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Contrast-Induced Nephropathy
Amir A. Borhani, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Abbreviations

              • Contrast-induced nephropathy (CIN)
            • Definitions

              • Acute kidney injury (AKI) within 24-48 hours following intravascular administration of contrast material (CM); must exclude other causes of AKI
                • AKI: Absolute increase in serum creatinine of 0.5 mg/dL or relative 25% increase from baseline value

            IMAGING

            • General Features

              DIFFERENTIAL DIAGNOSIS

                PATHOLOGY

                • General Features

                  • Microscopic Features

                    • Types of CM

                      CLINICAL ISSUES

                      • Presentation

                        • Demographics

                          • Natural History & Prognosis

                            • Treatment

                              DIAGNOSTIC CHECKLIST

                              • Consider

                                • Guidelines for Management of Patients Taking Metformin

                                  Selected References

                                  1. McDonald RJ et al: Intravenous contrast material exposure is not an independent risk factor for dialysis or mortality. Radiology. 273(3):714-25, 2014
                                  2. Klima T et al: Sodium chloride vs. sodium bicarbonate for the prevention of contrast medium-induced nephropathy: a randomized controlled trial. Eur Heart J. 33(16):2071-9, 2012
                                  3. ACT Investigators: Acetylcysteine for prevention of renal outcomes in patients undergoing coronary and peripheral vascular angiography: main results from the randomized Acetylcysteine for Contrast-induced nephropathy Trial (ACT). Circulation. 124(11):1250-9, 2011
                                  4. Hoste EA et al: Sodium bicarbonate for prevention of contrast-induced acute kidney injury: a systematic review and meta-analysis. Nephrol Dial Transplant. 25(3):747-58, 2010
                                  5. Goldfarb S et al: Contrast-induced acute kidney injury: specialty-specific protocols for interventional radiology, diagnostic computed tomography radiology, and interventional cardiology. Mayo Clin Proc. 84(2):170-9, 2009
                                  6. Marenzi G et al: Contrast volume during primary percutaneous coronary intervention and subsequent contrast-induced nephropathy and mortality. Ann Intern Med. 150(3):170-7, 2009
                                  7. Reed M et al: The relative renal safety of iodixanol compared with low-osmolar contrast media: a meta-analysis of randomized controlled trials. JACC Cardiovasc Interv. 2(7):645-54, 2009
                                  8. Brar SS et al: Sodium bicarbonate vs sodium chloride for the prevention of contrast medium-induced nephropathy in patients undergoing coronary angiography: a randomized trial. JAMA. 300(9):1038-46, 2008
                                  9. Joannidis M et al: Prevention of contrast media-induced nephropathy by isotonic sodium bicarbonate: a meta-analysis. Wien Klin Wochenschr. 120(23-24):742-8, 2008
                                  10. Newhouse JH et al: Frequency of serum creatinine changes in the absence of iodinated contrast material: implications for studies of contrast nephrotoxicity. AJR Am J Roentgenol. 191(2):376-82, 2008
                                  11. Pucelikova T et al: Contrast-induced nephropathy. Catheter Cardiovasc Interv. 71(1):62-72, 2008
                                  12. Bartorelli AL et al: Contrast-Induced Nephropathy. J Interv Cardiol. 2007
                                  13. Dussol B et al: A randomized trial of saline hydration to prevent contrast nephropathy in chronic renal failure patients. Nephrol Dial Transplant. 21(8):2120-6, 2006
                                  14. Tumlin J et al: Pathophysiology of contrast-induced nephropathy. Am J Cardiol. 98(6A):14K-20K, 2006
                                  15. Asif A et al: Prevention of radiocontrast-induced nephropathy. Am J Kidney Dis. 44(1):12-24, 2004
                                  16. Bettmann MA: Frequently asked questions: iodinated contrast agents. Radiographics. 24 Suppl 1:S3-10, 2004
                                  17. Rihal CS et al: Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention. Circulation. 105(19):2259-64, 2002
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Imaging

                                      • Top Differential Diagnoses

                                        • Pathology

                                          • Clinical Issues

                                            TERMINOLOGY

                                            • Abbreviations

                                              • Contrast-induced nephropathy (CIN)
                                            • Definitions

