Risk of Nephropathy After Consumption of Nonionic Contrast Media by Children Undergoing Cardiac Angiography: A Prospective Study

Abstract

Despite increasing reports on nonionic contrast media-induced nephropathy (CIN) in hospitalized adult patients during cardiac procedures, the studies in pediatrics are limited, with even less focus on possible predisposing factors and preventive measures for patients undergoing cardiac angiography. This prospective study determined the incidence of CIN for two nonionic contrast media (CM), iopromide and iohexol, among 80 patients younger than 18 years and compared the rates for this complication in relation to the type and dosage of CM and the presence of cyanosis. The 80 patients in the study consecutively received either iopromide (group A, n = 40) or iohexol (group B, n = 40). Serum sodium (Na), potassium (K), and creatinine (Cr) were measured 24 h before angiography as baseline values, then measured again at 12-, 24-, and 48-h intervals after CM use. Urine samples for Na and Cr also were checked at the same intervals. Risk of renal failure, Injury to the kidney, Failure of kidney function, Loss of kidney function, and End-stage renal damage (RIFLE criteria) were used to define CIN and its incidence in the study population. Accordingly, among the 15 CIN patients (18.75%), 7.5% of the patients in group A had increased risk and 3.75% had renal injury, whereas 5% of group B had increased risk and 2.5% had renal injury. Whereas 33.3% of the patients with CIN were among those who received the proper dosage of CM, the percentage increased to 66.6% among those who received larger doses, with a significant difference in the incidence of CIN related to the different dosages of CM (p = 0.014). Among the 15 patients with CIN, 6 had cyanotic congenital heart diseases, but the incidence did not differ significantly from that for the noncyanotic patients (p = 0.243). Although clinically silent, CIN is not rare in pediatrics. The incidence depends on dosage but not on the type of consumed nonionic CM, nor on the presence of cyanosis, and although CIN usually is reversible, more concern is needed for the prevention of such a complication in children.

Severe liver and renal injuries following cerebral angiography: late life-threatening complications of non-ionic contrast medium administration

“…A recent pediatric study assessing the risk of nephropathy after consumption of nonionic contrast media in children undergoing cardiac angiography found an incidence of CIN of 11.25 % for iopromide and 7.5 % for iohexol; however, none of them required dialysis. In fact, CIN as a complication of non-ionic contrast media is not rare in pediatric patients whereas renal impairment and dialysis dependency are rare [4].…”

“…Although more angiographic studies and interventional catheterization are being conducted in pediatric patients, reports of severe delayed contrast reactions associated with these procedures are still limited in children [2][3][4]. Considering that delayed contrast reactions can occur anywhere from 3 h to 7 days [5] following the administration of contrast and patients are generally discharged from the radiology department within 30 min of contrast administration, it is a concern that patients experiencing delayed reactions after iodinated contrast administration may have their conditions unrecognized or neglected.…”

Cystatin C as biomarker of contrast-induced nephropathy in pediatric cardiac angiography

“…Despite the fact that there are no comprehensive studies done on CIN in large pediatric patient groups, it is known that CIN is the third most widespread reason for acute renal cases developing in hospitals, with 12% of contrast media use in all acute renal failure cases, as well (3,6,12). Furthermore, CIN is known to have ranked third in causes of mortality in postrenal failure acquired in hospitals (5).…”

“…Furthermore, CIN is known to have ranked third in causes of mortality in postrenal failure acquired in hospitals (5). However, today pediatric angiography patients can be discharged within 24-48 h, with no CIN-induced mortality or morbidity being expected or reported (12). In the studies reporting postprocedural serum creatinine follow-ups in pediatric angiography patients, the patient groups were monitored for from 48 h to 2 weeks (9,12,(17)(18)(19)(20).…”

“…It has been shown that, in diagnosing contrast-induced nephropathy (CIN), the level of serum CysC in the first 24-48 h and the serum and urine NGAL levels in the first 4 h have seen to have increased (9)(10)(11)(12).…”