Contrast-Induced Nephropathy: A Review of Mechanisms and Risks.

Elham Shams,Harvey N Mayrovitz

doi:10.7759/cureus.14842

Abstract

Radiological procedures utilizing intravenous iodinated contrast agents are being widely utilized for both therapeutic and diagnostic purposes. This has resulted in an increasing incidence of procedure-related, contrast-induced nephropathy (CIN). CIN is commonly defined as a decline in kidney function occurring in a narrow time window after administration of iodinated contrast agents. Although self-limiting in most cases, CIN carries a risk of more permanent renal insufficiency, dialysis, and death. It remains a common and serious complication among at-risk patients after exposure of contrast agents. Therefore, it is important to identify patients who are at risk during early stages to implement preventative strategies to decrease the incidence of CIN. Minimizing the amount of contrast administered and providing adequate hydration are the cornerstones of an effective preventative approach. This review focuses on the basic concepts of CIN and summarizes the current understanding of its pathophysiology. In addition, it provides practical recommendations with respect to CIN prevention and management.

Highlights

BackgroundContrast media (CM) is given to patients before certain radiology imaging examinations to highlight features in the image to aid diagnosis
contrast-induced nephropathy (CIN) is a serious complication of angiographic procedures resulting from the administration of CM
It is possible that CIN is initiated soon after CM administration and that early and specific biomarkers could allow an early diagnosis of acute renal dysfunction (ARD) and hopefully improve the patients’ outcome

Summary

Introduction

Contrast media (CM) is given to patients before certain radiology imaging examinations to highlight features in the image to aid diagnosis. These include its use in computed tomography (CT) and magnetic resonance imaging (MRI). A complication associated with CM use is contrast-induced nephropathy (CIN) defined as a serious newonset complication or exacerbation of renal dysfunction after administration of CM [1]. Given the relationship between diabetes and its association with coronary disease, diabetic patients have become an important high-risk group for CIN [7]. We attempted to answer the following questions: (1) What is the current evidence that CIN remains clinically relevant and a dangerous condition for the patient? We attempted to answer the following questions: (1) What is the current evidence that CIN remains clinically relevant and a dangerous condition for the patient? (2) How do the physicochemical properties of CM play a role in CIN? (3) What is the evidence that periprocedural hydration is an effective, appropriate, and safe method to mitigate CIN?

Methods

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Disclosures