                                              • Acute kidney injury (AKI) within 24-48 hours following intravascular administration of contrast material (CM); must exclude other causes of AKI
                                                • AKI: Absolute increase in serum creatinine of 0.5 mg/dL or relative 25% increase from baseline value

                                            IMAGING

                                            • General Features

                                              DIFFERENTIAL DIAGNOSIS

                                                PATHOLOGY

                                                • General Features

                                                  • Microscopic Features

                                                    • Types of CM

                                                      CLINICAL ISSUES

                                                      • Presentation

                                                        • Demographics

                                                          • Natural History & Prognosis

                                                            • Treatment

                                                              DIAGNOSTIC CHECKLIST

                                                              • Consider

                                                                • Guidelines for Management of Patients Taking Metformin

                                                                  Selected References

                                                                  1. McDonald RJ et al: Intravenous contrast material exposure is not an independent risk factor for dialysis or mortality. Radiology. 273(3):714-25, 2014
                                                                  2. Klima T et al: Sodium chloride vs. sodium bicarbonate for the prevention of contrast medium-induced nephropathy: a randomized controlled trial. Eur Heart J. 33(16):2071-9, 2012
                                                                  3. ACT Investigators: Acetylcysteine for prevention of renal outcomes in patients undergoing coronary and peripheral vascular angiography: main results from the randomized Acetylcysteine for Contrast-induced nephropathy Trial (ACT). Circulation. 124(11):1250-9, 2011
                                                                  4. Hoste EA et al: Sodium bicarbonate for prevention of contrast-induced acute kidney injury: a systematic review and meta-analysis. Nephrol Dial Transplant. 25(3):747-58, 2010
                                                                  5. Goldfarb S et al: Contrast-induced acute kidney injury: specialty-specific protocols for interventional radiology, diagnostic computed tomography radiology, and interventional cardiology. Mayo Clin Proc. 84(2):170-9, 2009
                                                                  6. Marenzi G et al: Contrast volume during primary percutaneous coronary intervention and subsequent contrast-induced nephropathy and mortality. Ann Intern Med. 150(3):170-7, 2009
                                                                  7. Reed M et al: The relative renal safety of iodixanol compared with low-osmolar contrast media: a meta-analysis of randomized controlled trials. JACC Cardiovasc Interv. 2(7):645-54, 2009
                                                                  8. Brar SS et al: Sodium bicarbonate vs sodium chloride for the prevention of contrast medium-induced nephropathy in patients undergoing coronary angiography: a randomized trial. JAMA. 300(9):1038-46, 2008
                                                                  9. Joannidis M et al: Prevention of contrast media-induced nephropathy by isotonic sodium bicarbonate: a meta-analysis. Wien Klin Wochenschr. 120(23-24):742-8, 2008
                                                                  10. Newhouse JH et al: Frequency of serum creatinine changes in the absence of iodinated contrast material: implications for studies of contrast nephrotoxicity. AJR Am J Roentgenol. 191(2):376-82, 2008
                                                                  11. Pucelikova T et al: Contrast-induced nephropathy. Catheter Cardiovasc Interv. 71(1):62-72, 2008
                                                                  12. Bartorelli AL et al: Contrast-Induced Nephropathy. J Interv Cardiol. 2007
                                                                  13. Dussol B et al: A randomized trial of saline hydration to prevent contrast nephropathy in chronic renal failure patients. Nephrol Dial Transplant. 21(8):2120-6, 2006
                                                                  14. Tumlin J et al: Pathophysiology of contrast-induced nephropathy. Am J Cardiol. 98(6A):14K-20K, 2006
                                                                  15. Asif A et al: Prevention of radiocontrast-induced nephropathy. Am J Kidney Dis. 44(1):12-24, 2004
                                                                  16. Bettmann MA: Frequently asked questions: iodinated contrast agents. Radiographics. 24 Suppl 1:S3-10, 2004
                                                                  17. Rihal CS et al: Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention. Circulation. 105(19):2259-64, 2002