Contrast-Induced Nephropathy in Critical Care

Abstract

minutes before the imaging study to protect against contrast-induced nephropathy (CIN). Because of the frequency of nausea and vomiting associated with use of N-acetylcysteine, a nurse practitioner in the department suggests that the patient be given an infusion of sodium bicarbonate 150 mEq/L at a rate of 3.5 mL/kg per hour for 1 hour before the CT scan. A hospitalist who is with another patient overhears the discussion and adds that some evidence suggests that hydration with physiological saline at 1 mL/kg per hour may suffice.What is CIN and what is the best course of action for this patient? In this article, I describe CIN; the patients at risk for this abnormality; and the etiology, pathophysiology, preventive interventions, and treatments for this iatrogenic complication of imaging with contrast material. BackgroundCIN is a disorder characterized by the onset of acute renal failure within 24 to 72 hours after the administration of iodinated contrast medium. Contrast-induced nephropathy is an iatrogenic disease caused by the administration of iodinated contrast material to certain at-risk patients. The clinical features include renal failure, with oliguria, anuria, and electrolyte derangements. Contrastinduced nephropathy can prolong hospitalization, result in greater morbidity and mortality, and increase patients' costs. A variety of preventive and treatment strategies exist, including use of alternative imaging. Critical care nurses need to understand the nephropathy and the patients at risk and to develop a familiarity with prevention, treatment, and outcome. (Critical Care Nurse. 2012;32[6]:15-24) This article has been designated for CNE credit. A closed-book, multiple-choice examination follows this article, which tests your knowledge of the following objectives:1. State the pathophysiology of contrast-induced nephropathy 2. Identify patients at risk for developing contrast-induced nephropathy 3. State preventive therapies useful in high-risk patients CNEContinuing Nursing EducationA 62-year-old woman with a history of congestive heart failure and type 2 diabetes mellitus comes to the emergency department because she has had pain in the left lower quadrant of her abdomen and fever for 3 days.by AACN on May 9, 2018 http://ccn.aacnjournals.org/ Downloaded from typically asymptomatic, although a few patients experience renal dysfunction and may require dialysis. Despite its typically mild manifestations, CIN is associated with increases in hospital stays, [4][5][6] in-hospital mortality, 7,8 and 1-year mortality. 4,5,7 Lengths of stay can be twice as long as the stays of patients without CIN, 4,6 and both inpatient and 30-day mortality can be as much as 10-fold greater. 4,6,8 Several populations of patients are at risk, including patients with preexisting renal disease, congestive heart failure, and diabetes mellitus. Several treatment regimens are available to protect the kidneys during administration of contrast material. Contrast MediaContrast media are used in a wide array of medical imaging, inclu...

Nephrotoxicity Of Polymyxin B: Experimental Study In Cells And Implications For Nursing Practice

“…Clinical features include oliguria or anuria, elevation of serum creatinine and electrolyte disturbances (17) . The incidence of AKI may be associated with periods of prolonged hospitalization resulting in increased morbidity and mortality and, consequently, increase of hospital costs of these patients (18) .…”

“…The nephrotoxic AKI is an iatrogenic disease caused by the administration of drugs or contrasts for image diagnosis in patients with risk factors or situations (16)(17) . Clinical features include oliguria or anuria, elevation of serum creatinine and electrolyte disturbances (17) .…”

Renoprotective effect of the Echinodorus macrophyllus in induced renal injury

“…This practice can be demonstrated by care protocols with n-acetylcysteine for prophylaxis of nephrotoxicity induced by iodinated radiocontrast. (13) Clinically, the toxicity of cyclophosphamide has mild side effects, such as irritative urinary symptoms and transient, mild hematuria, and more severe ones such as acute kidney injury. (14) The main objective of therapies for the prevention of adverse effects is to maintain the efficacy of drug treatment and the use of protectives that demonstrate inhibition or interference in pathological mechanisms of cell injury.…”

Nefropatia induzida por contraste iodado e o diabetes mellitus: modelo experimental em ratos

“…Pacientes com doenças cardíacas internados em unidades de terapia intensiva (UTI) são particularmente de risco, visto que 49% das NICs ocorrem após cateterização cardíaca e angioplastia coronária, nas quais injeções repetidas de CI são frequentemente requeridas (5,8) . Já foi demonstrado que o uso indiscriminado dos CIs prolonga a permanência hospitalar e contribui para altos índices de morbidade e mortalidade, sendo essa nefropatia considerada a terceira causa de LRA adquirida em ambientes hospitalares, com 12% dos casos, e podendo evoluir para a necessidade de terapia de substituição renal em 1% dos pacientes (1,9) .…”

“…Uma diagramação dos possíveis mecanismos celulares envolvidos na lesão renal pelos contrastes iodados está apresentada na figura 1 (18) . A NIC em pacientes diabéticos consiste no modelo de lesão renal de origem nefrotóxica, acometendo até 29,4% dos pacientes que recebem esse agente (1,2,9) . O DM pode ser induzido por toxicidade química, endocrinopatias e desordens nos receptores de insulina, em associação com a doença exócrina pancreática.…”