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AKI and CIN: Real or Hype?

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Imaging in Nephrology

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Abstract

Nephrotoxicity of contrast media (CM) was considered a significant safety issue since the introduction of these agents. However recently a number of papers questioned or downgraded the risk of contrast-induced nephropathy (CIN), at least following intravenous contrast administration. These new data can substantially change the management of patients at risk for CIN. The Contrast Media Safety Committee (CMSC) of the European Society of Urogenital Radiology (ESUR) updated its guidelines on CIN in 2011 [1]. However these guidelines could be affected by the incoming new data. A personal critical appraisal to this topic will be provided.

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References

  1. Stacul F, Van Der Molen AJ, Reimer P, Webb JA, Thomsen HS, Morcos SK, Almen T, Aspelin P, Bellin MF, Clement O, Heinz-Peer G, Contrast Media Safety Committee of European Society of Urogenital, R. Contrast induced nephropathy: updated ESUR Contrast Media Safety Committee guidelines. Eur Radiol. 2011;21:2527–41.

    Article  Google Scholar 

  2. Davenport MS, Cohan RH, Khalatbari S, Ellis JH. The challenges in assessing contrast-induced nephropathy: where are we now? AJR Am J Roentgenol. 2014;202:784–9.

    Article  Google Scholar 

  3. Acute Kidney Injury Work Group, K. D. I. G. O. K. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2:1–138.

    Article  Google Scholar 

  4. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A, Acute Kidney Injury, N. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11:R31.

    Article  Google Scholar 

  5. Solomon R. Contrast-induced acute kidney injury: is there a risk after intravenous contrast? Clin J Am Soc Nephrol. 2008;3:1242–3.

    Article  Google Scholar 

  6. Dong M, Jiao Z, Liu T, Guo F, Li G. Effect of administration route on the renal safety of contrast agents: a meta-analysis of randomized controlled trials. J Nephrol. 2012;25:290–301.

    Article  CAS  Google Scholar 

  7. McCullough PA, Wolyn R, Rocher LL, et al. Acute renal failure after coronary intervention: incidence, risk factors, and relationship to mortality. Am J Med. 1997;103:368–75.

    Google Scholar 

  8. Katzberg RW, Lamba R. Contrast-induced nephropathy after intravenous administration: fact or fiction? Radiol Clin N Am. 2009;47:789–800.

    Article  Google Scholar 

  9. Nyman U, Almen T, Jacobsson B, Aspelin P. Are intravenous injections of contrast media really less nephrotoxic than intra-arterial injections? Eur Radiol. 2012;22:1366–71.

    Article  Google Scholar 

  10. McDonald RJ, McDonald JS, Bida JP, Carter RE, Fleming CJ, Misra S, Williamson EE, Kallmes DF. Intravenous contrast material-induced nephropathy: causal or coincident phenomenon? Radiology. 2013;267:106–18.

    Article  Google Scholar 

  11. McDonald JS, McDonald RJ, Comin J, Williamson EE, Katzberg RW, Murad MH, Kallmes DF. Frequency of acute kidney injury following intravenous contrast medium administration: a systematic review and meta-analysis. Radiology. 2013;267:119–28.

    Article  Google Scholar 

  12. McDonald RJ, McDonald JS, Carter RE, Hartman RP, Katzberg RW, Kallmes DF, Williamson EE. Intravenous contrast material exposure is not an independent risk factor for dialysis or mortality. Radiology. 2014;273:714–25.

    Article  Google Scholar 

  13. Davenport MS, Khalatbari S, Cohan RH, Dillman JR, Myles JD, Ellis JH. Contrast material-induced nephrotoxicity and intravenous low-osmolality iodinated contrast material: risk stratification by using estimated glomerular filtration rate. Radiology. 2013;268:719–28.

    Article  Google Scholar 

  14. McDonald RJ, McDonald JS, Newhouse JH, Davenport MS. Controversies in contrast material-induced acute kidney injury: closing in on the truth? Radiology. 2015;277:627–32.

    Article  Google Scholar 

  15. Herts BR, Schneider E, Poggio ED, Obuchowski NA, Baker ME. Identifying outpatients with renal insufficiency before contrast-enhanced CT by using estimated glomerular filtration rates versus serum creatinine levels. Radiology. 2008;248:106–13.

    Article  Google Scholar 

  16. Davenport MS, Cohan RH, Ellis JH. Contrast media controversies in 2015: imaging patients with renal impairment or risk of contrast reaction. AJR Am J Roentgenol. 2015;204:1174–81.

    Article  Google Scholar 

  17. McDonald JS, McDonald RJ, Williamson EE, Kallmes DF, Kashani K. Post-contrast acute kidney injury in intensive care unit patients: a propensity score-adjusted study. Intensive Care Med. 2017;43:774–84.

    Article  Google Scholar 

  18. Nyman U, Aspelin P, Jakobsen J, Bjork J. Controversies in contrast material-induced acute kidney injury: propensity score matching of patients with different dose/absolute glomerular filtration rate ratios. Radiology. 2015;277:633–7.

    Article  Google Scholar 

  19. Karlsberg RP, Dohad SY, Sheng R. Iodixanol peripheral computed tomographic angiography study investigator panel. Contrast medium-induced acute kidney injury: comparison of intravenous and intra-arterial administration of iodinated contrast medium. J Vasc Interv Radiol. 2011;22(8):1159–65.

