IMAGING IN RENAL IMPAIRMENT
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IMAGING IN RENAL IMPAIRMENT Contrast induced nephropathy (CIN) is the third most - PowerPoint PPT Presentation


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IMAGING IN RENAL IMPAIRMENT Contrast induced nephropathy (CIN) is the third most common cause of acute kidney injury in hospitalized patients Defined as increase in serum creatinine of >/+0.5 mg/dl within 48hr of exposure to contrast or relative 25%

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IMAGING IN RENAL IMPAIRMENT Contrast induced nephropathy (CIN) is the third most

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  • IMAGING IN RENAL IMPAIRMENT

  • Contrast induced nephropathy (CIN) is the third most

  • common cause of acute kidney injury in hospitalized

  • patients

  • Defined as increase in serum creatinine of >/+0.5 mg/dl

  • within 48hr of exposure to contrast or relative 25%

  • increase in serum creatinine from baseline

  • Clinical course is rise to serum creatinine within 24h of

  • contrast exposure, peak within 3-7 days and returns to

  • baseline within 14 days (25)


  • CIN AND IMAGING

  • Risk factors– chromic kidney, Diabetes, class IV heart

  • failure, age, hypovolemia, hypotension

  • Higher volumes of contrast increases the likelihood of CIN

  • The risk of CIN is quite low even for patients at higher risk


  • RECOMMENDATIONS FOR PREVENTION OF CIN

  • Evaluate the risk of CIN in all patients including CKD, diabetes,

  • heart failure

  • All patients should be encouraged to drink water liberally

  • before the procedure

  • High risk patients should receive intravenous volume

  • expansion with isotonic saline. Sodium bicarbonate

  • administration is debatable. IV fluids should be continued for

  • at least 6 hrs after contrast exposure. N-Acetylcysteine can be considered

  • in high risk patients


  • SUMMARY

  • IMAGING IN PATIENTS AT RISK OF CIN

  • Creatinine prior to CT

  • Adequate fluid replacement prior and

  • following contrast administration

  • Dialysis not definitively shown to be of benefit

  • Creatinine 48-72 hours post CT

http://www.appliedradiology.com/Issues/2010/09/Articles/AR_09-10_Katzberg/Contrast-induced-nephropathy-in-2010.aspx


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