Abstract
Contrast-induced nephropathy (CIN) remains a common and potentially serious complication
in at risk patients after exposure to contrast agents. Risk factors for CIN include
chronic kidney disease, hypotension, diabetes mellitus, recent previous exposure to
contrast and all of these are potentially additive. Therefore, careful pre-procedural
risk stratification is important. In high-risk patients, contrast should be avoided
if possible. If avoidance is not possible, the volume of contrast should be minimized
and the type of contrast used should if possible be non-ionic iso-osmolar contrast.
In view of the clinical importance of CIN, numerous potential risk-reduction strategies
have been evaluated. Adequate intravenous volume expansion with isotonic crystalloid
(1.0–1.5 mL/kg per hr) for 3–12 hr before the procedure and continued for 6–24 hr
afterward can lessen the probability of CIN in patients at risk. But there are insufficient
data on oral fluids as a preventive strategy. Nephrotoxic drugs should be withdrawn
before contrast administration in patients at risk for CIN. No adjunctive medical
or mechanical treatment has been proved to be efficacious in reducing risk for CIN
including prophylactic hemodialysis and hemofiltration, N-acetylcysteine, fenoldopam,
dopamine, calcium channel blockers, atrial natriuretic peptide, and L-arginine. The
CIN Consensus Working Panel considered that, of the pharmacologic agents that have
been evaluated, theophylline, 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors
(statins), ascorbic acid, and prostaglandin E deserve further evaluation.
Keywords
Contrast-induced nephropathy - acute kidney injury - acute renal failure
