Acute renal dysfunction after major arteriography

Gomes, Antoinette S.; Baker, J.Dennis; Martín‐Paredero, Vicente; Dixon, Shauna; Takiff, Howard; Machleder, Herbert I.; Moore, Wesley S.

doi:10.2214/ajr.145.6.1249

Cited by 106 publications

(43 citation statements)

References 14 publications

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“…Almost all studies mentioned pre-existing renal impairment as the first and foremost risk for contrast induced nephropathy. [11][12][13][14] In a registry from Michigan Cardiovascular consortium, it was shown that of 16,592 PCIs the incidence of CIN increased with worsening baseline renal function 15 which was also confirmed in a series of 1,826 patients. 16 Another registry study showed that the incidence of renal failure after PCI increased from 2.5% in patients with mild renal impairment (serum creatinine 1.2 -1.9 mg/dL) to 30.6% in those with more severe impairment (serum creatinine > 3.0 mg/dL).…”

Section: Discussionmentioning

confidence: 78%

Contrast Induced Nephropathy in Patients Undergoing Elective Pci in a Tertiary Care Centre in Coastal Kerala

Vasu¹,

Bastian²,

Mohan³

et al. 2017

jemds

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BACKGROUNDContrast induced nephropathy after PCI is associated with significant morbidity and mortality after PCI. Patients undergoing PCI who had risk factors for renal compromise are at higher risk.The aim of this study was to evaluate the incidence, predictors and in-hospital outcome of contrast-induced nephropathy (CIN) after elective percutaneous coronary intervention (PCI) for stable ischaemic heart disease patients.

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Section: Discussionmentioning

confidence: 78%

Contrast Induced Nephropathy in Patients Undergoing Elective Pci in a Tertiary Care Centre in Coastal Kerala

Vasu¹,

Bastian²,

Mohan³

et al. 2017

jemds

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“…It has already been shown that dehydration potentiates the vasoconstrictive effects of contrast media and some investigators have attempted to reduce the likelihood of contrast media induced nephropathy by pretreatment with volume expansion or diuresis [17,21]. Intravenous fluid could be beneficial before the administration of contrast agents by correcting plasma volume depletion [2,8,18], but Charles et al proposed that hydration with intravenous saline before and after the procedure was not related to the development of nephropathy [3]. Mannitol with efficacy in preventing or reducing the severity of ischemic renal insufficiency in humans is also controversial [2].…”

Section: Discussionmentioning

confidence: 99%

Effect of Dopamine on Excretory Urographic Image Quality and the Prevention of Contrast-Induced Nephropathy in Dogs.

Choi

Lee

Chang

et al. 2001

The Journal of Veterinary Medical Science

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ABSTRACT. The effect of low dose dopamine on the excretory urographic image quality and contrast media-induced nephropathy in normal dogs (experiment 1) and the dogs with decreased renal function (experiment 2) were assessed. In experiment 2, decreased renal function was induced by gentamicin overdose. In each experiment, animals were divided into 3 groups. In group 1, only contrast medium (iohexol) was administered. In group 2, contrast medium plus intravenous fluid (0.9% saline) were administered. And in group 3, contrast medium plus intravenous fluid and low dose dopamine were administered. Investigated parameters included intrarenal resistive index (RI), serum BUN and creatinine concentrations, contrast medium elimination time and radiographic image quality. In experiment 1, RI of group 1 increased at 80 min after contrast medium administration (p<0.05), but RI of group 3 decreased at 48 and 72 hr (p<0.05). Serum BUN concentration of group 1 was higher than that of group 2 and 3 (p<0.05); in radiographic examination, contrast medium elimination time decreased in group 2 and 3, but image quality of group 2 was inferior to that of group 3. In experiment 2, image quality of group 3 only provided adequate visualization of renal structures. The formula of contrast medium plus low dose dopamine was found to provide good nephrogram and pyelogram image quality without supplemental contrast medium, and to protect renal tubules from prolonged exposure to concentrated contrast medium. KEY WORDS: canine contrast-induced nephropathy, dopamine, excretory urography.

