Contrast-Induced Nephropathy in Patients Undergoing Percutaneous Coronary Intervention

Abstract

Contrast Induced Nephropathy (CIN) is a feared complication of numerous radiological procedures that expose patients to contrast media. The most notorious of these procedures is percutaneous coronary intervention (PCI). Not only is this a leading cause of morbidity and mortality, but it also adds to increased costs in high risk patients undergoing PCI. It is thought to result from direct cytotoxicity and hemodynamic challenge to renal tissue. CIN is defined as an increase in serum creatinine by either ≥0.5 mg/dL or by ≥25% from baseline within the first 2-3 days after contrast administration, after other causes of renal impairment have been excluded. The incidence is considerably higher in diabetics, elderly and patients with pre-existing renal disease when compared to the general population. The nephrotoxic potential of various contrast agents must be evaluated completely, with prevention as the mainstay of focus as no effective treatment exists. The purpose of this article is to examine the pathophysiology, risk factors, and clinical course of CIN, as well as the most recent studies dealing with its prevention and potential therapeutic interventions, especially during PCI. The role of gadolinium as an alternative to iodinated contrast is also discussed.

Incidence and Main Determinants of Contrast-Induced Nephropathy following Coronary Angiography or Subsequent Balloon Angioplasty

“…In the study by Mehran and Nikolsky [3], the variables with which the risk for CIN after PCI was assessed were hypotension, intra-aortic balloon pump use, congestive heart failure, a serum creatinine level >1.5 mg/dl, age >75 years, anemia, diabetes mellitus, and contrast medium volume. The risk factors for CIN were classified into modifiable factors (such as volume depletion, anemia, blood loss, nephrotoxic medication, low serum albumin, volume, osmolarity, or iconicity of contrast media) and nonmodifiable factors (such as age, patients' medical history and risk factors, emergency PCI, intra-aortic balloon pump insertion, or previous renal transplantation) [18]. In the present study, the two cardiovascular risk factors that emerged as determinants of CIN following angiography or angioplasty were a myocardial infarction before the procedure and a prior history of hypertension.…”

Iatrogenic left main coronary artery dissection: Incidence, classification, management, and long-term follow-up

“…является одним из проявлений диагностических ятрогений, число случаев которой возрастает за по-следнее время, особенно у больных после чрескож-ных коронарных вмешательств [3]. КИН определя-ется как повышение абсолютного и относительного содержания креатинина крови (выше 0,5 мг/дл и бо-лее 25% по сравнении с исходным соответственно) через 48-72 часа после введения ПСК при отсут-ствии других причин [4].…”

Early renal dysfunction after contrast media administration despite prophylactic hydration

“…According to the increasing availability of imaging techniques with JC, renal disturbances recently become an important clinical problem. The phenomenon of contrast induced nephropathy (CIN) is currently defined as impairment of renal function which is manifested by an increase of creatinine of 0.5 mg/dL or 25 % from baseline, or a decrease in creatinine clearance of more than 5 mL/min in the period from 24 h to 5 days after administration of contrast agent [3, 4]. Based on the above definition, it occurs in 1–6 % of population undergoing coronary angiography, of which about 0.3 % require dialysis [4, 5].…”

“…The phenomenon of contrast induced nephropathy (CIN) is currently defined as impairment of renal function which is manifested by an increase of creatinine of 0.5 mg/dL or 25 % from baseline, or a decrease in creatinine clearance of more than 5 mL/min in the period from 24 h to 5 days after administration of contrast agent [3, 4]. Based on the above definition, it occurs in 1–6 % of population undergoing coronary angiography, of which about 0.3 % require dialysis [4, 5]. On the other hand, CIN was observed, even in up to 20 % of patients with severe cardiovascular burden, undergoing imaging tests using JC [5, 6].…”