Contrast-associated acute kidney injury

From IDWiki

Background

  • Risk based on eGFR1
    • eGFR >45 mL/min: 2%
    • eGFR <60 mL/min: 5%

Clinical Manifestations

  • Presents with AKI following administration of CT contrast dye, usually non-oliguric
  • Increase in serum creatinine usually seen 24 to 48 hours after infusion
  • Urine microscopy may show findings of acute tubular necrosis with muddy brown casts, epithelial casts, and free renal tubular epithelial cells

Prognosis

  • Usually only causes mild AKI that generally starts to recover within 3 to 7 days, with eventual return to baseline renal function
  • Rarely progresses to dialysis

Differential Diagnosis

Management

Prevention

  • Prophylaxis with preinfusion of saline is common but the only RCT to date showed no benefit2
  • The evidence in favour of N-acetylcysteine is similarly poor

Further Reading

  • Contrast-associated acute kidney injury: does it really exist, and if so, what to do about it? F1000Res. 2019;8:F1000 Faculty Rev-753. doi: 10.12688/f1000research.16347.1

References

  1. ^  Richard Solomon. Contrast-Induced Acute Kidney Injury: Is There a Risk after Intravenous Contrast?. Clinical Journal of the American Society of Nephrology. 2008;3(5):1242-1243. doi:10.2215/cjn.03470708.
  2. ^  Wim Vandenberghe, Eric Hoste. Contrast-associated acute kidney injury: does it really exist, and if so, what to do about it?. F1000Research. 2019;8:753. doi:10.12688/f1000research.16347.1.