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Contrast-Induced Nephropathy
Kevin Kalisz, MD; Benjamin Wildman-Tobriner, MD; Amir A. Borhani, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Abbreviations

              • Contrast-induced nephropathy (CIN)
              • Acute tubular necrosis (ATN)
              • Glomerular filtration rate (GFR)
              • Acute kidney injury (AKI)
            • Synonyms

              • Other terms suggested, which remove implied causality of contrast in AKI
                • Postcontrast AKI (PC-AKI)
                • Contrast-associated AKI (CA-AKI)
            • Definitions

              • CIN: Sudden deterioration in renal function caused by intravascular administration of iodinated contrast medium
                • Causative diagnosis
                • Subset of PC-AKI patients
                • Differentiation of CIN from PC-AKI incidence requires appropriate control group in studies (rarely performed in available literature)
              • AKI: One of following occurs within < 48 hours after nephrotoxic event (Acute Kidney Injury Network criteria)
                • Absolute serum creatine increase ≥ 0.3 mg/dL
                • Increase in serum creatinine ≥ 50%
                • Urine output ≤ 0.6 mL/kg/hour for at least 6 hours
              • PC-AKI: Sudden deterioration of renal function occurring < 48 hours following IV administration of iodinated contrast medium
                • Correlative diagnosis

            IMAGING

            • General Features

              DIFFERENTIAL DIAGNOSIS

                PATHOLOGY

                • General Features

                  CLINICAL ISSUES

                  • Presentation

                    • Demographics

                      • Natural History & Prognosis

                        • Treatment

                          DIAGNOSTIC CHECKLIST

                          • Consider

                            • Reporting Tips

                              Selected References

                              1. American College of Radiology: ACR Manual on Contrast Media. Committee on Drugs and Contrast Media.10.3, 2020
                              2. Davenport MS et al: Use of intravenous iodinated contrast media in patients with kidney disease: consensus statements from the American College of Radiology and the National Kidney Foundation. Kidney Med. 2(1):85-93, 2020
                              3. Kiss N et al: Histopathological evaluation of contrast-induced acute kidney injury rodent models. Biomed Res Int. 2016:3763250, 2016
                              4. Valdenebro M et al: IgA nephropathy associated with acute interstitial nephritis after administering iodinated contrast media. Nefrologia. 35(6):582-4, 2015
                              5. Davenport MS et al: Contrast material-induced nephrotoxicity and intravenous low-osmolality iodinated contrast material: risk stratification by using estimated glomerular filtration rate. Radiology. 268(3):719-28, 2013
                              6. McDonald JS et al: Frequency of acute kidney injury following intravenous contrast medium administration: a systematic review and meta-analysis. Radiology. 267(1):119-28, 2013
                              7. Zoungas S et al: Systematic review: sodium bicarbonate treatment regimens for the prevention of contrast-induced nephropathy. Ann Intern Med. 151(9):631-8, 2009
                              8. Mehta RL et al: Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 11(2):R31, 2007
                              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)
                                          • Acute tubular necrosis (ATN)
                                          • Glomerular filtration rate (GFR)
                                          • Acute kidney injury (AKI)
                                        • Synonyms

                                          • Other terms suggested, which remove implied causality of contrast in AKI
                                            • Postcontrast AKI (PC-AKI)
                                            • Contrast-associated AKI (CA-AKI)
                                        • Definitions

                                          • CIN: Sudden deterioration in renal function caused by intravascular administration of iodinated contrast medium
                                            • Causative diagnosis
                                            • Subset of PC-AKI patients
                                            • Differentiation of CIN from PC-AKI incidence requires appropriate control group in studies (rarely performed in available literature)
                                          • AKI: One of following occurs within < 48 hours after nephrotoxic event (Acute Kidney Injury Network criteria)
                                            • Absolute serum creatine increase ≥ 0.3 mg/dL
                                            • Increase in serum creatinine ≥ 50%
                                            • Urine output ≤ 0.6 mL/kg/hour for at least 6 hours
                                          • PC-AKI: Sudden deterioration of renal function occurring < 48 hours following IV administration of iodinated contrast medium
                                            • Correlative diagnosis

                                        IMAGING

                                        • General Features

                                          DIFFERENTIAL DIAGNOSIS

                                            PATHOLOGY

                                            • General Features

                                              CLINICAL ISSUES

                                              • Presentation

                                                • Demographics

                                                  • Natural History & Prognosis

                                                    • Treatment

                                                      DIAGNOSTIC CHECKLIST

                                                      • Consider

                                                        • Reporting Tips

                                                          Selected References

                                                          1. American College of Radiology: ACR Manual on Contrast Media. Committee on Drugs and Contrast Media.10.3, 2020
                                                          2. Davenport MS et al: Use of intravenous iodinated contrast media in patients with kidney disease: consensus statements from the American College of Radiology and the National Kidney Foundation. Kidney Med. 2(1):85-93, 2020
                                                          3. Kiss N et al: Histopathological evaluation of contrast-induced acute kidney injury rodent models. Biomed Res Int. 2016:3763250, 2016
                                                          4. Valdenebro M et al: IgA nephropathy associated with acute interstitial nephritis after administering iodinated contrast media. Nefrologia. 35(6):582-4, 2015
                                                          5. Davenport MS et al: Contrast material-induced nephrotoxicity and intravenous low-osmolality iodinated contrast material: risk stratification by using estimated glomerular filtration rate. Radiology. 268(3):719-28, 2013
                                                          6. McDonald JS et al: Frequency of acute kidney injury following intravenous contrast medium administration: a systematic review and meta-analysis. Radiology. 267(1):119-28, 2013
                                                          7. Zoungas S et al: Systematic review: sodium bicarbonate treatment regimens for the prevention of contrast-induced nephropathy. Ann Intern Med. 151(9):631-8, 2009
                                                          8. Mehta RL et al: Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 11(2):R31, 2007