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Wang W, Qu W, Sun D, Liu X. Meta-analysis of effect of renin-angiotensin-aldosterone system blockers on contrast-induced nephropathy. J Renin Angiotensin Aldosterone Syst 2020; 21:1470320320919587. [PMID: 32370685 PMCID: PMC7227145 DOI: 10.1177/1470320320919587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background: The purpose of this study was to systematically evaluate the effect of renin–angiotensin–aldosterone system blockers on the incidence of contrast-induced nephropathy in patients undergoing coronary angiography or percutaneous coronary intervention. Methods: A systematic literature search of several databases was conducted to identify studies that met the inclusion criteria. A total of 12 studies with 14 trials that performed studies on a total of 4864 patients (2484 treated with renin–angiotensin–aldosterone system blockers and 2380 in the control group) were included. The primary endpoint was the overall incidence of contrast-induced nephropathy. Analyses were performed with STATA version 12.0. Results: The overall contrast-induced nephropathy incidence in renin–angiotensin–aldosterone system blocker and control groups was 10.43% and 6.81%, respectively. The pooled relative risk of contrast-induced nephropathy incidence was 1.22 (95% confidence interval: 0.81–1.84) in the renin–angiotensin–aldosterone system blocker group. An increased risk of developing contrast-induced nephropathy in the renin–angiotensin–aldosterone system blocker group was observed among older people, non-Asians, chronic users, and studies with larger sample size, and the pooled RRs and 95% confidence intervals were 2.02 (1.21–3.36), 2.30 (1.41–3.76), 1.69 (1.10–2.59) and 1.83 (1.28–2.63), respectively. Conclusions: Intervention with renin–angiotensin–aldosterone system blockers was associated with an increased risk of contrast-induced nephropathy among non-Asians, chronic users, older people, and studies with larger sample size. Large clinical trials with strict inclusion criteria are needed to confirm our results and to evaluate the effect further.
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Affiliation(s)
- Weidong Wang
- Department of Nephrology, The First Hospital of China Medical University, People's Republic of China
| | - Wei Qu
- Department of Nephrology, The First Hospital of China Medical University, People's Republic of China
| | - Dan Sun
- Department of Nephrology, The First Hospital of China Medical University, People's Republic of China
| | - Xiaodan Liu
- Department of Nephrology, The First Hospital of China Medical University, People's Republic of China
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Factors affecting the incidence of contrast-induced nephropathy in patients undergoing computed tomography. RADIOLOGIA 2018. [DOI: 10.1016/j.rxeng.2018.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Heras Benito M, Garrido Blázquez M, Gómez Sanz Y, Bernardez Mardomingo M, Ruiz Cacho J, Rodríguez Recio FJ, Fernández-Reyes Luis MJ. Factors affecting the incidence of contrast-induced nephropathy in patients undergoing computed tomography. RADIOLOGIA 2018; 60:326-331. [PMID: 29779857 DOI: 10.1016/j.rx.2018.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/27/2018] [Accepted: 03/29/2018] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To analyze the incidence of contrast-induced nephropathy in a cohort of patients undergoing computed tomography (CT) with intravenous iodinated contrast material. To evaluate the efficacy of N-acetylcysteine in preventing contrast-induced nephropathy. PATIENTS AND METHODS This prospective observational study was carried out in the months comprising March 2016 through July 2016. We selected the first five patients scheduled to undergo CT examination each day who agreed to participate and signed the informed consent form. We recorded patients' cardiovascular histories, chronic treatments, and indications for the CT examination. We measured blood levels of creatinine and urea before and after the CT examination. We used the Modification of Diet in Renal Disease (MDRD-4) equation to estimate the glomerular filtration rate. We analyzed the type and dose of contrast material. We recorded whether N-acetylcysteine was administered before the CT examination. We used SPSS 15.0® to compare means and proportions. Statistical significance was set at p < 0.05. RESULTS No incidents of contrast-induced nephropathy were detected in any of the 202 patients included [mean age, 63.92 ± 12 years (range 22-87); 57.4% male; 21.8% diabetic; 39.6% hypertensive; 87.1% had MDRD4 ≥ 60 ml/min/1.73 m2 (89.45 ± 14, range 62.36-134.14) and 12.9% had MDRD4 < 60 ml/min/1.73 m2 (45.38 ± 11, range 9.16-58.90)]. The most common indication for CT examinations was oncologic (81.2%). The only contrast agent administered was iopamidol; the mean dose was 107.83 ± 11 ml (range 70-140). The mean interval between pre-CT and post-CT laboratory tests was 4.06 ± 1 days. Only 13 patients received N-acetylcysteine; 9 of these had MDRD < 60 ml/min/1.73 m2 and 4 had MDRD4 ≥ 60 ml/min/1.73 m2 (p = 0.000). CONCLUSIONS The incidence of contrast-induced nephropathy was not significant in patients with glomerular filtration rates greater than 30 ml/min/1.73 m2: these favorable results might be due to analyzing only scheduled examinations and to using relatively low doses of a "nonionic" iodinated contrast agent.
