Contrast-induced nephropathy

Abstract

How contrast medium-induced nephropathy (CIN) comes about is not fully understood, although CIN constitutes a leading cause of renal failure. Here, a short review of clinical trials and a more thorough outline of mechanisms thought to cause CIN are outlined. Osmolality is only one of several physicochemical properties of contrast media (CM). Iso-osmolar CM are dimers, not monomers. Thus, they have physicochemical features different from other CM, e.g., in terms of viscosity (which is over fivefold greater than plasma viscosity). This may be of considerable pathophysiologic and clinical importance. There are studies providing evidence for a greater perturbation in renal functions by iso-osmolar CM in comparison to nonionic low-osmolar CM. Conversely, some previous clinical trials indicate an advantage of the iso-osmolar CM. This review highlights altered rheological properties, perturbation of renal hemodynamics, regional hypoxia, auto- and paracrine factors (adenosine, endothelin, reactive oxygen species) and direct cytotoxic effects, which are all thought to participate in causing CIN. It is concluded that the use of CM in general, and high viscous iso-osmolar CM in particular, can be deleterious to the kidney due to augmented resistance in the renal tubules.

The Effects of the Iodinated X-Ray Contrast Media Iodixanol, Iohexol, Iopromide, and Ioversol on the Rat Kidney Epithelial Cell Line NRK 52-E

“…3 In patients with preexisting renal impairment, CIN is more frequently reported, and the poorer the renal function the higher the incidence of CIN. 4 The pathophysiology of CIN is poorly understood, although hemodynamic effects, direct tubular toxicity, and oxidative stress are considered to be amongst the most important factors.…”

Routine pre-procedure laboratory testing for patients undergoing outpatient cerebral angiography is not indicated

“…Keeping in mind that CIN only indicates a rise in serum CR and does not necessarily imply renal dysfunction, let alone renal failure, the utility of routinely performing a renal function test to identify a very small subset of patients at risk of elevating a laboratory value (CIN) is highly debatable. In fact the characterization of CIN by itself as a harbinger of more serious renal damage is doubtful since most cases have been reported to be self-limiting 15. None of our patients developed acute renal failure or required an admission for renal dysfunction.…”

Dynamic 4D-CT Angiography for Guiding Transarterial Chemoembolization: Impact on the Reduction of Contrast Material, Operator Radiation Exposure, Catheter Consumption, and Diagnostic Confidence

“…In this regard, not so much osmolality as higher viscosity during intra-arterial injection was presumed to be a potential explanation [16,18]. On the contrary, in a recent study, the incidence of CIN following TACE of HCC seemed to be comparable to that after intra-venous contrast media administration [12].…”

“…Assessing the administered contrast material volume for both cohorts was the first priority of our study, as the prevention of CIN remains an issue of great current interest [12,17,18,20]. As we demonstrated that 4D-CTA TACE can be performed with twothirds less arterially administered contrast media volume in comparison to the standard TACE procedure, we presume that this technique might decrease the risk of CIN and may enable TACE treatment for patients with reduced renal function, although our study did not aim at investigating this end point.…”