Contrast nephropathy refers to the worsening of kidney function due to the administration of iodinated radio-contrast medium usually through intravenous route. However, some of the cases of contrast nephropathy occur with intra-arterial administration. It is a serious complication of angiographic procedures.
It is not clear how a radio-contrast material causes toxicity to the nephrons of the kidney. However, their effect is mainly due to high osmolarity. The possible mechanisms include:
Usually, most of the patients with contrast nephropathy do not show any symptoms even before the kidney function returns to normal. Only laboratory values help in identifying the condition.
The following patient or procedure-related factors can increase the risk of developing contrast nephropathy:
The diagnosis of contrast induced nephropathy involves the measurement of serum creatinine levels over a period of 24 to 48 hours after the administration of the contrast material. There will be a progressive increase in the serum creatinine.
A differential diagnosis may be necessary in patients who undergo femoral artery catheterization to distinguish renal artheroembolism from contrast nephropathy.
Contrast nephropathy is self-limiting in most of the people with the serum creatinine returning to the normal values in 7-10 days. Usually a supportive treatment is provided for contrast nephropathy. The main aim of the treatment is to rehydrate the body and improve the volume and electrolyte balance.
The following are the treatment approaches of contrast nephropathy:
Additionally, the doctor regularly monitors the kidney function while giving the above treatment.
In some patients, dialysis or renal replacement therapy is necessary to remove the contrast material. However, this is needed only for a short time.
Contrast nephropathy is one of the common causes for hospital-acquired acute kidney failure (AKI). It accounts to about 10% of all the cases. Contrast nephropathy increases the risk of hospitalization. Even in patients who do not need dialysis, there is an increased risk of mortality within 1-year after developing contrast nephropathy.
Prevention is the cornerstone of management of contrast nephropathy. The best possible ways to prevent contrast nephropathy are as follows:
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