Contrast Induce NephropathyCollage Of Medicine Al-Qadisiya University IraqDone By :- Ziyad SalihIndex :IntroductionDefinitionEpidemiologyPathophysiologyRisk markersRisk scoreContrast agents Management
INTRODUCTIONCIN (CI -AKI ) its a leading cause of acute kidney injury in hospitalized patients.Most frequent renal complication of endovascular interventional procedures.Increases short and long term morbidity and mortality.Treatment is limited to supportive measures while awaiting the resolution of renal impairement
QUESTIONS IN MINDHow CIN occurs ?What is the definition of CIN ?Are contrast agents directly nephrotoxic ?How can it be prevented ?Will CIN be never having an effective treatment ?
Historical view about contrastIn 1906,Von Lichtenberg and Voelcker used 2% colloidal silver solution,for retrograde pyelography studies.(toxic to kidneys,death).In 1920, Osborne and colleagues ,10% NaI for Rx of syphilis, fortuiously found it to be radiopaque ,excreted by kidneys.--first pyelogram.1924,Brooks first angiogram (under GA).
Definition CI-AKI is defined by the Kidney Disease Global Outcomes (KDIGO) guidelines as an :- increase in serum creatinine of 0.5 mg/dL or greater within 48 hours of contrast use or a 25% or greater increase from baseline serum creatinine within 7 days.The serum creatinine usually increases within 24 -48hrs after contrast administration, peaks at 3 to 5 days,and returns to baseline in 1 -3 weeks.
EpidemiologyAccording to the US FDA, the incidence of renal failure after contrast administration ,ranged from 0.6%to2.3%.However, rates of CIN maybe as high as 50%, depending on the presence of well characterized risk factors, the most important of which are baseline chronic renal insufficiency and DM.Risk Factors Systolic blood pressure 75 y - 4 points Hematocrit level 60 ml/min Moderate Risk: GFR 30-59 ml/min High Risk: GFR < 30ml/min
Pathophysiology Not well understood until now , but there's theoretical explanation :- 1- tubular toxicity 2- microvascular alteration 3- oxidative stress 4- inflammation 5- protein precipitation 6- Regional Hypoxia Pathophysiology
Important considerations in choosing a contrast agentIts an important factor is to choose the appropriate contrast media depending on its harmful or beneficial effect
Types Of Contrast MediaA decreased incidence of contrast nephropathy appears to be associated with nonionic agents ,which, are either low osmolal or iso-osmolal SOLUBILITY Classified into ionic and nonionic groups based on water solubility.OSMOLALITY ( High Iso Low )VISCOSITY ( High Low )How could hyperosmolality cause nephropathy ?
How could hyperosmolality cause nephropathy ?
Types Of Contrast MediaSo, recommended to use of either Isosmolar or Low Osmolar iodinated contrast media, rather than High Osmolar iodinated contrast media in patients at increased risk of CI-AKI.Why we use Iso-Osmolar ?ISOSMOLAR Iodinated contrast media is recommended for the following groups of patients:All high risk patients (eGFR