Contrast-Induced Nephropathy: Current practice

Volume 1 - Issue 1

Sonali Gupta¹*, Pradeep Goyal², Nishant Gupta³, Harpreet Sawhney⁴ and Vivek Kumar⁵

Received: May 24, 2018;   Published: June 05, 2018

DOI: 10.32474/JUNS.2018.01.000103

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Abstract

Contrast induced nephropathy (CIN) is a common cause of hospital acquired acute kidney injury (AKI) and associated with adverse clinical outcomes. There is still debate regarding the exact definition, which has greatly influenced the reported incidence of CIN in literature. Recent studies have challenged the universal concern regarding risk of CIN in general population. It is found to occur more commonly after intra-arterial (IA) administration of contrast as in interventional cardiology and vascular procedures especially in patients with multiple comorbidities and underlying renal impairment. Recent studies report negligible risk after intravenous (IV) contrast administration for modern diagnostic radiological examinations. Since it is a potentially preventable clinical condition, it is imperative for health care professional to be well aware of this entity. All patients undergoing iodinated contrast exposure should be risk stratified and preventive measures should be employed in high risk population. This paper will review the epidemiology, controversies regarding definition, pathophysiology, risk stratification, iodinated contrast commonly used in practice and preventive strategies.

Keywords: Contrast Induced Nephropathy; Iodinated Contrast Media; Acute Kidney Injury; Cardiac Angiography; Contrast Enhanced Computed Tomography

Abbrevations: CIN: Contrast Induced Nephropathy; AKI: Acute Kidney Injury; CM: Contrast Media; ICU: Intensive Care Unit; CECT: Contrast Enhanced Computed Tomography; PTCA: Percutaneous Trans-Luminal Coronary Angioplasty; ACR: American College of Radiology; AKIN: Acute Kidney Injury Network; eGFR: Glomerular Filtration Rate; NGAL: Neutrophil Gelatinase-Associated Lipocalin; CES: Cholesterol Embolism Syndrome; ERBP: European Renal Best Practice; KDIGO: Kidney Disease Improving Global Outcomes; NSAIDS: Non-Steroidal Anti-Inflammatory Drugs; HOCM: High Osmolar Contrast Media; LOCM: Low Osmolar Isosmolar CM; HD: hemodialysis; HF: hemofiltration; NAC: N-acetylcysteine; ESUR: European Society of Urogenital Radiology; CAR: Canadian Association of Radiologist; ESRD: End Stage Renal Disease; TOF: Time Of Flight; CKD: Chronic Kidney Disease; NSF: Nephrogenic Systemic Fibrosis; NCCT: Non contrast computed Tomography; CO₂: Carbon Dioxide

Abstract| Introduction| Epidemiology| Definition| Diagnosis| Pathophysiology| Risk Factors| Conclusion| References|