The Pathophysiology and the Management of Radiocontrast-Induced Nephropathy

Abstract

Contrast-induced nephropathy (CIN) is an impairment of renal function that occurs after the administration of an iodinated contrast medium (CM). Kidney dysfunction in CIN is considered transient and reversible in most cases. However, it is the third most common cause of hospital-acquired acute kidney injury and is associated with increased morbidity and mortality, especially in high-risk patients. Diagnostic and interventional procedures that require intravascular CM are being used with increasing frequency, especially among the elderly, who can be particularly susceptible to CIN due to multiple comorbidities. Therefore, identifying the exact mechanisms of CIN and its associated risk factors is crucial not only to provide optimal preventive management for at-risk patients, but also to increase the feasibility of diagnostic and interventional procedure that use CM. CM induces kidney injury by impairing renal hemodynamics and increasing the generation of reactive oxygen species, in addition to direct cytotoxicity. Periprocedural hydration is the most widely accepted preventive strategy to date. Here, we review the latest research results on the pathophysiology and management of CIN.

Three-Dimensional Kidney-on-a-Chip Assessment of Contrast-Induced Kidney Injury: Osmolality and Viscosity

“…Under static conditions, higher cytotoxicity was observed even at low concentrations of CM compared to that of the control, which is not seen under in vivo conditions and in clinical settings. Since CIN mainly occurs when high-dose CM are used in patients with risk factors [ 29 ], our results under shear-stress conditions are more similar to the clinical situations. These findings may indicate the beneficial effects of fluid shear-stress within physiological levels.…”

“…Although the exact mechanisms are yet to be elucidated, there has been some evidence related to the harmful effects of increased shear-stress on the cells. Studies on microfluidic platforms suggest that excessive shear-stress has detrimental effects on cells by detaching or disrupting the cytoskeleton [ 29 , 30 ]. Exposure of HK2 cells to high shear-stress (5 dyne/cm 2 ) for 48 h caused structural derangement, including the loss of tight junctions, adherent junctions, and primary cilia [ 17 ].…”

Renal outcomes of suprarenal vs. infrarenal endograft fixation in endovascular abdominal aortic aneurysm repair: a narrative review

“…The exact mechanism is complex, but the oxidative stress formation and peroxidation of lipids seems to be key in promoting the inflammatory processes resulting in renal injury (42). Since EVAR requires contrast media for imaging throughout the treatment process, contrast-induced nephropathy (CIN) (43) could be another cause for RFD post-EVAR, although the exact mechanism is not well established (30,36).…”

Brain natriuretic peptide as a biomarker for predicting contrast-induced nephropathy in patients undergoing coronary angiography/intervention: A systematic review and meta-analysis

“…A variety of risk factors for CIN have been identified, such as impaired renal function, diabetes mellitus, age, heart failure, and effective intravascular volume depletion. [ 7 ] Many risk-predictive models have been developed to stratify the risk of CIN [ 8 – 10 ] ; however, certain variables included in these models, such as the volume of contrast, can only be obtained post-procedure, limiting their usefulness as guidance for preventing CIN before CAG or PCI. In the past few years, significant progress has been made in the field of biomarkers for early detection of CIN.…”

“…[ 11 , 12 ] It reflects the state of ventricular wall tension and volume load, and is associated with the renin-angiotensin and sympathetic nervous systems which contribute to the development of CIN. [ 7 ] Studies have reported that the brain natriuretic peptide can be viewed as a predictor of CIN. A systematic review and meta-analysis was recently conducted to assess the diagnostic value of brain natriuretic peptide for CIN [ 13 ] ; however, the meta-analysis focused only on patients with acute coronary syndrome patients, which refers to a small proportion of patients undergoing interventional therapy.…”