Watch Incidence and Outcomes of Contrast Induced Nephropathy.
The steadily increasing use of contrast media in radiological and interventional cardiac procedures has led to more research and well designed studies of prophylactic strategies for its leading life threatening side effect of contrast induced nephropathy (CIN). CIN adversely affects the prognosis after interventional procedure and poses substantial extra burden on health care costs. The importance of understanding of CIN lies in the fact that no available treatment can reverse or ameliorate it once it develops, but prevention is possible. Herein, we discuss the detailed pathophysiological aspects, risk factors, proposed risk prediction algorithms and various prophylactic strategies for contrast induced nephropathy.
Contrast Nephropathy - Clinical Medicine & Research
It is unclear whether Visipaque is associated with a decreased incidence of contrast nephropathy compared to low osmolar agents, and thus its routine administration in at-risk patients is not yet recommended based upon current data.
The authors make an exhaustive analysis of the risk associated with different demographic, clinical, and hemodynamic variables. Of particular interest is the analysis of the influence of the type, site, and treatment of myocardial infarction in the development of contrast nephropathy. In the conclusions, the authors present a risk classification different to the traditionally accepted one of Merham27 (Table 2), but, without doubt, the one used by the authors is more appropriate for the subgroup of patients included in their study.
Contrast nephropathy: A form of acute renal failure that starts soon after administration of contrast media (dye) for X-rays. The disorder usually runs a benign course and only rarely requires recourse to dialysis.Contrast nephropathy will increase mortality up to 30% following angiographic procedures. Before performing such procedures a careful reassessment of the risk/benefit ratio ...Contrast nephropathy will increase mortality up to 30% following angiographic procedures. Before performing such procedures a careful reassessment of the risk/benefit ...A PubMed literature search was conducted in March 2014 using search terms, ‘contrast nephropathy and coronary angiography’. The data analysed included 15 trials and two meta-analyses in order to determine whether patients given N-acetylcysteine (NAC), sodium chloride or sodium bicarbonate had better clinical outcomes. Study data were reviewed and quality of data discussed. Defining contrast nephropathy on the basis of elevated creatinine 2-3 days after receiving contrast is convenient for investigators, but it is unclear what these creatinine elevations really mean (4).Many studies have reported that although some patients develop contrast nephropathy, the average creatinine among all patients is either stable or improved (e.g., , , ).This raises the possibility that we may be observing variations in creatinine following a normal distribution, and labeling the outliers as having “contrast nephropathy:” (5)The best data related to the pathogenesis of contrast nephropathy come from animal models. Studies show evidence of acute tubular necrosis (ATN), but the mechanism by which ATN occurs is not well understood . The two major theories are that ATN is caused by renal vasoconstriction resulting in medullary hypoxia, possibly mediated by alterations in nitric oxide, endothelin, adenosine, and that ATN is a direct result of the cytotoxic effects of the contrast agents .Contrast nephropathy is a generally reversible form of acute kidney injury (AKI) that occurs soon after the administration of radiocontrast media . Important issues that remain unresolved include its pathogenesis and relative efficacies of various prophylactic strategies.The question requires us to start by setting a prior. My priors tend to be more informative than some people would be happy with (see my posting – ). In this case I felt that the treatment would do something between having no effect (log(1)=0) and halving the rate of contrast nephropathy (log(0.5)=-0.7). This led me to a rather conservative prior of N(-0.4,sd=0.3). We could also put priors on the sigma’s but as we only want a distribution conditional on knowing the sigma’s, there is no point.However, unlike other types of ATN, contrast nephropathy is usually characterized by relatively rapid recovery of renal function. If ATN contributes to contrast nephropathy, it is not clear why recovery occurs relatively quickly (ie, within a few days), compared with a longer duration (ie, one to three weeks), as with ATN due to other causes. There are at least two possibilities to explain the short duration of ATN:Contrast nephropathy will increase mortality up to 30% following angiographic procedures. Before performing such procedures a careful reassessment of the risk/benefit ratio should be performed. Mannitol and diuretics play no role in prevention. Hydration and correction of abnormal electrolyte levels should be done in all patients. Pre-treatment with acetylcysteine and theophylline is a well-accepted strategy and should always be utilized. If creatinine levels are above 2.5 to 3 mg/dl, fenoldopam may provide additional protection, particularly in diabetic patients. However, the role of fenoldopam is controversial. Prophylactic hemodialysis may prove to be an additional tool in the fight against this disease in selected patients.