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Semin intervent Radiol 2021; 38(01): 139-143
DOI: 10.1055/s-0041-1724016
Morbidity & Mortality

Postcontrast Acute Kidney Injury After Transarterial Chemoembolization

Ali Kord
1   Division of Interventional Radiology, Department of Radiology, University of Illinois College of Medicine, Chicago, Illinois
,
Simon J. Park
1   Division of Interventional Radiology, Department of Radiology, University of Illinois College of Medicine, Chicago, Illinois
,
Amith Rao
1   Division of Interventional Radiology, Department of Radiology, University of Illinois College of Medicine, Chicago, Illinois
,
Atul Eppurath
1   Division of Interventional Radiology, Department of Radiology, University of Illinois College of Medicine, Chicago, Illinois
,
Andrew Lipnik
1   Division of Interventional Radiology, Department of Radiology, University of Illinois College of Medicine, Chicago, Illinois
,
Charles E. Ray
1   Division of Interventional Radiology, Department of Radiology, University of Illinois College of Medicine, Chicago, Illinois
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Intravascular (IV) administration of contrast media (CM) is commonly utilized to enhance the capabilities of imaging modalities commonplace in both diagnostic and therapeutic interventions. There are numerous iatrogenic reactions associated with CM administration that have been described in literature,[1] broadly categorized as allergic and nonallergic. Postcontrast acute kidney injury (PC-AKI) is a subset of nonallergic CM reactions and is especially important in patients with an underlying medical condition such as chronic kidney disease (CKD). This may be exacerbated by IV administration of CM during long interventional procedures such as angiography. In this article, a case of PC-AKI is presented followed by a discussion of the topic. In addition, guidelines for prevention and treatment of PC-AKI are presented.



