The major risk factor that predicts cin is preexisting chronic kidney disease. Hydration and contrastinduced kidney injury the lancet. Ppt post pci contrast induced nephropathy powerpoint presentation free to download id. This is an extreme presentation of a common iatrogenic problem. The contrast dye used at that time probably was poisonous 50% diodone, a highosmolar contrast dye which nobody would imagine using today.
Contrastinduced nephropathy following angiography and. Contrast induced acute kidney injury is a common iatrogenic complication associated with increased health resource utilization and adverse outcomes, including short and longterm mortality and accelerated progression of preexisting renal insufficiency. Contrast induced nephropathy cin is one of the most important complications of contrast media. Intravenous nacetylcysteine for prevention of contrast. It is a condition with impairment in renal function defined as an increase in scr by more than 25% within three days following intravenous. Nac reduces the occurrence of contrast induced nephropathy after nonionic contrast medium administration by half in high risk patients. Contrast induced nephropathy natural history, complications and prognosis in the news. The most common definition of ciaki is a rise of serum creatinine of 0. Risk for development of contrastinduced nephropathy cin according to cin risk score. The primary goal should be avoiding contrast media to prevent contrast induced nephropathy, if at all possible, and risk factors should be recognized. Contrast induced nephropathy david knesek eric muller goals contrast induced nephropathy david knesek eric muller goals identify pts at risk for contrast induced nephropathy discuss how to decrease the risk for those pts. The primary goal should be avoiding contrast media to prevent contrastinduced nephropathy, if at all possible, and risk factors should be recognized. Pentoxifylline for the prevention of contrastinduced. Contrast induced nephropathy cin has been extensively studied since the 1950s due, in part, to its devastating adverse events.
Ppt update in nephrology contrast induced nephropathy. Contrast induced nephropathy cin is common cause of hospital acquired renal failure, defined as iatrogenic deterioration of renal function following intravascular contrast administration in the absence of another nephrotoxic event. Contrastinduced nephropathy most commonly manifests as a nonoliguric and asymptomatic transient decline in renal function. Blogs on contrast induced nephropathy natural history, complications and prognosis. Contrast induced nephropathy slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Contrast induced nephropathy cin is a serious complication of angiographic procedures and results from administration of iodinated contrast media cm. Directions to hospitals treating contrast induced nephropathy. Contrast medium induced acute kidney injury ciaki is a serious complication of coronary angiography ca. Lack of a universal cin definition and varied glomerular filtration rate markers have. Use of intravenous iodinated contrast media in patients.
Contrastinduced nephropathy and dehydration allan j. Background contrast induced nephropathy cin is the third most common cause of hospitalacquired kidney injury and is related to increased longterm morbidity and mortality. Oral po hydration with water is inexpensive and readily available but its role for cin prevention is yet to be determined. Despite advancements in imaging and interventional techniques, iodinated contrast continues to pose a risk of contrastinduced acute kidney injury ciaki for a subgroup of patients at risk for this complication. Main results from the randomized acetylcysteine for contrast induced nephropathy trial. This has resulted in an increasing incidence of procedurerelated contrast induced nephropathy cin. Results from the pratoacs study protective effect of rosuvastatin and antiplatelet therapy on contrast induced acute kidney injury and myocardial damage in patients with acute coronary syndrome. Apr 01, 2014 contrast induced nephropathy is a common cause of acute renal functional impairment and accounts forsignificant morbidity and mortality. Contrast induced nephropathy cin is a specific type of kidney disease that is caused by a routine medical procedure.