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Affiliation(s)
- M Heras Benito
- Servicio de Nefrología, Hospital General de Segovia, Segovia, España.
| | | | - Y Gómez Sanz
- Enfermería, Servicio de Radiología, Hospital General de Segovia, Segovia, España
| | | | - J Ruiz Cacho
- Servicio de Análisis Clínicos, Hospital General de Segovia, Segovia, España
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Interleukin 18 and neutrophil-gelatinase associated lipocalin in assessment of the risk of contrast-induced nephropathy in children. Cent Eur J Immunol 2016; 40:447-53. [PMID: 26862309 PMCID: PMC4737741 DOI: 10.5114/ceji.2015.56967] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 10/12/2015] [Indexed: 12/23/2022] Open
Abstract
The aim of the study was to determine the usefulness of interleukin 18 (IL-18) and neutrophil-gelatinase associated lipocalin (NGAL) in the risk assessment of contrast nephropathy in children. The study included patients among whom radiological examinations were performed using intravascular contrast agent. The material consisted of 33 children (19 girls, 14 boys) aged 6.37 ±5.41 years. 20/33 (61%) of patients had hydronephrosis, 9/33 (27%) had other urinary tract defects referred as “no hydronephrosis” and 4/33 (12%) had urolithiasis. NGAL determination was performed with the use of Human Lipocalin-2 / NGAL Immunoassay. To determine the concentration of human IL-18 an ELISA Kit (MBL International Corporation) was used. There were no statistically significant differences in the concentrations of NGAL and IL-18 in serum determined before the procedure, and after the administration of contrast agent. Concentrations of NGAL and IL-18 were determined in urine three times: before the procedure, 2-4 hours after administration of the contrast agent, and 48 hours after the performed procedure. The analysis showed that the concentration of IL-18 and NGAL in urine did not differ significantly in three consecutive preformed measurements. The study has also found no statistically significant differences between serum creatinine before and 48 hours after injection of contrast. Implementation of new biomarkers such as NGAL and IL-18 expands the possibilities of renal function assessment in children undergoing radiological procedures using contrast agents. In examined children with normal or slightly impaired renal function they did not demonstrate the risk of contrast nephropathy.
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Lee SY, Rhee CM, Leung AM, Braverman LE, Brent GA, Pearce EN. A review: Radiographic iodinated contrast media-induced thyroid dysfunction. J Clin Endocrinol Metab 2015; 100:376-83. [PMID: 25375985 PMCID: PMC4318903 DOI: 10.1210/jc.2014-3292] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 10/30/2014] [Indexed: 12/17/2022]
Abstract
CONTEXT Thyroid hormone production is dependent on adequate iodine intake. Excess iodine is generally well-tolerated, but thyroid dysfunction can occur in susceptible individuals after excess iodine exposure. Radiological iodinated contrast media represent an increasingly common source of excess iodine. OBJECTIVE This review will discuss the thyroidal response after acute exposure to excess iodine; contrast iodine-induced thyroid dysfunction; risks of iodine-induced thyroid dysfunction in vulnerable populations, such as the fetus, neonate, and patients with impaired renal function; and recommendations for the assessment and treatment of contrast iodine-induced thyroid dysfunction. METHODS Data for this review were identified by searching PubMed, Google Scholar, and references from relevant articles from 1948 to 2014. CONCLUSIONS With the increase in the use of computed tomography scans in the United States, there is increasing risk of contrast-induced thyroid dysfunction. Patients at risk of developing iodine-induced thyroid dysfunction should be closely monitored after receiving iodinated contrast media and should be treated as needed.