Publication History

Article published online:
15 April 2021

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  • References

  • 1 American Board of Radiology. Noninterpretive Skills. 2020: 23-29 . Accessed September 15, 2020 at: https://www.theabr.org/wp-content/uploads/2020/02/NIS-Study-Guide-2020.pdf
    PubMedGoogle Scholar
  • 2 Stacul F, van der Molen AJ, Reimer P. et al; Contrast Media Safety Committee of European Society of Urogenital Radiology (ESUR). Contrast induced nephropathy: updated ESUR Contrast Media Safety Committee guidelines. Eur Radiol 2011; 21 (12) 2527-2541
    CrossrefPubMedGoogle Scholar
  • 3 ACR Committee on Drugs and Contrast Media. ACR Manual on Contrast Media: ACR. 2020: 33-45 . Accessed September 15, 2020 at: https://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast_Media.pdf
    PubMedGoogle Scholar
  • 4 The Kidney Disease: Improving Global Outcomes. KDIGO Clinical Practice Guideline for acute kidney injury. Kidney Int 2012; 2: 1-113
    PubMedGoogle Scholar
  • 5 van der Molen AJ, Reimer P, Dekkers IA. et al. Post-contrast acute kidney injury - Part 1: Definition, clinical features, incidence, role of contrast medium and risk factors: recommendations for updated ESUR Contrast Medium Safety Committee guidelines. Eur Radiol 2018; 28 (07) 2845-2855
    CrossrefPubMedGoogle Scholar
  • 6 Davenport MS, Perazella MA, Yee J. et al. Use of intravenous iodinated contrast media in patients with kidney disease: consensus statements from the American College of Radiology and the National Kidney Foundation. Radiology 2020; 294 (03) 660-668
    CrossrefPubMedGoogle Scholar
  • 7 Sendeski MM. Pathophysiology of renal tissue damage by iodinated contrast media. Clin Exp Pharmacol Physiol 2011; 38 (05) 292-299
    CrossrefPubMedGoogle Scholar
  • 8 Andreucci M, Faga T, Pisani A, Sabbatini M, Michael A. Acute kidney injury by radiographic contrast media: pathogenesis and prevention. BioMed Res Int 2014; 2014: 362725
    PubMedGoogle Scholar
  • 9 Detrenis S, Meschi M, Musini S, Savazzi G. Lights and shadows on the pathogenesis of contrast-induced nephropathy: state of the art. Nephrol Dial Transplant 2005; 20 (08) 1542-1550
    CrossrefPubMedGoogle Scholar
  • 10 Andreucci M, Solomon R, Tasanarong A. Side effects of radiographic contrast media: pathogenesis, risk factors, and prevention. BioMed Res Int 2014; 2014: 741018
    PubMedGoogle Scholar
  • 11 Kohan DE, Inscho EW, Wesson D, Pollock DM. Physiology of endothelin and the kidney. Compr Physiol 2011; 1 (02) 883-919
    CrossrefPubMedGoogle Scholar
  • 12 Margulies KB, Hildebrand FL, Heublein DM, Burnett Jr JC. Radiocontrast increases plasma and urinary endothelin. J Am Soc Nephrol 1991; 2 (05) 1041-1045
    CrossrefPubMedGoogle Scholar
  • 13 Ulas T, Buyukhatipoglu H, Dal MS. et al. Urotensin-II and endothelin-I levels after contrast media administration in patients undergoing percutaneous coronary interventions. J Res Med Sci 2013; 18 (03) 205-209
    PubMedGoogle Scholar
  • 14 Heyman SN, Rosenberger C, Rosen S, Khamaisi M. Why is diabetes mellitus a risk factor for contrast-induced nephropathy?. BioMed Res Int 2013; 2013: 123589
    CrossrefPubMedGoogle Scholar
  • 15 Kalani M. The importance of endothelin-1 for microvascular dysfunction in diabetes. Vasc Health Risk Manag 2008; 4 (05) 1061-1068
    CrossrefPubMedGoogle Scholar
  • 16 Lee J. Nitric oxide in the kidney: its physiological role and pathophysiological implications. Electrolyte Blood Press 2008; 6 (01) 27-34
    CrossrefPubMedGoogle Scholar
  • 17 Ozkok S, Ozkok A. Contrast-induced acute kidney injury: a review of practical points. World J Nephrol 2017; 6 (03) 86-99
    CrossrefPubMedGoogle Scholar
  • 18 Persson PB, Hansell P, Liss P. Pathophysiology of contrast medium-induced nephropathy. Kidney Int 2005; 68 (01) 14-22
    CrossrefPubMedGoogle Scholar
  • 19 Pattharanitima P, Tasanarong A. Pharmacological strategies to prevent contrast-induced acute kidney injury. BioMed Res Int 2014; 2014: 236930
    CrossrefPubMedGoogle Scholar
  • 20 Solomon R. Contrast media: are there differences in nephrotoxicity among contrast media?. BioMed Res Int 2014; 2014: 934947
    CrossrefPubMedGoogle Scholar
  • 21 Bucher AM, De Cecco CN, Schoepf UJ. et al. Is contrast medium osmolality a causal factor for contrast-induced nephropathy?. BioMed Res Int 2014; 2014: 931413
    CrossrefPubMedGoogle Scholar
  • 22 Pflueger A, Larson TS, Nath KA, King BF, Gross JM, Knox FG. Role of adenosine in contrast media-induced acute renal failure in diabetes mellitus. Mayo Clin Proc 2000; 75 (12) 1275-1283
    CrossrefPubMedGoogle Scholar
  • 23 Mueller C, Buerkle G, Buettner HJ. et al. Prevention of contrast media-associated nephropathy: randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty. Arch Intern Med 2002; 162 (03) 329-336
    CrossrefPubMedGoogle Scholar
  • 24 Weisbord SD, Palevsky PM. Prevention of contrast-induced nephropathy with volume expansion. Clin J Am Soc Nephrol 2008; 3 (01) 273-280
    CrossrefPubMedGoogle Scholar
  • 25 Merten GJ, Burgess WP, Gray LV. et al. Prevention of contrast-induced nephropathy with sodium bicarbonate: a randomized controlled trial. JAMA 2004; 291 (19) 2328-2334
    CrossrefPubMedGoogle Scholar
  • 26 Zoungas S, Ninomiya T, Huxley R. et al. Systematic review: sodium bicarbonate treatment regimens for the prevention of contrast-induced nephropathy. Ann Intern Med 2009; 151 (09) 631-638
    CrossrefPubMedGoogle Scholar
  • 27 Hiremath S, Akbari A, Shabana W, Fergusson DA, Knoll GA. Prevention of contrast-induced acute kidney injury: is simple oral hydration similar to intravenous? A systematic review of the evidence. PLoS One 2013; 8 (03) e60009
    CrossrefPubMedGoogle Scholar
  • 28 Søreide E, Ljungqvist O. Modern preoperative fasting guidelines: a summary of the present recommendations and remaining questions. Best Pract Res Clin Anaesthesiol 2006; 20 (03) 483-491
    CrossrefPubMedGoogle Scholar
  • 29 Subramaniam RM, Suarez-Cuervo C, Wilson RF. et al. Effectiveness of prevention strategies for contrast-induced nephropathy: a systematic review and meta-analysis. Ann Intern Med 2016; 164 (06) 406-416
    CrossrefPubMedGoogle Scholar
  • 30 Pappy R, Stavrakis S, Hennebry TA, Abu-Fadel MS. Effect of statin therapy on contrast-induced nephropathy after coronary angiography: a meta-analysis. Int J Cardiol 2011; 151 (03) 348-353
    CrossrefPubMedGoogle Scholar
  • 31 Li Y, Liu Y, Fu L, Mei C, Dai B. Efficacy of short-term high-dose statin in preventing contrast-induced nephropathy: a meta-analysis of seven randomized controlled trials. PLoS One 2012; 7 (04) e34450
    CrossrefPubMedGoogle Scholar