Hospital-acquired nephrotoxic exposures in the precipitation of acute kidney injury – A case series analysis and a call for more preventative nephrology practices

Abstract

Hospital-acquired nephrotoxic exposures in the precipitation of acute kidney injury-A case series analysis and a call for more preventative nephrology practices

The demise of contrast nephropathy; can this be true? A contrarian view; a representative case report of contrast nephropathy from Mayo Clinic Health System in Northwestern Wisconsin

“…Lopez et al in the JASN editorial had surmised that it was premature to endorse the indiscriminate use of contrast, because although the incidence of AKI is low, the sheer number of patients who would be exposed to contrast may be substantial and they therefore acknowledged that we as care givers should continue to carefully weigh the potential benefits versus the risks of the procedure (4). We would however go even much further than that to posit that it is not only premature, but potentially dangerous, to liberalize the use of iodinated contrast in older patients with estimated glomerular filtration rate (eGFR) <30 mL/min as was the case in our patient presented above (15). We have the following suggested preventative algorithms for consideration be physicians as they make decisions whether to expose a patient to contrast media administration or not; i.…”

“…In the words of McCullough et al, contrast nephropathy is predictable and presents an opportunity to utilize preventive strategies, given the increasing numbers of patients undergoing contrast procedures worldwide (5). In March-April, 2017, alone, in the Renal Unit, Mayo Clinic Health System, in northwestern Wisconsin, we had managed three patients who had developed AKI requiring hemodialysis in which contrast nephropathy played the major role, if not the sole role, for the observed nephrotoxicity (15). The resulting increased patient morbidity and potential patient mortality, the escalated healthcare costs and the social burden on families, of potentially preventable AKI requiring renal replacement therapy cannot be overemphasized (5,11,15).…”