Contrast Induced Nephropathy

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Cardio-Nephrology

Abstract

Contrast induced nephropathy continues to be a common cause of acute kidney injury and is associated with significant mortality and morbidity. The pathogenesis involves tubular injury from renal ischemia, reactive oxygen species as well as direct cytotoxic effects of the contrast media. Prevention remains the best option for management of patients at risk. Though multiple strategies have been evaluated, only a few have been shown to be of definite benefit. Novel strategies to reduce contrast volume as well as those targeted at the inflammatory response to tubular ischemia hold promise in being able to reduce nephron loss after dye exposure.

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References

  1. KDIGO AKI. Work Group: KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2:1–138.

    Google Scholar 

  2. Rudnick M, Feldman H. Contrast induced nephropathy: what are the true clinical consequences? Clin J Am Soc Nephrol. 2008;3:263–72.

    Article  CAS  PubMed  Google Scholar 

  3. McCullough PA, Wolyn R, Rocher LL, Levin RN, O’Neill WW. Acute renal failure after coronary intervention: incidence, risk factors, and relationship to mortality. Am J Med. 1997;103:368–75.

    Article  CAS  PubMed  Google Scholar 

  4. Nemoto N, Iwasaki M, Nakanishi M, Araki T, Utsunomiya M, Hori M, et al. Impact of continuous deterioration of kidney function 6–8 months after percutaneous coronary intervention for acute coronary syndrome. Am J Cardiol. 2014;113:1647–51.

    Article  PubMed  Google Scholar 

  5. Heyman SN, Rosen S, Brezis M. Radiocontrast nephropathy: a paradigm for the synergism between toxic and hypoxic insults in the kidney. Exp Nephrol. 1994;2:153–7.

    Google Scholar 

  6. Rudnick, et al. Contrast-induced nephropathy: How it develops, how to prevent it. Cleve Clin J Med. 2006;73:75–87.

    Article  PubMed  Google Scholar 

  7. Michael A, Faga T, Pisani A, et al. Molecular mechanisms of renal cellular nephrotoxicity due to radiocontrast media. BioMed Res Int. 2014;2014:10.

    Article  Google Scholar 

  8. Sterling KA, Tehrani T, Rudnick MR. Clinical significance and preventive strategies for contrast-induced nephropathy. Curr Opin Nephrol Hypertens. 2008;17:616–23.

    Article  PubMed  Google Scholar 

  9. Mehran R, Aymong ED, Nikolsky E, et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol. 2004;44:1393–9.

    PubMed  Google Scholar 

  10. Mueller C, Buerkle G, Buettner HJ, et al. Prevention of contrast media associated nephropathy: randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty. Arch Intern Med. 2002;162:329–36.

    Article  CAS  PubMed  Google Scholar 

  11. Zapata-Chica CA, Bello Marquez D, Serna-Hiquita LM, et al. Sodium bicarbonate vs. isotonic saline solution to prevent Contrast-induced nephropathy: a systematic review and meta-analysis. Colomb Med (Cali). 2015;46(3):90–103.

    Google Scholar 

  12. Bader BD, Berger ED, Heede MB, et al. What is the best hydration regimen to prevent contrast media-induced nephrotoxicity? Clin Nephrol. 2004;62(1):1–7.

    Article  CAS  PubMed  Google Scholar 

  13. Brar SS, Aharonian V, Mansukhani P, et al. Haemodynamic-guided fluid administration for the prevention of contrast-induced acute kidney injury: the POSEIDON randomized controlled trial. Lancet. 2014;383:1814–23.

    Article  PubMed  Google Scholar 

  14. Stevens MA, McCullough PA, Tobin KJ, et al. A prospective randomized trial of prevention measures in patients at high risk for contrast nephropathy: results of the P.R.I.N.c.e. study. Prevention of radiocontrast induced nephropathy clinical evaluation. J Am Coll Cardiol. 1999;33:403–11.

    Article  CAS  PubMed  Google Scholar 

  15. Qian Geng, Zhenhong Fu, Guo Jun, et al. Prevention of contrast-induced nephropathy by central venous pressure-guided fluid administration in chronic kidney disease and congestive heart failure patients. J Am Coll Cardiol Interv. 2017;9(1):89–96.

    Article  Google Scholar 

  16. Solomon R, Werner C, Mann D, et al. Effects of saline, mannitol and furosemide to prevent acute decreases in renal function induced by radiocontrast agents. N Engl J Med. 1994;331:1416.

    Article  CAS  PubMed  Google Scholar 

  17. Briguori C, Visconti G, Focaccio A, et al. Renal insufficiency after contrast media administration trial II (REMEDIAL II): renal guard system in high-risk patients for contrast-induced acute kidney injury. Circulation. 2011;124:1260–9.

    Article  CAS  PubMed  Google Scholar 

  18. Marenzi G, Ferrari C, Marana I, et al. Prevention of contrast nephropathy by furosemide with matched hydration: the MYTHOS (Induced diuresis with matched hydration compared to standard hydration for contrast induced nephropathy prevention) trial. JACC Cardiovasc Interv. 2012;5:90–7.

    Article  PubMed  Google Scholar 

  19. Investigators ACT. 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. 2011;124:1250.

    Article  Google Scholar 

  20. Nayak KR, Mehta HS, Price MJ, et al. A novel technique for ultra-low contrast administration during angiography or intervention. Catheter Cardiovasc Interv. 2010;75:1076–83.

    PubMed  Google Scholar 

  21. Mariani J Jr, Guedes C, Soares P, et al. Intravascular ultrasound guidance to minimize the use of iodine contrast in percutaneous coronary intervention: the MOZART (minimizing contrast utilization with IVUS guidance in coronary angioplasty) randomized controlled trial. JACC Cariovasc Interv. 2014;7(11):1287–93.

    Article  Google Scholar 

  22. Zhang T, Shen LH, Hu LH, He B. Statins for the prevention of contrast-induced nephropathy: a systematic review and meta-analysis. Am J Nephrol. 2011;33(4):344–51.

    Article  PubMed  Google Scholar 

  23. Liu YH, Liu Y, Duan CY, et al. Statins for the Prevention of contrast-induced nephropathy after coronary angiography/percutaneous interventions: a meta-analysis of randomized controlled trials. J Cardiovasc Pharmacol Ther. 2015;20(2):181–92.

    Article  CAS  PubMed  Google Scholar 

  24. Hausenloy DJ, Candilio L, Evans R, et al. Remote ischemic preconditioning and outcomes of cardiac surgery. N Engl J Med. 2015;373(15):1408–17.

    Article  CAS  PubMed  Google Scholar 

  25. Balta S, Aparci M. The relation between renin-angiotensin-aldosterone system blockade and contrast-induced nephropathy: an unresolved issue. Cardiology. 2015;130(1):1–3.

    Article  PubMed  Google Scholar 

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Correspondence to Michael R. Rudnick .

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Kohli, J., Sethi, A.N., Rudnick, M.R. (2017). Contrast Induced Nephropathy. In: Rangaswami, J., Lerma, E., Ronco, C. (eds) Cardio-Nephrology. Springer, Cham. https://doi.org/10.1007/978-3-319-56042-7_33

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  • DOI: https://doi.org/10.1007/978-3-319-56042-7_33

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-56040-3

  • Online ISBN: 978-3-319-56042-7

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