    Article  Google Scholar 

  20. Kooiman J, Le Haen PA, Gezgin G, De Vries JP, Boersma D, Brulez HF, Sijpkens YW, Van Der Molen AJ, Cannegieter SC, Hamming JF, Huisman MV. Contrast-induced acute kidney injury and clinical outcomes after intra-arterial and intravenous contrast administration: risk comparison adjusted for patient characteristics by design. Am Heart J. 2013;165:793–9, 799.e1

    Article  Google Scholar 

  21. McDonald JS, Leake CB, McDonald RJ, Gulati R, Katzberg RW, Williamson EE, Kallmes DF. Acute kidney injury after intravenous versus intra-arterial contrast material administration in a paired cohort. Investig Radiol. 2016;51:804–9.

    Article  CAS  Google Scholar 

  22. Nijssen C, Rennenberg R, Nelemans P, Essers B, Janssen M, Vermeeren M, Vanommen V, Wildberger J. Prophylactic hydration to protect renal function from intravascular iodinated contrast material in patients at high risk of contrast-induced nephropathy (AMACING): a prospective, randomised, phase 3, controlled, open-label, non-inferiority trial. Lancet. 2017;389:1312–22.

    Article  Google Scholar 

  23. Bruce RJ, Djamali A, Shinki K, Michel SJ, Fine JP, Pozniak MA. Background fluctuation of kidney function versus contrast-induced nephrotoxicity. AJR Am J Roentgenol. 2009;192:711–8.

    Article  Google Scholar 

  24. Newhouse JH, Kho D, Rao QA, Starren J. Frequency of serum creatinine changes in the absence of iodinated contrast material: implications for studies of contrast nephrotoxicity. AJR Am J Roentgenol. 2008;191:376–82.

    Article  Google Scholar 

  25. Newhouse JH, Roychoudhury A. Quantitating contrast medium-induced nephropathy: controlling the controls. Radiology. 2013;267:4–8.

    Article  Google Scholar 

  26. Dunn RS, Gabuzda GM, Superdock KR, Kolecki RS, Schaedler RW, Simenhoff M. Induction of creatininase activity in chronic renal failure: Timing of creatinine degradation and effect of antibiotics. Am J Kidney Dis. 1997;29:72–7.

    Article  CAS  Google Scholar 

  27. Joffe M, Hsu CY, Feldman HI, Weir M, Landis JR, Hamm LL, Chronic Renal Insufficiency Cohort Study, G. Variability of creatinine measurements in clinical laboratories: results from the CRIC study. Am J Nephrol. 2010;31:426–34.

    Article  CAS  Google Scholar 

  28. Macedo E, Bouchard J, Soroko SH, Chertow GM, Himmelfarb J, Ikizler TA, Paganini EP, Mehta RL, Program to Improve Care in Acute Renal Disease, S. Fluid accumulation, recognition and staging of acute kidney injury in critically-ill patients. Crit Care. 2010;14:R82.

    Article  Google Scholar 

  29. Puzantian HV, Townsend RR. Understanding kidney function assessment: the basics and advances. J Am Assoc Nurse Pract. 2013;25:334–41.

    Article  Google Scholar 

  30. Van Slambrouck CM, Salem F, Meehan SM, Chang A. Bile cast nephropathy is a common pathologic finding for kidney injury associated with severe liver dysfunction. Kidney Int. 2013;84:192–7.

    Article  Google Scholar 

  31. Sharma A, Mucino MJ, Ronco C. Renal functional reserve and renal recovery after acute kidney injury. Nephron Clin Pract. 2014;127:94–100.

    Article  CAS  Google Scholar 

  32. Murray PT, Mehta RL, Shaw A, Ronco C, Endre Z, Kellum JA, Chawla LS, Cruz D, Ince C, Okusa MD, Workgroup, A. Potential use of biomarkers in acute kidney injury: report and summary of recommendations from the 10th Acute Dialysis Quality Initiative consensus conference. Kidney Int. 2014;85:513–21.

    Article  Google Scholar 

  33. Ronco C, Stacul F, McCullough PA. Subclinical acute kidney injury (AKI) due to iodine-based contrast media. Eur Radiol. 2013;23:319–23.

    Google Scholar 

  34. Fishman EK, Reddan D. What are radiologists doing to prevent contrast-induced nephropathy (CIN) compared with measures supported by current evidence? A survey of European radiologists on CIN associated with computed tomography. Acta Radiol. 2008;49:310–20.

    Article  CAS  Google Scholar 

  35. Thomsen HS, Stacul F. CIN: can we forget it? Acta Radiol. 2014;55:1027–30.

    Article  Google Scholar 

  36. WWW.ESUR.ORG. [Accessed].

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Authors and Affiliations

  1. Retired, S.C. Radiologia Ospedale Maggiore, Trieste, Italy

    Fulvio Stacul

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  1. Fulvio Stacul
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Editors and Affiliations

  1. Department of Nephrology and Dialysis, “Cannizzaro” Emergency Hospital, Catania, Italy

    Antonio Granata

  2. Department of Radiology, Cattinara Hospital, University of Trieste, Trieste, Italy

    Michele Bertolotto

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Stacul, F. (2021). AKI and CIN: Real or Hype?. In: Granata, A., Bertolotto, M. (eds) Imaging in Nephrology. Springer, Cham. https://doi.org/10.1007/978-3-030-60794-4_4

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  • DOI: https://doi.org/10.1007/978-3-030-60794-4_4

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-030-60794-4

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