Safety Essentials: Acute Reactions to Iodinated Contrast Media

Iyer, Ramesh S.; Schopp, Jennifer G.; Swanson, Jonathan O.; Thapa, Mahesh; Phillips, Grace S.

doi:10.1016/j.carj.2011.12.014

Cited by 30 publications

(38 citation statements)

References 46 publications

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“…Iodinated contrast media are classified into high-, iso- or low-osmolar and iodixanol (IOCM) as well as iohexol (LOCM) is commonly used in clinical practice [17]. HK-2 cell-line is derived from human renal proximal tubular cells.…”

Section: Introductionmentioning

confidence: 99%

Mitophagy Plays a Protective Role in Iodinated Contrast-Induced Acute Renal Tubular Epithelial Cells Injury

Lei

Zhao

Tang

et al. 2018

Cell Physiol Biochem

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Background/Aims: Contrast induced-acute kidney injury (CI-AKI) is one of the most common causes of acute kidney injury (AKI) in hospitalized patients. Mitophagy, the selective elimination of mitochondria via autophagy, is an important mechanism of mitochondrial quality control in physiological and pathological conditions. In this study, we aimed to determine effects of iohexol and iodixanol on mitochondrial reactive oxygen species (ROS), mitophagy and the potential role of mitophagy in CI-AKI cell models. Methods: Cell viability was measured by cell counting kit-8. Cell apoptosis, mitochondrial ROS and mitochondrial membrane potential were detected by western blot, MitoSOX fluorescence and TMRE staining respectively. Mitophagy was detected by the colocalization of LC3-FITC with MitoTracker Red, western blot and electronic microscope. Results: The results showed that mitophagy was induced in human renal tubular cells (HK-2 cells) under different concentrations of iodinated contrast media. Mitochondrial ROS displayed increased expression after the treatment. Rapamycin (Rap) enhanced mitophagy and alleviated contrast media induced HK-2 cells injury. In contrast, autophagy inhibitor 3-methyladenine (3-MA) down-regulated mitophagy and aggravated cells injury. Conclusions: Together, our finding indicates that iohexol and iodixanol contribute to the generation of mitochondrial ROS and mitophagy. The enhancement of mitophagy can effectively protect the kidney from iodinated contrast (iohexol)-induced renal tubular epithelial cells injury.

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Section: Introductionmentioning

confidence: 99%

Mitophagy Plays a Protective Role in Iodinated Contrast-Induced Acute Renal Tubular Epithelial Cells Injury

Lei

Zhao

Tang

et al. 2018

Cell Physiol Biochem

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“…Although the exact mechanism(s) of anaphylactoid reactions are unknown, it is thought to be secondary to the release of vasoactive compounds, conversion of arginine to nitric oxide, and release of pseudoantigens and histamine resulting in allergy-like symptoms 1. The activation of Hageman factor of the coagulation cascade results in the production of bradykinin with vasodilatation, increased vascular permeability, and bronchospasm 2. Non-anaphylactoid or chemotoxic reactions are dose dependent and are influenced by the physicochemical properties of the contrast 1 4.…”

Section: Discussionmentioning

confidence: 99%

“…Most HRs are anaphylactoid, usually secondary to nonspecific mast cell release. HRs are classified as mild (localized urticaria, itching, flushing, nausea, vomiting), moderate (systemic urticaria, severe vomiting, angioedema, mild bronchospasm, throat tightness, tachycardia/bradycardia), or severe (laryngeal edema, severe bronchospasm, cardiovascular collapse, loss of consciousness, seizures) 2. Mild reactions are self-limited and do not require treatment; moderate reactions necessitate medical management, while severe reactions are life threatening and mandate resuscitative measures.…”

Section: Introductionmentioning

confidence: 99%

Patients with a history of hypersensitivity reaction to iodinated contrast medium and given iodinated contrast during an interventional pain procedure

Benzon

Schechtman

Zheng

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

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In patients with a history of a hypersensitivity reaction to iodinated contrast medium, iodinated contrast medium is avoided, antihistamine and steroid premedication are given, or a gadolinium-based contrast agent is employed. Six patients with a history of a hypersensitivity reaction to iodinated contrast medium and who were not premedicated had an unintentional injection of iodinated contrast. None of the patients developed a moderate or severe reaction. All patients had gadopentetate dimeglumine in one of their injections; three had repeated injections of the gadopentetate. The lack of a significant reaction may be due to any or all of the following: questionable history of iodinated contrast reaction, low dose of iodinated contrast given, concomitant injection of (epidural) steroid, and slower absorption from epidural compared with intravenous injection. While it is reassuring to know that there is a low possibility of a moderate to severe reaction in these patients, every effort should be made to avoid this scenario, appropriate drugs and resuscitation equipment should be immediately available, and the patients should be observed adequately and followed for the possibility of late reactions. Recent publications have called for caution in the use of gadolinium-based contrast agents.

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“…treated with hydration and urine alkalinization [18]. Contrast reactions are a constant threat; their management is similar to that for anaphylaxis [25]. Arterial lines are rarely necessary.…”

Section: Key Pointsmentioning

confidence: 99%