Contrast Medium-induced Nephropathy. Aspects on Incidence; Consequences; Risk Factors; and Prevention

ABSTRACT

"Contrast media-induced nephropathy (CIN) is a well-known complication of radiological examinations employing iodine contrast media (I-CM). The rapid development and frequent use of coronary interventions and multi-channel detector computed tomography with concomitant administration of relatively large doses of I-CM has contributed to an increasing number of CIN cases during the last few years. Reduced renal function; especially when caused by diabetic nephropathy or renal arteriosclerosis; in combination with dehydration; congestive heart failure; hypotension; and administration of nephrotoxic drugs are risk factors for the development of CIN. When CM-based examinations cannot be replaced by other techniques in patients at risk of CIN; focus should be directed towards analysis of number and type of risk factors; adequate estimation of GFR; institution of proper preventive measures including hydration and post-procedural observation combined with surveillance of serum creatinine for 1-3 days. For the radiologist; there are several steps to consider in order to minimise the risk for CIN use of ""low-"" or ""iso-osmolar"" I-CM and dosing the I-CM in relation to GFR and body weight being the most important as well as utilizing radiographic techniques to keep the I-CM dose in gram iodine as low as possible below the numerical value of estimated GFR. There is as yet no pharmacological prevention that has been proven to be effective."