Intravenous Contrast-Induced Nephropathy-The Rise and Fall of a Threatening Idea

Advances in Chronic Kidney Disease
Lyndon LukJeffrey H Newhouse

Abstract

Contrast-induced nephropathy (CIN) has been considered to be a cause of renal failure for over 50 years, but careful review of past and recent studies reveals the risks of CIN to be overestimated. Older studies frequently cited the use of high-osmolality contrast media, which have since been replaced by low-osmolality contrast media, which have lower risks for nephropathy. In addition, literature regarding CIN typically describes the incidence following cardiac angiography, whereas the risk of CIN from intravenous injection is much lower. Most of the early published literature also lacked appropriate control groups to compare to those that received iodinated contrast, and thus attributed rises in creatinine to intravenous contrast without considering normal creatinine fluctuations (frequent in patients with kidney disease) and other acute pathologic states such as hypotension or nephrotoxic drug administration. The aim of this paper is to review the literature detailing CIN risk, discuss why CIN risk is often overestimated and how withholding contrast can lead to misdiagnosis and delay in appropriate patient management.

Citations

Oct 28, 2019·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Amanda M Uber, Scott M Sutherland
Nov 6, 2018·BMC Emergency Medicine·Karim HajjarGilbert Abou Dagher
Jul 31, 2020·Korean Journal of Radiology : Official Journal of the Korean Radiological Society·Dihia BelabbasGuillaume Mahe
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Nov 22, 2020·The Journal of Thoracic and Cardiovascular Surgery·Sana Waheed, Michael J Choi
Mar 19, 2021·Journal of the American Association of Nurse Practitioners·Mohamed Toufic El Hussein, Ali Bayrouti

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