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Affiliation(s)
| | | | - Angela M. Leung
- Section of Endocrinology, Diabetes, and Nutrition (S.Y.L., L.E.B., E.N.P.), Boston University School of Medicine, Boston, Massachusetts 02118; Division of Nephrology and Hypertension (C.M.R.), Department of Medicine, University of California Irvine, Orange, California 92868; and Division of Endocrinology (A.M.L., G.A.B.), Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California 90095
| | - Lewis E. Braverman
- Section of Endocrinology, Diabetes, and Nutrition (S.Y.L., L.E.B., E.N.P.), Boston University School of Medicine, Boston, Massachusetts 02118; Division of Nephrology and Hypertension (C.M.R.), Department of Medicine, University of California Irvine, Orange, California 92868; and Division of Endocrinology (A.M.L., G.A.B.), Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California 90095
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Jones TE, Vasileff H, Hewton C. Should monitoring of vancomycin be delayed? A case of likely nephrotoxicity occasioned by morbid obesity and minimal monitoring. Br J Clin Pharmacol 2012; 74:1063-5. [DOI: 10.1111/j.1365-2125.2011.04006.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Mautone A, Brown JR. Contrast-induced nephropathy in patients undergoing elective and urgent procedures. J Interv Cardiol 2011; 23:78-85. [PMID: 20465721 DOI: 10.1111/j.1540-8183.2009.00523.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Contrast-induced nephropathy (CIN) is an acute and severe complication after contrast media administration. The most important step in preventing CIN is identifying high-risk patients. In this review, we evaluate and summarize the evidence regarding the CIN prophylaxis, including the withdrawal of the potentially nephrotoxic drugs, hydration by isotonic solution or NaHCO(3), pharmaceutical treatment with N-acetylcysteine (N-AC), adenosine antagonists, ascorbic acid, renal procedures including hemofiltration or dialysis, and to the optimal use of the contrast. We suggest it is possible to reduce the burden of CIN by carefully incorporating these recommendations. After review of published literature in this field, we conclude that the cornerstone of the CIN prevention should be combination of hydration (normal saline or NaHCO(3)) and the use of N-AC.
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Bickham P, Golembiewski J. Contrast Media Use in the Operating Room. J Perianesth Nurs 2010; 25:94-103. [DOI: 10.1016/j.jopan.2010.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Accepted: 01/22/2010] [Indexed: 11/17/2022]
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Alexopoulos E, Spargias K, Kyrzopoulos S, Manginas A, Pavlides G, Voudris V, Lerakis S, McLean DS, Cokkinos DV. Contrast-induced acute kidney injury in patients with renal dysfunction undergoing a coronary procedure and receiving non-ionic low-osmolar versus iso-osmolar contrast media. Am J Med Sci 2010; 339:25-30. [PMID: 19996728 DOI: 10.1097/maj.0b013e3181c06e70] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Although the superiority of low-osmolar over high-osmolar contrast agents in prevention of contrast-induced acute kidney injury (CI-AKI) is generally accepted, the relative nephrotoxicity of iso-osmolar over low-osmolar agents has not yet clearly defined. We examined the incidence of CI-AKI according to the type of contrast agent used in a randomized study of ascorbic acid for CI-AKI prevention. METHODS A total of 222 patients with baseline serum creatinine >or=1.2 mg/dL who were undergoing a coronary procedure and who were randomized to receive ascorbic acid or placebo were evaluated. The iso-osmolar agent iodixanol was used in 144 patients, whereas low-osmolar non-ionic agents were used in 78 patients (iomeprol, n = 40; iobitridol, n = 30; iopentol, n = 8). CI-AKI was defined by an absolute serum creatinine increase of >or=0.5 mg/dL or a relative increase of >or=25% measured 2 to 5 days after the procedure. RESULTS The groups of patients who received iso-osmolar and low-osmolar non-ionic agents were well balanced in terms of demographic, clinical, and procedural characteristics. The overall CI-AKI incidence was 14.6% for the iso-osmolar iodixanol versus 14.1% for the combined low-osmolar non-ionic agents (iomeprol, 10%; iobitridol, 10%; iopentol, 50%). For iodixanol, the incidence of CI-AKI was 7.4% for patients randomized to receive ascorbic acid and 21.6% for placebo (P = 0.02). The corresponding incidences for the low-osmolar non-ionic agents were 9.1% and 20.6%, respectively (P = 0.19). CONCLUSION No differences in CI-AKI incidence were apparent among patients receiving non-ionic iso-osmolar iodixanol and non-ionic low-osmolar contrast agents. The preventative effect of ascorbic acid was also similar.
