Contrast Media-induced Acute Renal Failure Research Articles

Effects of hypercholesterolemia on contrast media-induced nephrotoxicity in rats

To explore the effects of short- and long-term dietary hypercholesterolemia on contrast media-induced nephrotoxicity in rats. The male Wistar rats were fed either a normal rodent diet or a high cholesterol diet. At the end of 2 and 8 weeks, 8 rats from each group received a tail vein injection of either Iohexol injection (groups NC and HC) or vehicle (groups N and H). Blood lipid, renal function, renal hemodynamics, renal and urinary prostaglandin E2 (PGE2) and thromboxane B2 (TXB2), renal nitric oxide and malondialdehyde (MDA) were determined at Day 1 following the administration of contrast media. The dosing of contrast media induced obviously increased serum creatinine compared with normal rats ((185 ± 28) vs (53 ± 3) µmol/L, P < 0.01) and severe renal tubular necrosis in rats with a high cholesterol diet for 8 weeks but did not in normal-diet rats or rats with a high cholesterol diet for 2 weeks. The renal and urinary levels of PGE2 and TXB2 increased significantly in rats of groups H and HC at the end of 8 weeks. The renal production of nitric oxide decreased while the concentration of MDA increased markedly in groups HC and H at the end of 8 weeks. Long-term hypercholesterolemia appears to be a risk factor of contrast media-induced acute renal failure. And it may be associated with the disorder of intrarenal prostaglandins and the abnormality of renal nitric oxide system as induced by lipid peroxidation.

Arterial imaging in patients with lower extremity ischemia and diabetes mellitus

Precise, comprehensive imaging of the arterial circulation is the cornerstone of successful revascularization of the ischemic extremity in patients with diabetes mellitus. Arterial imaging is challenging in these patients because the disease is often multisegmental with a predilection for the distal tibial and peroneal arteries. Occlusive lesions and the arterial wall itself are often calcified and patients presenting with ischemic complications frequently have underlying renal insufficiency. Intra-arterial digital subtraction angiography (DSA), contrast enhanced magnetic resonance angiography (MRA), and more recently, computerized tomographic angiography (CTA) have been used as imaging modalities in lower extremity ischemia. Each has specific advantages and shortcomings in this patient population, which will be summarized and contrasted in this review. DSA is an invasive technique most often performed from a femoral arterial puncture and requires the injection of arterial contrast, which can occasionally cause allergic reactions. In patients with pre-existing renal insufficiency, contrast infusion can result in worsening renal failure; although usually self-limited, it may occasionally require hemodialysis, especially in patients with diabetes. However, DSA provides the highest degree of spatial resolution and image quality. It is also the only modality in which the diagnosis and treatment of arterial disease can be performed simultaneously. MRA is noninvasive, and when enhanced with gadolinium contrast injection provides arterial images of comparable quality to DSA and in some circumstances may uncover distal arterial targets not visualized on DSA. However, spatial resolution is inferior to DSA and erroneous interpretations due to acquisition artifacts are common. Specialized equipment and imaging techniques are necessary to minimize their occurrence in the distal lower extremity. In addition, due to the risk of inducing nephrogenic systemic fibrosis, gadolinium-enhanced MRA cannot be used in patients with renal insufficiency. CTA is noninvasive and rapidly performed, with better spatial resolution than MRA, but requires the largest volume of contrast infusion, exposes patients to high-doses of radiation, and is subject to interpretive error due to reconstruction artifacts especially in heavily calcified arteries, limiting its usefulness in many patients with diabetes. For patients in whom the planned intervention is a surgical bypass, DSA and MRA will provide high quality images of the lower extremity arterial anatomy. For patients in whom a catheter-based intervention is the likely treatment, a diagnostic DSA immediately followed by a catheter-based treatment in the same procedure is the preferred approach. In patients with pre-existing renal dysfunction, in which gadolinium-enhanced MRA is contraindicated, DSA or CTA can be performed. However, patients should have an infusion of intravenous normal saline solution or sodium bicarbonate before the procedure to reduce the incidence of contrast-induced nephropathy.

Severe renal vasoconstriction and anuria after intravenous urography in a patient with renal impairment

Acute renal failure caused by radiocontrast agents remains a severe problem, particularly in patients with risk factors. There is debate concerning the pathophysiology of contrast media-induced acute renal failure, including, but not limited to, renal ischemia or tubular damage. Vascular ischemia is considered a major contributor because consistent changes in renal hemodynamics have been recorded experimentally. We describe a patient who has a typical course of contrast-associated renal failure manifested by severe renal vasoconstriction and backflow of the contrast agent during renal angiography performed after 6 days of an intravenous urography. Such degree of renal vasoconstriction is noteworthy in that this particular case might serve as a model in delineation of the pathogenetic mechanisms of acute renal failure after contrast media administration.

Reliability of experimental models of iodinated contrast media-induced acute renal failure. From methodological considerations to pathophysiology.

Reliability of experimental models of iodinated contrast media-induced acute renal failure. From methodological considerations to pathophysiology.

