Learning objectives
To review the literature on contrast-induced nephropathy (NCI).
To analyze the different prevention measures,
and propose a prophylaxis protocol .
Background
INTRODUCTION
Contrast induced nephropathy (CIN) is a generally reversible decrease in renal function,
defined as an increase a rise of 25% in the serum creatinine when the baseline is less than 1,5 mg/dl,
or an absolute rise of 0.5 mg/dl when the baseline is greater than 1,5 mg/dl in serum creatinine within 3 days of the intravascular administration of a iodinated contrast medium (ICM) in the absence of an alternative aetiology for the renal impairment.
CIN is the third most common cause of hospital-acquired renal...
Imaging findings OR Procedure details
Data were mainly extracted from the most actual and representative articles as the research basis,
and recommendations of practice guidelines of official organizations of radiology and nephrology (ESUR,
ACR,
NKF).
GENERAL PREVENTION MEASURES:
Alternative diagnostic techniques that do not utilize iodine contrast media must be considered in high risk patients.
Other measures include limiting contribuitory risk factors (like hypovolaemia,
NSAIDs and certain antibiotics) and limit both the total dose and the number of doses administered in a 48 - 72 hour period.
Different autors have...
Conclusion
CONCLUSIONS
The best index of kidney function is the GFR which can be estimated using the MDRM formula.
The measure that has shown greater efficiency is intravenous hydration,
no drug provides consistent protection against the NFC,
studies on acetylcysteine show inconclusive results,
although it tends to his administration
Patients with near-normal renal function are at little risk and few precautions are necessary other than avoidance of volume depletion.
In those patients who are at high risk of contrast nephropathy,
more effective preventive measures,
are as...
References
•Thomsen HS.
ESUR guidelines on contrast media,
version 7.0.Heidelberg,
Germany: European Society of Urogenital Radiology;2013.
•Radiology.
ACR.
Manual on contrast media,
version 8.
2012.
Available at: http://www.acr.org/SecondaryMainMenuCategories/quality_safety/contrast_manual.aspx.
•Maurice Laville,
Laurent Juillard Contrast-induced acute kidney injury: how should at-risk patients be identified and managed? JNEPHROL 2010; 23(04): 387-398
•Anna Kagan,
MD,
PhD and David Sheikh-Hamad,
MD.
Contrast-induced Kidney Injury: Focus on Modifiable Risk Factors and Prophylactic Strategies.
Clin.
Cardiol.
33,
2,
62–66 (2010).
•Raff M,
MSc(Wits),
MBChB(Pret),
FFA(SA) Contrast nephropathy: can we see the whole picture....