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Affiliation(s)
- Elias Alexopoulos
- Department of Cardiology, Onassis Cardiac Surgery Centre, Athens, Greece
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MAUTONE ALESSANDRO, BROWN JEREMIAHR. Contrast-Induced Nephropathy in Patients Undergoing Elective and Urgent Procedures. J Interv Cardiol 2010. [DOI: 10.1111/j.1540-8183.2010.00523.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Feasibility of post-gadolinium three-dimensional gradient-echo sequence to evaluate the pulmonary arterial vasculature. Magn Reson Imaging 2009; 27:1198-207. [DOI: 10.1016/j.mri.2009.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2008] [Revised: 03/19/2009] [Accepted: 05/07/2009] [Indexed: 11/22/2022]
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Altun E, Semelka RC, Cakit C. Nephrogenic systemic fibrosis and management of high-risk patients. Acad Radiol 2009; 16:897-905. [PMID: 19375360 DOI: 10.1016/j.acra.2009.01.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2008] [Revised: 12/31/2008] [Accepted: 01/02/2009] [Indexed: 01/01/2023]
Abstract
The purpose of this work is to provide current information on the rapidly evolving subject of nephrogenic systemic fibrosis (NSF), to establish the radiologic approach to the management of high-risk patients for NSF, and to assess the probabilistic risk of NSF compared to contrast induced nephropathy (CIN), as encountered with iodinated contrast media used in computed tomographic (CT) imaging. NSF is a disease process of considerable concern following gadolinium-containing contrast agents (GCCA) exposure in patients with diminished renal function. To minimize the possibility of NSF development in high-risk patients, GGCAs should not be used when they are not necessary, or the GCCAs, that have not at present been associated with NSF development, should be used at the lowest possible diagnostic dose, when they are necessary. Contrast-induced nephropathy is also a great risk in this patient population following the adminstration of iodinated contrast media (CM). In patients with diminished renal function who are not on regular dialysis, the risk of CIN following the administration of iodinated CM is higher than the risk of NSF following the administration of the most stable GCCAs. Risk benefit analysis should be performed prior to the administration of all CM, and the best combination of safety and diagnostic accuracy should be sought. Concern of NSF or CIN should not prevent the use of contrast agents in magnetic resonance imaging or computed tomography when they are deemed essential.
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Affiliation(s)
- Ersan Altun
- Department of Radiology, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC 27599, USA.
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Solomon R. Preventing contrast-induced nephropathy: problems, challenges and future directions. BMC Med 2009; 7:24. [PMID: 19439063 PMCID: PMC2684869 DOI: 10.1186/1741-7015-7-24] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2009] [Accepted: 05/13/2009] [Indexed: 12/17/2022] Open
Abstract
Contrast-induced nephropathy is an injury to the kidney occurring as a result of exposure to intravascular contrast media. It results in both short- and long-term adverse events including mortality. Since treatment of the injury after it has occurred is ineffective, efforts to prevent the injury are the focus of investigators and clinicians alike. In this commentary, the pathogenesis and clinical relevance of contrast-induced nephropathy are reviewed. Prophylactic strategies are discussed with a focus on the use of meta-analysis of small single-center trials.
