1 / 23

Radiocontrast Nephropathy

Radiocontrast Nephropathy. Jason S. Finkelstein, M.D. Tulane University HSC Division of Cardiology 3/2/04. Outline. Incidence and Clinical Features of RCN Risk Factors Pathophysiology Agents used for Prevention of RCN. Incidence.

jam
Télécharger la présentation

Radiocontrast Nephropathy

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Radiocontrast Nephropathy Jason S. Finkelstein, M.D. Tulane University HSC Division of Cardiology 3/2/04

  2. Outline • Incidence and Clinical Features of RCN • Risk Factors • Pathophysiology • Agents used for Prevention of RCN

  3. Incidence • In the year 2000, an estimated 1.8 million caths were performed in the US • Two studies looked at 1826/1196 patients and the incidence of RCN was 14.4% & 11.1% respectively • 0.3-4% of patients required short-term dialysis • Approx 60,000 cases of RCN occur each year

  4. Definition • Absolute increase of Cr > 0.5 mg/dl or relative increase of 25-50% from baseline within 48 hours of contrast exposure in absence of other causes • Third most common cause of acute renal failure

  5. Definition • Typically occurs within 24-48 hours of contrast exposure • Creatinine typically peaks in 3-5 days and returns to baseline in 1-3 weeks • RCN is non-oliguric in most patients

  6. Outcome • Causes increased length of hospital stay and costs • Significant in-hospital morbidity • 5-10% require transient dialysis; <1% require long term dialysis

  7. Increased mortality • 3.8% -- Increase in Cr 0.5-0.9 mg/dl • 64% -- Increase in Cr > 3.0 mg/dl

  8. Osmolality • Contrast media are water soluble structures composed of triiodobenzene ring with varying numbers of iodine molecules • Increased iodine content results in increased osmolality • Pooled data from 25 randomized trials have shown that high osmolality agents pose a greater risk of CN than low-osmolality agents

  9. Risk Factors for RCN • Pre-existing renal insufficiency (37%) • Diabetes (risk is 4.1%) • Contrast volume • Dehydration • Advanced Age • Nephrotoxic drugs (ACE, NSAIDS) • CHF, Liver disease

  10. Pathophysiology • Medullary ischemia • Direct tubular toxicity • Tubular obstruction

  11. Medullary Ischemia • Contrast agents cause a selective renal medullary vasoconstriction • Shunting of blood to the renal cortex • Also known as the “steal phenomenon” • This leads to tubular injury

  12. Tubular obstruction • Possible role in pathogenesis of RCN • Precipitation of Dye crystals in the renal tubules • In presence of dehydration, precipitation of urate or dye crystals could lead to tubular obstruction

  13. Direct Tubular Toxicity • Toxic ATN • Oxygen Free Radicals • Leads to apoptosis in renal tubular and glomerular cells

  14. Iohexol Cooperative Study • Objective • To compare the incidence of contrast nephrotoxicity between nonionic “Iohexol” and the ionic contrast agent “diatrizoate” in a large population of low and high risk patients undergoing angiogram • 1196 pts, randomized trial

  15. Conclusion • The incidence of RCN depends on the presence of risk factors • Pts with CRI and DM are at highest risk • RCN can be associated with significant morbidity and mortality • There are preventive interventions to decrease the risk of toxicity

More Related