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“…Surprisingly, another early study on 364 patients undergoing angiography did not find a preventive effect of hydration on CIN. 35 Should fluids be administered intravenously or orally? On the one hand, Trivedi et al 36 compared the effects of intravenous normal saline at a rate of 1 mL/kg per hour for 24 hours beginning 12 hours before contrast administration versus hydration with unrestricted oral fluids on the incidence of CIN.…”

Section: Evidence For Periprocedural Hydrationmentioning

confidence: 99%

Contrast-Induced Nephropathy

2006

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ontrast medium-induced nephropathy (CIN) is a common cause of acute renal dysfunction. During the past few years, several publications have provided clinical and experimental data on this topic. Our review focuses on 4 major concerns of CIN relevant in clinical practice: (1) What is the evidence that CIN is a clinically relevant and a dangerous condition for the patient? (2) Is there a difference in CIN rate among different contrast media, and how is that related to the physicochemical properties of different available contrast media? (3) What is the evidence that periprocedural hydration is an effective, appropriate, and safe method to prevent CIN? (4) What is the evidence for the use of a drug, in particular acetylcysteine, to prevent CIN? Clinical RelevanceCIN has gained increased attention in the clinical setting, particularly during cardiac intervention but also in many other radiological procedures in which iodinated contrast media are used. There is at present good clinical evidence from well-controlled randomized studies that CIN is a common cause of acute renal dysfunction. 1,2 CIN is the acute deterioration of renal function after parenteral administration of radiocontrast media in the absence of other causes. CIN is generally defined as an increase in serum creatinine concentration of Ͼ0.5 mg/dL (Ͼ44 mol/L) or 25% above baseline within 48 hours after contrast administration. [3][4][5][6][7] Although the exact mechanisms of CIN have yet to be fully elucidated, several causes have been described. Increased adenosine-, endothelin-, and free radical-induced vasoconstriction and reduced nitric oxide-and prostaglandin-induced vasodilatation have been observed. These mechanisms cause ischemia in the deeper portion of the outer medulla, an area with high oxygen requirements and remote from the vasa recta supplying the renal medulla with blood. Contrast agents also have direct toxic effects on renal tubular cells, causing vacuolization, altered mitochondrial function, and apoptosis. 8 Atopy does not play a role in the pathogenesis of CIN.The incidence of CIN in the general population has been calculated to be Ͻ2%. In high-risk patients, ie, patients with chronic renal impairment, diabetes mellitus, congestive heart failure, and older age, the incidence has been calculated to be Ͼ20% to 30%. 3-7 CIN has been associated with increased morbidity, extended length of hospital stay, and increased costs. 9 Several risk factors have been described for CIN. 10 -12 A risk score for prediction of CIN after percutaneous coronary intervention has been reported by Mehran et al. 12 That risk score includes hypotension (5 points, if systolic blood pressure Ͻ80 mm Hg for at least 1 hour requiring inotropic support), use of intra-aortic balloon pump (5 points), congestive heart failure (5 points, if class III/IV by New York Heart Association classification or history of pulmonary edema), age (4 points, if Ͼ75 years), anemia (3 points, if hematocrit Ͻ39% for men and Ͻ36% for women), diabetes mellitus (3 points), contrast media...

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Acute renal dysfunction after major arteriography

Cited by 106 publications

References 14 publications

Contrast Induced Nephropathy in Patients Undergoing Elective Pci in a Tertiary Care Centre in Coastal Kerala

Contrast Induced Nephropathy in Patients Undergoing Elective Pci in a Tertiary Care Centre in Coastal Kerala

Effect of Dopamine on Excretory Urographic Image Quality and the Prevention of Contrast-Induced Nephropathy in Dogs.

Contrast-Induced Nephropathy

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