Ppt contrast nephropathy powerpoint presentation free. The adobe flash plugin is needed to view this content. Ppt post pci contrast induced nephropathy powerpoint. In most cases, contrast induced nephropathy cin is characterized by an elevation of creatinine within 24 to 48 hours following exposure, reaching a peak within 3 to 5 days, followed by a return to baseline within 7 to 10 days. View or download all content the institution has subscribed to. Whether intravenous nacetylcysteine nac is beneficial for the prevention of contrast induced nephropathy is uncertain. Oliguric acute renal failure requiring hemodialysis. Contrastinduced nephropathy cin is most commonly defined as renal impairment or acute kidney injury occurring within 48 hr of administration of intravascular radiographic contrast material that is not attributable to other causes. In spite of the vast clinical importance of cin, its understanding and the pathophysiology behind cin remain incomplete. Cin was first described during the 1950s in case reports of. Contrast induced nephropathy cin describes an association between intravenous or intraarterial contrast administration and renal impairment, but increasingly the evidence shows that contrast is not the cause of the renal impairment and that confounding factors such as sepsis are likely to be responsible.
Contrast induced nephropathy cin is agenerally reversible form of acute kidney injury aki that occurs soon after the administration of radiocontrast media. Contrast induced nephropathy cin or contrast induced acute kidney injury ciaki is the third most common cause of acute renal injury in the hospital setting. Contrast induced acute kidney injury ciaki, also known as contrast induced nephropathy, is a frequent complication following angiographic procedures with significant impact on health care costs and a powerful predictor of unfavorable early and longterm outcomes. Contrastinduced acute kidney injury in the preserve trial. Update on contrast induced nephropathy an article from the ejournal of the esc council for cardiology practice vol. If so, share your ppt presentation slides online with. The prevention of contrastinduced aki ciaki has been a longstanding subject of much interest 11, with a recent pubmed search for contrast nephropathy clinical trial yielding 1700 references. Oliguria and need for dialysis are unusual and are primarily seen in patients with diabetes with severe chronic kidney disease. Despite the development of low and isoosmolar iodinated contrast material icm and the institution of hydration protocols, patients with chronic kidney disease ckd, especially those with concomitant diabetes, remain at risk for contrast induced nephropathy cin. The incidence of contrast induced nephropathy cin has been reported to range from 0% to 24%. Carstensen et al studied renal risks of intravenous iv iodine contrast for planned outpatient contrast computed tomography ct and focused on the listed risk factors in table 1 of their article. Contrastinduced nephropathy journal of vascular surgery.
Contrast induced nephropathy cin is a common cause of hospitalacquired acute renal failure. Contrastinduced nephropathy cin is a leading cause of hospitalacquired renal failure and affects mortality and morbidity. Update in nephrology contrast induced nephropathy, nephrogenic systemic fibrosis and acute phosphate nephropathy is the property of its rightful owner. We also search references from multiple articles to find additional studies on risk of aki in patients with ais undergoing cta or ctp. Contrast induced nephropathy in patients with chronic kidney disease undergoing computed tomography. Contrastinduced nephropathy cin is an increasingly common cause of iatrogenic acute kidney injury aki associated with increased health. Systematic oral hydration with water is similar to. Remove this presentation flag as inappropriate i dont like this i like this remember as a favorite.
It represents a significant health problem that causes the increase in mortality, morbidity, and medical costs. Early highdose rosuvastatin for contrast induced nephropathy prevention in acute coronary syndrome. Contrast induced nephropathy cin is a frequent complication of many radiological procedures involving the application of contrast media. Contrast nephropathy is an infrequent complication of angiographic procedures, but is much more common in highrisk patients. For the prevention of cin, a number of methods have been proposed to be effective. Contrast induced nephropathy cin represents an increasing healthcare burden and challenge as the frequency of diagnostic imaging and interventional studies increase, particularly among populations at risk of developing cin. Risk factors for contrast medium induced nephropathy patient related egfr less than 60 mlmin1. Contrastinduced nephropathy an overview sciencedirect topics. Radiological procedures utilizing intravascular iodinated contrast media injections are being widely applied for both diagnostic and therapeutic purposes. The present study was a randomized clinical trial, which was investigated the impact of ptx in the prevention of cin among 90 diabetic patients undergoing.
