Abstract
In the cognate nephrology literature, a few recent publications from major academic centers in the United States have suggested that the incidence of contrast nephropathy was exaggerated and overstated. These investigators have concluded that intravenous contrast material administration was not associated with an increased risk of acute kidney injury (AKI), emergent dialysis, and short-term mortality in a cohort of patients with diminished renal function. As a contrarian opinion, we first describe a clear cut case of contrast-nephropathy resulting in AKI requiring hemodialysis treatment managed in the Renal Unit of the Mayo Clinic Health System, Northwestern Wisconsin, in the Spring of 2017. We subsequently revisit the overwhelming evidence-base in the English literature that supports the enormous impact of contrast-nephropathy as a clinical syndrome. We finally posit that these recent repudiations of the existence and significance of contrast-nephropathy as a significant clinical entity represent an overreach in statistical expertise. There is no basis for a requiem song over contrast-nephropathy
Highlights
In the cognate nephrology literature, there has been a spate of publications suggesting that contrast nephropathy is an exaggerated and overstated reality (13)
We describe a clear cut case of contrast-nephropathy resulting in acute kidney injury (AKI) requiring hemodialysis treatment managed in the Renal Unit of the Mayo Clinic Health System, Northwestern Wisconsin, in the Spring of 2017, and subsequently revisit the overwhelming evidence in support of the enormous impact of contrastnephropathy as a clinical syndrome in the nephrology literature
This difference may have been due to greater renal vasoconstriction with intraarterial injections as well as the larger volume of contrast media employed during cardiac catheterization (12)
Summary
In the cognate nephrology literature, there has been a spate of publications suggesting that contrast nephropathy is an exaggerated and overstated reality (13). Case Report In the last week of March 2017, a 77-year-old type 2 diabetic Caucasian female patient with known ischemic heart disease, hypertension, previous myocardial fraction, 2-vessel coronary artery bypass procedure in 2006, previously stable CKD stage IIIB with serum creatinine of 1.43-1.67 mg/dL (eGFR = 30-36 mL/min/1.73 m2 BSA) between 2015 and 2017, atrial fibrillation on anticoagulation, biventricular congestive heart failure with severe right-sided heart failure, and severe tricuspid regurgitation presented to us with worsening renal failure (Figures 1 and 2) She had been evaluated the week prior to admission in our hospital at a tertiary health institution, for consideration for entry into a percutaneous tricuspid valve intervention study because she was otherwise a very high surgical risk. The working diagnosis was severe oliguric AKI on CKD secondary to contrast nephropathy associated with high anion gap metabolic acidosis, increasing hypervolemia, nausea, anorexia, fatigue and falling urine output She required initiation of renal replacement therapy and quickly consented to hemodialysis. 70 Journal of Nephropharmacology, Volume 7, Number 2, July 2018 http://www.jnephropharmacology.com
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