a contrast agent is associated with a high risk (>15%) of contrast-induced AKI in the transplanted kidney.…”