Induction, prevention and mechanisms of contrast media-induced acute renal failure

This study describes the development of an experimental model of reversible acute renal failure following infusion of contrast media radiographic dye. Experiments were also performed to investigate possible methods of prevention as well as examine single nephron mechanisms involved in the pathogenesis of the renal failure. Acute renal failure was consistently produced by indomethacin treatment (18 mg/kg) and an intravenous infusion of contrast media (7 ml/kg) into New Zealand rabbits that had been on a low sodium diet for one week. Glomerular filtration rate (GFR), measured by daily creatinine clearance in unanesthetized animals, was significantly decreased (P less than 0.001) 24, 48, and 72 hours following infusion of the contrast dye. Two weeks after induction of acute renal failure, GFR had returned to control. GFR was unchanged during the same time period when the sodium deprived rabbits were given either indomethacin or contrast media alone. Chronic administration of DOCA (1 mg/kg s.c.) and saline drinking water which increased sodium and solute excretions and decreased plasma renin activity also prevented the decrease in GFR. However, acute infusion of either saline or mannitol, which transiently increased sodium and solute excretions and decreased plasma renin activity, did not protect against the development of acute renal failure. Light microscopy revealed no glomerular or tubular changes and no visible obstruction. Micropuncture experiments were performed on three additional groups of anesthetized rabbits: control, acute renal failure, and recovery. Recovery rabbits were allowed a two week period after renal failure before they were micropunctured.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Renal Failure After Enhanced Computed Tomography

Acute renal failure has been reported after the administration of a variety of radiographic contrast media. We treated a patient with preexisting renal insufficiency who received contrast media during computed tomography (CT) and had acute renal failure. The fractional excretion of sodium (FENa) was observed to be 0.2% before contrast media exposure and 3.5% after exposure. Patients with risk factors leading to contrast media-induced acute renal failure should be carefully screened before receiving enhanced CT.

Low risk of contrast media-induced acute renal failure in nonazotemic type 2 diabetes mellitus

The risk of developing contrast media-induced acute renal failure was studied in 49 randomly selected nonazotemic type 2 adult diabetic patients subjected to IVU. There were 19 men and 30 women in the group whose mean age was 62 +/- 10 years (range, 38 to 82 years). In preparation for IVU, patients were neither dehydrated nor given a laxative. The IVU was performed in the morning, using sodium diatrizoate and meglumine diatrizoate. Serum creatinine levels were measured pre-IVU and on days 1, 3, and 6 after the IVU. A total of three patients (6%) had an elevation of serum creatinine greater than 25% above the baseline by post-IVU day 3. One patient developed oliguria (less than 400 ml/24 hr) that lasted 2 days. Creatinine clearances of the three patients showing contrast media toxicity were 74, 60, and 105 ml/min pre-IVU. In each of the three patients, a return to pre-IVU serum creatinine concentration was noted within 2 weeks. It is concluded that the risk of acute renal failure post-IVU is small in hydrated nonazotemic type 2 diabetic patients.

Fractional Excretion of Sodium in Acute Renal Failure

<h3>To the Editor.</h3> —In the April 1980Archives(140;531-533), Fang et al underlined the low fractional excretion of sodium (FE_Na) values that they found in all 12 cases of contrast media-induced acute renal failure; they said this finding is characteristic of contrast media-induced acute renal failure. We would like to juxtapose our findings in an already presented prospective study.¹In this study, we found that in five of seven cases of acute renal failure caused by contrast media, the FE_Navalues fluctuated definitely above 1. In fact, in two of our patients, the FE_Navalues were 6.89 and 6.95, respectively. The two patients with FE_Navalues below 1 had less serious clinical features. The biochemical disturbances, on the other hand, lasted for only 24 hours. The only oliguric patient belonged to the group with high FE_Navalues, while all the rest of the patients

Low Fractional Excretion of Sodium With Contrast Media-Induced Acute Renal Failure

Risk factors, clinical courses, and urinary indices were examined in 12 consecutive patients with contrast media-induced acute renal failure. A high prevalence of preexisting renal disease, diabetes, vascular disease, and compromised cardiac output was observed. All patients had transient oliguria one to four days in duration, and all patients had return of renal function to their baseline values within five to ten days. Consistently low urinary sodium concentration and fractional excretion of sodium (FENa) were seen during the oliguric phase of the acute renal failure. Fractional excretion of sodium of less than 1% persisted for up to five days despite unequivocal renal function deterioration. The findings raise the possibility that acute renal failure secondary to contrast media may be mediated either by decreases in renal perfusion or by acute tubular obstruction.

Low fractional excretion of sodium with contrast media-induced acute renal failure

Low fractional excretion of sodium with contrast media-induced acute renal failure

Contrast Media-Induced Acute Renal Failure

RECENT reports have emphasized the risk of radiographic contrast-induced acute renal failure in diabetic nephropathy and have suggested an increasing incidence with a decreasing glomerular filtration rate.^1,2An absolute contraindication to intravenous pyelography has been proposed for diabetic patients whose serum creatinine level is greater than 5 mg/dl, with a relative contraindication in the presence of any degree of azotemia.²No safe cutoff in renal function or in contrast volume has yet been established. We report what we believe to be the first mortality due to intravenous pyelographic contrast media-induced renal failure in an elderly patient whose serum creatinine level would not ordinarily be sufficient to consider him at high risk for any further renal compromise. <h3>Report of a Case</h3> A 74-year-old man was admitted to the New England Deaconess Hospital on May 6, 1977, because of an inability to walk and weight loss. His past medical history