Contrastinduced nephropathy cin is a common cause of hospitalacquired acute renal failure. Clinical guidelines recommend prophylactic hydration to reduce the risk of contrast induced nephropathy in highrisk patients, including those with chronic kidney disease. Although the risk of renal function impairment associated with radiological procedures is. Apr 01, 20 such injury, termed contrast materialinduced nephropathy cin, is typically defined as an absolute or percentage increase in serum creatinine scr level over baseline. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Ischemic preconditioning for prevention of contrast medium. This definition is problematic because in most cases, exclusion of other. Cin is classically defined as a serum creatinine increase of at least 25% andor an absolute increase in serum creatinine of 0. Acute renal failure is a well known complication of procedures that involve iodinated contrast media. Contrast induced nephropathy cin is the 3rd most common cause of hospitalacquired acute renal failure. Contrast induced acute kidney injury or contrast induced nephropathy cin is a significant complication of intravascular contrast medium cm. Continue reading to learn more information about the causes, symptoms, and. The intellectual push for additional investigation into pathogenesis and prevention has heightened in recent years due to increased utilization of contrast enhanced imaging studies.
Contrast media cause acute kidney injury through two major mechanisms. Coronary angiography and percutaneous intervention rely on the use of iodinated intravascular contrast for vessel and chamber imaging. The use of contrast media in diagnostic procedures is a potential risk for the development of acute renal failure. Estelle nijssen and colleagues1 found that in patients at high risk for contrast induced nephropathy who had an elective procedure with contrast medium, contrast induced nephropathy occurred at similar rates whether the patients were treated before with intravenous saline or not.
Feb 21, 2020 contrastinduced nephropathy cin is defined as the impairment of renal function and is measured as either a 25% increase in serum creatinine scr from baseline or 0. Benefit of statin pretreatment in prevention of contrast. Ciaki is one of the leading causes of hospitalacquired acute renal failure, accounting for 12% of all cases, and is associated with considerable morbidity and mortality. Use of isoosmolar nonionic dimeric contrast media in multidetector row computed tomography angiography for patients with renal impairment. Contrastinduced nephropathy following angiography and cardiac. Contrastinduced nephropathy cin is a fairly common yet underrecognized clinical condition in the interventional cardiological practice.
Contrastinduced nephropathy cin is defined as renal hypofunction with an increase in the serum creatinine scr concentration of 25% or more, or by 44. In this metaanalysis of randomized controlled trials, we aimed to assess the efficacy of intravenous nac for preventing cin after. A widespread, rather general, definition of contrast induced nephropathy cin is an impairment in renal function occurring within 3 days following the intravascular administration of contrast media cm and the absence of an alternative aetiology. Clinical pharmacy and pharmacology research institute, the third xiangya hospital of central south university, changsha, hunan, china several models have been developed for prediction of contrast. The serum creatinine level begins to rise within 24 hr of contrast administration, usually peaks within 35 days, and returns to baseline within 1014 days 11, 17. Contrastinduced nephropathy in patients with chronic kidney disease undergoing computed tomography. Contrast induced nephropathy cin this slide deck was prepared by professor s k morcos. Contrastinduced nephropathy cin, usually defined as an increase in serum creatinine of 44 mol litre. Usually, contrast induced nephropathy develops within the first 2 to 3 days with a peak in serum creatinine level 3 to 5 days after contrast exposure. They found many patients at risk for contrast induced nephropathy cin. To reduce the occurrence of contrast induced nephropathy, assessment and. Contrast induced nephropathy cin is a form of kidney damage in which there has been recent exposure to medical imaging contrast material without another clear cause for the acute kidney injury. Adequate intravenous iv hydration has been demonstrated to lessen its occurrence.
Risk calculators and risk factors for contrast induced nephropathy natural history, complications and prognosis. Use of intravenous iodinated contrast media in patients with. However, the field has been hindered by underpowered studies with heterogeneous inclusion. Incidence and outcomes of contrastinduced nephropathy after. Contrastinduced nephropathy cin, also known as contrastinduced acute kidney injury, is an iatrogenic renal injury that follows. Sep 01, 2014 contrast induced nephropathy cin is agenerally reversible form of acute kidney injury aki that occurs soon after the administration of radiocontrast media. Although the incidence of cin is low, the number of patients receiving intravenous contrast media is enormous and is expected to rise as the population ages and greater numbers of patients will be subjected to diagnostic and therapeutic procedures. Sudden and rapid deterioration in kidney function occurs in some patients after the use of iodinated contrast medium, referred to as contrast induced nephropathy cin, if other alternative explanations do not exist.
