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European Radiology

, Volume 23, Issue 5, pp 1260–1263 | Cite as

Letter to the Editor re: Are intravenous injections of contrast media really less nephrotoxic than intra-arterial injections?

  • Piero StrattaEmail author
  • Cristina Izzo
  • Caterina Canavese
  • Marco Quaglia
Contrast Media

Abstract

In a recent paper, the authors oppose the opinion that “ intra-arterial administration of iodinated-based contrast media (CM) appears to pose a greater risk of contrast-induced nephropathy (CIN) than intravenous administration” . As nephrologists, we are happy to have the opportunity to offer our expertise in the setting of renal disease aimed at optimizing diagnostic algorithm and preventive strategies. Our comment relies on the fact that, from a nephrologist’s point of view, there is no doubt that renal damage following CM intra-venous administration in patients not in intensive care or emergency department and treated with conventional preventive strategies not only occurs with low frequency, but also appears of negligible clinical impact; it is confined to an asymptomatic increase of serum creatinine of 25% or 0.5 mg/dL lacking any prognostic negative impact, and in some case not significantly different from controls.

True CIN, just related to intravenous CM injection for diagnostic purpose, has to be differentiated from all the other cause of renal involvement in people stricken with sudden and acute illness also receiving intra-arterial CM injection, in order to avoid patients being denied necessary radiological examinations due to an inappropriate fear of risk.

Key Points

Contrast induced nephropathy (CIN) is not any nephropathy following contrast medium(CM).

CIN should only refer to renal damage strictly due to CM infusion.

True CIN following CM intravenous infusion is a clinically insignificant event.

Renal damage following intra-arterial CM infusion in compromised patients is not CIN.

Patients should not forego necessary radiological examinations for inappropriate understanding about risk.

