A significant consequence of angiographic procedures caused by the administration of contrast media is contrast-induced nephropathy. It accounts for roughly 12% of cases and is the third most frequent cause of acute renal damage acquired in hospitals. A rise in serum creatinine of more than 25% or 0.5 mg/dl (44 mol/l) from baseline within 48 hours is referred to be contrast-induced nephropathy.
A sudden decline in kidney function during a 48–72-hour period is linked to contrast-induced nephropathy with signs similar to renal illness include :
Increased tiredness
An inability to eat.
Swelling in the feet and ankles
Puffiness around the eyes
Dry, itchy skin
Contrast-induced nephropathy is frequently reversible, and patients can recover. However, it can occasionally result in more severe renal issues as well as potential heart and blood vessel issues. If you have any of these symptoms visit a Nephrologist to be diagnosed and treated properly.
Contrast-induced nephropathy risk factors are classified as patient-related, procedure-related, and contrast-related (although the risk variables are still being identified and remain poorly understood) :
Patient-related risk factors include :
Age
Chronic kidney disease
Diabetes mellitus
Hypertension
Metabolic syndrome
Anemia
Multiple myeloma
Hypoalbuminemia
Kidney transplant
Hypovolemia and decreased effective circulating volumes.
Procedure-related risk factors include :
Urgent versus elective
Arterial versus venous
Diagnostic versus therapeutic
Contrast-related risk factors include :
Volume of contrast
Contrast characteristics, including osmolarity, ionicity, molecular structure, and viscosity
The tests listed below can help in Contrast-induced nephropathy diagnosis and evaluation:
Blood tests :
Serum creatinine
Serum cystatin C
Fractional excretion of sodium (FENa)
Urine analysis :
Renal tubular epithelial cells
Pigmented granular casts.
Urate crystals
Debris
Urine osmolality
Kidney biopsy to look for cell vacuolization, interstitial inflammation, and cellular necrosis
Contrast Induced Nephropathy has no known cure, but over time, symptoms might become better. Although new treatments are showing encouraging outcomes, prevention is still essential.
New treatments include :
Sodium bicarbonate
N-acetylcysteine (NAC)
Statins
Ascorbic acid
The adenosine antagonists (theophylline and aminophylline)
Vasodilators
Forced diuresis.
Renal replacement therapy
Prostaglandin E1.
Prevention strategies include :
Hydration Therapy, preventing volume depletion.
Use of concurrent diuretics or nephrotoxins, such as cytotoxic medications, aminoglycosides, and NSAIDs, should be avoided.
Reduce the volume of Contrast media.
Prevent activation of renal vasoconstriction.
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