Abstract
Contrast-induced nephropathy (CIN) is an iatrogenic acute renal failure (ARF) occurring after the intravascular injection of iodinated radiographic contrast media. During the past several years, in many patients undergoing computed tomography, iodinated contrast media have not been used for the fear of ARF, thereby compromising the diagnostic procedure. But recent studies have demonstrated that CIN is rarely occurring in patients with normal renal function and that preexisting chronic renal failure and/or diabetes mellitus represent(s) predisposing condition(s) for its occurrence. After the description of CIN and its epidemiology and pathophysiology, underlying the important role played by dehydration and salt depletion, precautions for prevention of CIN are listed, suggested, and discussed. Maximum priority has to be given to adequate hydration and volume expansion prior to radiographic procedures. Other important precautions include the need for monitoring renal function before, during, and after contrast media injection, discontinuation of potentially nephrotoxic drugs, use of either iodixanol or iopamidol at the lowest dosage possible, and administration of antioxidants. A long list of references is provided that will enable readers a deep evaluation of the topic.
Highlights
Contrast-induced nephropathy (CIN), which is called contrast-induced acute kidney injury (CI-AKI), is an iatrogenic disease occurring after the intravascular injection of iodinated radiographic contrast media
Meinel et al [4] have recently underlined (a) that after modern iodinated radiographic media had been introduced in clinical practice they have been considered responsible for acute renal failure (ARF) [5], (b) that numerous subsequent noncontrolled observational studies appeared to confirm the causal role of contrast media for most cases of ARF following their intravascular administration [6], and (c) that, for many patients undergoing computed tomography (CT) iodinated contrast media have not been used for the fear of ARF, thereby compromising the diagnostic procedure [7]
In most cases it is a nonoliguric ARF with an asymptomatic transient decline in renal function, so that it may go undetected by those clinicians who do not check the renal function in the days following the contrast administration, as it is the case in nonhospitalized patients
Summary
Contrast-induced nephropathy (CIN), which is called contrast-induced acute kidney injury (CI-AKI), is an iatrogenic disease occurring after the intravascular injection of iodinated radiographic contrast media. The common opinion is that multiple myeloma per se cannot be considered a main risk factor for developing acute kidney injury following intravascular administration of iodinated contrast media [2]. Meinel et al [4] have recently underlined (a) that after modern iodinated radiographic media had been introduced in clinical practice they have been considered responsible for ARF [5], (b) that numerous subsequent noncontrolled observational studies appeared to confirm the causal role of contrast media for most cases of ARF following their intravascular administration [6], and (c) that, for many patients undergoing computed tomography (CT) iodinated contrast media have not been used for the fear of ARF, thereby compromising the diagnostic procedure [7]. The logical question that the clinicians ask themselves is whether CIN is still a clinical problem
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