Keywords

Contrast Medium Contrast Induce Nephropathy Femoral Access Prognostic Negative Impact Acute Kidney Failure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Nyman U, Almén T, Jacobsson B, Aspelin P (2012) Are intravenous injections of contrast media really less nephrotoxic than intra-arterial injections? Eur Radiol 22:1366–1371PubMedCrossRefGoogle Scholar
  2. 2.
    Katzberg RW, Lamba R (2009) Contrast-induced nephropathy after intravenous administration: fact or fiction? Radiol Clin North Am 47:789–800PubMedCrossRefGoogle Scholar
  3. 3.
    Katzberg RW, Newhouse JH (2010) Intravenous contrast medium-induced nephrotoxicity: is the medical risk really as great as we have come to believe? Radiology 256:21–28PubMedCrossRefGoogle Scholar
  4. 4.
    Canavese C, Morra F, Morellini V et al (2004) How can we be sure that renal dysfunction after coronary angiography is just explained by contrast nephropathy? Kidney Int 66:1717PubMedCrossRefGoogle Scholar
  5. 5.
    Stratta P, Bozzola C, Quaglia M (2012) Pitfall in nephrology: contrast nephropathy has to be differentiated from renal damage due to atheroembolic disease. J Nephrol 25:282–289PubMedCrossRefGoogle Scholar
  6. 6.
    Vuurmans T, Byrne J, Fretz E et al (2010) Chronic kidney injury in patients after cardiac catheterisation or percutaneous coronary intervention: a comparison of radial and femoral approaches (from the British Columbia Cardiac and Renal Registries). Heart 96:1538–1542PubMedCrossRefGoogle Scholar
  7. 7.
    Wu C, Liao D, Dyer AM et al (2011) The transradial approach is associated with lower risk of adverse outcomes following percutaneous coronary intervention: a single-center experience. J Invasive Cardiol 23:88–92PubMedGoogle Scholar
  8. 8.
    Weisz G, Leon MB (2010) Interventional cardiology: Hand me your radial artery to protect your kidney. Nat Rev Cardiol 7:674–675PubMedCrossRefGoogle Scholar
  9. 9.
    Stratta P, Bozzola C, Quaglia M (2012) Could radial instead of femoral access for coronary angiography change renal outcome? Nephrologists call for help. Am Heart J163:e19CrossRefGoogle Scholar
  10. 10.
    Perrin T, Descombes E, Cook S (2012) Contrast-induced nephropathy in invasive cardiology. Swiss Med Wkly 142:w13608PubMedGoogle Scholar
  11. 11.
    Balemans CE, Reichert LJ, van Schelven BI, van den Brand JA, Wetzels JF (2012) Epidemiology of contrast material-induced nephropathy in the era of hydration. Radiology 263:706–713PubMedCrossRefGoogle Scholar
  12. 12.
    Rashid AH, Brieva JL, Stokes B (2009) Incidence of contrast-induced nephropathy in intensive care patients undergoing computerised tomography and prevalence of risk factors. Anaesth Intensive Care 37:968–975PubMedGoogle Scholar
  13. 13.
    Bruce RJ, Djamali A, Shinki K et al (2009) Background fluctuation of kidney function versus contrast-induced nephrotoxicity. AJR Am J Roentgenol 192:711–718PubMedCrossRefGoogle Scholar
  14. 14.
    Murakami R, Hayashi H, Sugizaki KI et al (2012) Contrast-induced nephropathy in patients with renal insufficiency undergoing contrast-enhanced MDCT. Eur Radiol 22:2147-2152Google Scholar
  15. 15.
    Cely CM, Schein RM, Quartin AA (2012) Risk of contrast induced nephropathy in the critically ill: a prospective, case matched study. Crit Care 16:R67PubMedCrossRefGoogle Scholar
  16. 16.
    Josephson SA, Dillon WP, Smith WS (2005) Incidence of contrast nephropathy from cerebral CT angiography and CT perfusion imaging. Neurology 64:1805–1806PubMedCrossRefGoogle Scholar
  17. 17.
    Asif A, Cherla G, Merrill D et al (2005) Venous mapping using venography and the risk of radiocontrast-induced nephropathy. Semin Dial 18:239–242PubMedCrossRefGoogle Scholar
  18. 18.
    Ng CS, Shaw AD, Bell CS et al (2010) Effect of IV contrast medium on renal function in oncologic patients undergoing CT in ICU. AJR Am J Roentgenol 195:414–422PubMedCrossRefGoogle Scholar
  19. 19.
    Langner S, Stumpe S, Kirsch M et al (2008) No increased risk for contrast-induced nephropathy after multiple CT perfusion studies of the brain with a nonionic, dimeric, iso-osmolal contrast medium. AJNR Am J Neuroradiol 1525-9Google Scholar
  20. 20.
    Pahade JK, LeBedis CA, Raptopoulos VD et al (2011) Incidence of contrast-induced nephropathy in patients with multiple myeloma undergoing contrast-enhanced CT. AJR Am J Roentgenol 196:1094–1101PubMedCrossRefGoogle Scholar
  21. 21.
    Lufft V, Hoogestraat-Lufft L, Fels LM et al (2002) Contrast media nephropathy: intravenous CT angiography versus intraarterial digital subtraction angiography in renal artery stenosis: a prospective randomized trial. Am J Kidney Dis 40:236–242PubMedCrossRefGoogle Scholar
  22. 22.
    Baumgarten DA, Ellis JH (2008) Contrast-induced nephropathy: contrast material not required? AJR Am J Roentgenol 191:383–386PubMedCrossRefGoogle Scholar
  23. 23.
    Murphy SW, Barrett BJ, Parfrey PS (2000) Contrast nephropathy. J Am Soc Nephrol 11:177–182PubMedGoogle Scholar
  24. 24.
    Stratta P, Quaglia M, Airoldi A, Aime S (2012) Structure-function relationships of iodinated contrast media and risk of nephrotoxicity. Curr Med Chem 19:736–743PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2013

Authors and Affiliations

  • Piero Stratta
    • 1
    Email author
  • Cristina Izzo
    • 1
  • Caterina Canavese
    • 1
  • Marco Quaglia
    • 1
  1. 1.Department of Clinical and Experimental Medicine, Nephrology and Transplantation, & International Research Centre Autoimmune Disease (IRCAD)Maggiore Hospital of Novara, Amedeo Avogadro UniversityNovaraItaly

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