Understanding and preventing contrastinduced acute kidney. Contrast induced nephropathy will occur in 2% to 25% of patients undergoing coronary intervention. The risk of contrast nephropathy is virtually zero, the cost of co 2 is extremely low, and there is no risk of contrast allergy, further enhancing the safety profile of this approach. Prevention of contrastinduced acute kidney injury by. While this has been linked to an increased risk of aki in some studies, the association remains controversial. Mar 09, 2016 14 contrast induced nephropathy is a sudden deterioration is renal function within 48 to 72 hours of contrast administration in patients without other attributable factors for renal insufficiency. Contrast alternatives for iodinated contrast allergy and. A simple risk score for prediction of contrastinduced nephropathy after percutaneous coronary intervention. These guidelines are intended as a practical approach to risk stratification and prevention. Contrast induced nephropathy is a serious condition in patients with stsegmentelevation myocardial infarction treated with primary percutaneous coronary intervention.
They concluded that renal risk factor assessment is indicated before ct. It occurs in % of nondiabetics, and in 20% of diabetics who received contrast. No trial to date has investigated the effect of nac on hard clinical end points such as in hospital morbidity rates. Contrast induced nephropathy with intravenous iodinated. Contrastinduced nephropathy radiology reference article. Contrast induced nephropathy cin is defined as impairment of renal function, an increase in serum creatinine levels by more than 25 percent or 0. Contrastinduced nephropathy cin is a form of kidney damage in which there has been recent exposure to medical imaging contrast material without another clear cause for the acute kidney injury. Contrastinduced nephropathy cin is a frequent and severe complication in subjects receiving iodinated contrast media for diagnostic or therapeutic purposes.
Contrastinduced nephropathy is a common cause of acute renal functional impairment and accounts forsignificant morbidity and mortality. Predictors, prevention, and management is the property of its rightful owner. Prevention of contrastinduced nephropathy with nak. Download figure open in new tab download powerpoint.
Background contrast induced nephropathy cin is one of the common causes of acute renal insufficiency after contrast procedures. Nonoliguric renal failure typically occurs within 2472 hours. Recently, however, the causal link between intravenous iodinated contrast material and nephrotoxicity has come under scrutiny based on several observations 6, 7. Canadian association of radiologists consensus guidelines for. The concept of contrast nephropathy was born in the 1950s, when it was observed that some patients developed renal failure following injection of iv contrast dye for intravenous pyelography.
A recent singlecenter randomized trial showed no significant difference in the incidence of contrast induced nephropathy in ambulatory patients with stage 3 chronic kidney disease who were randomized to no prophylactic. Contrast induced acute kidney injury ciaki occurs in up to 30% of patients who receive iodinated contrast media and is generally considered to be the third most common cause of. Teaching module v contrast induced nephropathy cin. Contrastinduced nephropathy circulation aha journals. How can this finding be reconciled with that of previous studies, which showed the benefit of volume expansion. Initial search terms were ais, stroke, cerebrovascular accident, aki, nephropathy, contrast induced nephropathy, and iodinated contrast. We aimed to evaluate the preventive effects of pentoxifylline ptx on cin in diabetic patients undergoing angioplasty using cystatin c. Kidney in cv disease acute renal failure contrast induced nephropathy cin postbypass arf cin is now the 3rd leading cause of inhospital arf cin in patients with pci poor procedural success longer hospital stay and increased mortality nash et al, am j kidney dis,2002. There has been interest for many years in the prevention of ciaki, and the preserve trial tested two interventions that have been common in clinical practice for many years. This has resulted in an increasing incidence of procedurerelated contrastinduced nephropathy cin.
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