Acute Renal Failure/Acute Kidney Injury (AKI) Associated with Endovascular Procedures

Abstract

AKI is one of the most common yet underdiagnosed postoperative complications that can occur after any type of surgery. Contrast-induced nephropathy (CIN) is still poorly defined and due to a wide range of confounding individual variables, its risk is difficult to determine. CIN mainly affects patients with underlying chronic kidney disease, diabetes, sepsis, heart failure, acute coronary syndrome and cardiogenic shock. Further research is necessary to better understand pathophysiology of contrast-induced AKI and consequent implementation of effective prevention and therapeutic strategies. Although many therapies have been tested to avoid CIN, the only potent preventative strategy involves aggressive fluid administration and reduction of contrast volume. Regardless of surgical technique—open or endovascular—perioperative AKI is associated with significant morbidity, mortality and cost. Endovascular procedures always require administration of a contrast media, which may cause acute tubular necrosis or renal vascular embolization leading to renal ischemia and as a consequence, contribute to increased number of post-operative AKIs.

Heat Shock Protein 27 Is an Emerging Predictor of Contrast-Induced Acute Kidney Injury on Patients Subjected to Percutaneous Coronary Interventions

“…Additionally, the RCMs exert direct toxic effects on both endothelial and tubular cells, finally resulting in cell damage, apoptosis, and cell death. Moreover, both processes can aggravate each other [ 2 , 3 , 7 , 8 ].…”

“…CI-AKI is a serious complication associated with considerable morbidity and mortality. The incidence of CI-AKI is significant, and CI-AKI remains a concern for patients undergoing percutaneous coronary interventions (PCI) [ 1 , 2 , 3 , 4 ].…”

“…The mechanisms underlying the CI-AKI have not been completely understood. The growing evidence exists, however, that ischemia reperfusion injury (IRI), hypoxia, and increased oxidative stress play a significant role in the CI-AKI pathogenesis [ 1 , 2 , 3 , 5 , 6 , 7 ].…”

Erythropoietin Attenuates Experimental Contrast-Induced Nephrology: A Role for the Janus Kinase 2/Signal Transducer and Activator of Transcription 3 Signaling Pathway

“…CIN has been discovered as the third most common cause of hospital-acquired AKI (1). The incidence of CIN ranges from 10 to 30% according to different studied populations and diagnostic criteria (1)(2)(3)(4).…”

Experimental Analysis of the Utility of Liquid Metal Gallium as a Contrast Agent for CT Hepatic Artery Angiography in Living Rabbits

“…In addition, contrast-induced nephropathy (CIN), the most common adverse reaction in the urinary system caused by non-ionic iodized contrast agents, has become the third leading cause of acute kidney injury among inpatients, second only to renal hypoperfusion and drug-induced acute kidney injury, accounting for approximately 11% of the total acute kidney injury in hospitalized patients 16,17,18,19 . In a coronary angiography study involving 319 patients, Burch ADRt et al found that most patients had serum creatinine (SCr) levels and blood urea nitrogen (BUN) increases within 12 to 18 hours after the injection of the contrast agent, and their glomerular ltration and creatinine clearance rate (CCR) were decreased 20 .…”