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
- Renal atheroembolism (with intraarterial contrast)
- Ischemic acute tubular necrosis
- Acute interstitial nephritis
- Prerenal changes related to medication adjustments
- Other causes of acute kidney injury
Management
- Managed similarly for all AKI
- Stop nephrotoxic medications such as aminoglycosides, vancomycin, non-steroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers
- Optimize hemodynamics and volume status
- Closely monitor kidney function and fluid balance
- Avoid hyperglycemia
- Avoid further exposure to contrast agents
- Avoid gelatins, colloids, and chloride-rich solutions
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
- ^ 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.
- ^ 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.