Contrast-associated nephropathy - old clinical problem and new therapeutic perspectives

Comparison of Serum Creatinine and Cystatin C for Early Diagnosis of Contrast-Induced Nephropathy after Coronary Angiography and Interventions

“…Baseline GFR was also calculated by use of the Modification of Diet in Renal Disease formula (20 ). According to the conventional definition, patients with a relative increase in serum creatinine concentration of at least 25% compared to baseline within 48 h after the procedure were identified as having developed CIN (7 ).…”

“…CIN is generally considered to cause transient damage, with return to basal renal function occurring within approximately 1 week of the exposure to the iodine contrast medium, although irreversible renal damage and even end-stage renal disease may occur (7 ). The reported incidence ranges from Ͻ5% in low-risk patients to 50% in high-risk populations (2)(3)(4)(5)(6)(7)(8); in particular, a preexisting chronic kidney disease (CKD) and the volume of contrast are the most important predictors of CIN. Among patient-related factors, age, sex, diabetes, anemia, and heart failure with hypovolemia or low cardiac output are associated with CIN (3,9,10 ).…”

Risk Factors for Contrast-Induced Nephropathy

“…Advanced heart failure and Table 2. Patient-related possible risk factors for the development of CIN Hypoalbuminemia [9] Structural kidney disease or damage [1] Female gender [32] Hypercholesterolemia [57] Cirrhosis of the liver [2] Nephrotic syndrome [1] Diuretic usage [12] Sepsis [2] Multiple myeloma [53] Hypertriglyceridemia [71] Use of nephrotoxic drugs [50,51] Multivessel coronary involvement [27] Renal artery stenosis [15] Hyperuricemia [61] Proteinuria [1] Renal transplant [67] Pulmonary edema [15] Urine albumin-creatinine ratio >30 [1] Serum sodium <135 mEq/l [9] Impaired fasting glucose [71] Metabolic syndrome [71] Low effective circulatory volume [10] [3,12,14] . In the study done by Rihal et al [10] , it was shown that congestive heart failure is an independent risk for CIN (OR = 1.53, p = 0.007).…”

“…However, the individual roles of these medications as independent risk factors of CIN have not been determined in large clinical trials [2] . Nonetheless, it seems quite likely that nonselective NSAIDs and selective COX-2 inhibitors decrease the generation of vasodilatory prostaglandins in the kidney and potentiate the vasoconstrictive effects of CM [51] .…”

Frequency of Contrast Induced Nephropathy (CIN) Following Exposure to Contrast in Coronary Angiography, in Diabetics with Previously Normal Renal Function

“…16 Diabetes is thought to be an independent risk factor for the occurrence of CIN. 17 However this notion has not been found to be conclusive in a lot of prospective studies. For instance, Parfreyet al, 18 conducted a study focused on diabetes as a sole independent factor in the establishment of CIN and it was found that in the diabetic arm, there was no significant incidence of CIN.…”