The Incidence Of Contrast-Induced Nephropathy Or Radiocontrast Nephropathy

摘要

BACKGROUND AND PURPOSE: Most studies of contrast-induced nephropathy (CIN) or radiocontrast nephropathy (RCN) have been derived from intra-arterial administration of contrast and percutaneous coronary intervention, the results of which may not be easily applicable in radiology, where most contrast administration is via the intravenous route. The purpose of this study is to document the rate of CIN/RCN in patients undergoing computed tomography angiography (CTA) of the head and/or neck, who were given contrast via the intravenous route.MATERIALS AND METHODS: This is a retrospective study involving a random sample of 594 patients with normal serum creatinine and normal estimated glomerular filtration rate who had CTA of the head and/or neck.RESULTS: Two hundred and twenty eight patients (38.39%) had a decrease in serum creatinine, 212 patients (35.69%) had no change in serum creatinine, and 154 patients (25.93%) had an increase in serum creatinine after contrast administration. There were 2 patients (0.3%) who had greater than 0.5 mg/dL increase in 48-hour serum creatinine, 40 (6.7%) patients who had 25% or greater increase in serum creatinine, and 2 patients (0.3%) who had greater than 0.5 mg/dL increase serum creatinine and 25% or greater increase in serum creatinine 48 hours after contrast administration.CONCLUSION: The rate of CIN/RCN is 0.3-6.7% depending on the definition used. CIN/RCN is a rare complication in patients given intravenous contrast. The intravenous administration of contrast for CTA of the head and neck is safe, and may be used in routine evaluation of stroke and trauma. INTRODUCTION Contrast-induced nephropathy (CIN) or radiocontrast nephropathy (RCN) is acute renal failure occurring after contrast administration. An accepted definition of CIN/RCN is increase of serum creatinine of > 0.5 mg/dL or 25% above baseline within 48 hours after contrast administration. The pathophysiology of CIN/RCN is not clear but contrast may have ischemic and direct toxic effect on renal tubular cells. The most important risk factors of CIN/RCN are pre-existing renal insufficiency and diabetes. The incidence of CIN/RCN is highly variable, depending on the patient population, length of patient follow-up, definition of CIN/RCN, type of procedure, type and dose of contrast used, and route of contrast administration (1-11).Most of the studies of contrast-induced nephropathy (CIN) or radiocontrast nephropathy (RCN) have been derived from intra-arterial administration of contrast (98.7%) (2), and percutaneous coronary intervention, the results of which may not be easily applicable in radiology, where most contrast administration is via the intravenous route. Although most studies of CIN/RCN have been based on changes in serum creatinine, serum creatinine is not a reliable measure of renal impairment. Serum creatinine is affected by many factors including age, sex, and ethnicity. Glomerular filtration rate (GFR) or estimated glomerular filtration rate (eGFR) is a more appropriate assessment of renal function because it takes into account age, sex, and ethnicity of the patients (11-19).Computed tomography angiography (CTA) of the head and neck are routinely used in the evaluation of acute stroke and acute trauma. The intravenous administration of contrast is associated with the risk of contrast-induced nephropathy (CIN) or radiocontrast nephropathy (RCN). The aim of this study is to document the rate of contrast-induced nephropathy (CIN) or radiocontrast nephropathy (RCN) in patients undergoing CTA of the head and/or neck, who were given contrast via the intravenous route. CIN/RCN is diagnosed by changes in serum creatinine and estimated glomerular filtration rate (eGFR) as determined by the older Modification of Diet in Renal Disease (MDRD) Study and the newer Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. I believe that this is the first time that CIN/RCN has been diagnosed by changes in serum creatinine and e