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Affiliation(s)
- Richard Solomon
- University of Vermont College of Medicine, Burlington, VT 05405-0068, USA.
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N-Acetylcysteine Use to Prevent Contrast Medium–induced Nephropathy: Premature Phase III Trials. J Vasc Interv Radiol 2008; 19:309-18. [DOI: 10.1016/j.jvir.2007.11.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Revised: 10/31/2007] [Accepted: 11/01/2007] [Indexed: 11/20/2022] Open
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Abstract
Contrast-induced nephropathy (CIN) is a well-known complication of therapeutic and diagnostic procedures requiring contrast administration and accounts for 10% of acute renal failure in hospitalized patients. Although the incidence of this complication is relatively low, its consequences can be catastrophic. The development of CIN is associated with increased length of hospital stay, an increased requirement for acute dialysis, and an increased risk of death. Preexisting renal dysfunction, age, diabetes, congestive heart failure, and volume of administered contrast are all associated with a risk of developing CIN. Despite a large number of clinical trials that have evaluated prophylaxis strategies for CIN, no uniform strategies have been developed so far. The use of N-acetyl-L-cysteine (NAC) or theophylline in specific subgroups of patients has been shown to reduce dialysis requirement and mortality in patients undergoing angiographic procedures. Hemofiltration has also shown positive results. In this review we will discuss the epidemiology and the risk factors for CIN and the evidence for commonly employed prophylaxis strategies, and we will provide general recommendations with respect to CIN prevention and management.A practicable strategy to prevent CIN includes: correct identification of individuals at greatest risk, thorough evaluation of whether other diagnostic maneuvers could be employed instead (i.e., sonography), application of low-osmolar contrast media at the minimum acceptable dose, stopping potential nephrotoxic drugs (NSAID), hydration with sodium chloride 0.9% 1 ml/kg per h i.v. 12 h before and after CM application, administration of acetylcysteine 600 mg twice the day before and after (in cases of emergency investigation and high-risk patients 1200 mg i.v.), and theophylline (250-350 mg) the day before and the day after CM application (in cases of emergency investigation 5 mg/kg i.v.).
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Affiliation(s)
- C Erley
- St. Joseph-Krankenhaus Berlin, Bäumerplan 24, 12101 Berlin, Deutschland.
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von Tengg-Kobligk H, Böckler D, Jose TM, Ganten M, Kotelis D, Nagel S, Giesel FL, Kirchin MA, Delorme S, Schumacher H, Allenberg JR, Kauczor HU. Feeding Arteries of the Spinal Cord at CT Angiography Before and After Thoracic Aortic Endografting. J Endovasc Ther 2007. [DOI: 10.1583/1545-1550(2007)14[639:faotsc]2.0.co;2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
PURPOSE OF REVIEW The present review covers the European Society of Urogenital Radiology guidelines for safe use of contrast media of importance for referring urologists. RECENT FINDINGS During the recent years contrast medium-induced nephropathy has become a hot topic. It is of importance to reduce its incidence. First of all, the patients at risk should be identified prior to the administration of a contrast medium, so that appropriate measures can be taken. Before intravenous administration of an iodinated agent but not before gadolinium-based and ultrasound agents, all patients should be questioned about the potential renal dysfunction at the time of referral, and only those who answer affirmative to at least one question should have their serum creatinine level determined. Before intraarterial injection, the serum creatinine should always be measured. In case of an abnormal level, another imaging procedure should be considered. If impossible, hydration should be instituted and administration of nephrotoxic drugs should be stopped. After administration, delayed reactions such as nephrogenic systemic fibrosis, thyreotoxicosis, skin rash, etc. may be seen. Interaction with isotope studies and biochemical analysis occurs too. SUMMARY The awareness regarding the potential adverse reactions due to contrast media and the necessary precautions to be taken are of utmost importance both for radiologists and referring physicians. This is the only way to reduce their incidence.
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Affiliation(s)
- Henrik S Thomsen
- Department of Diagnostic Radiology, Copenhagen University Hospital at Herlev, Herlev, Denmark.
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