Contrast media-induced nephropathy: risk assessment and reduction

Fulvio Stacul qualified in diagnostic radiology at the University of Trieste in 1982. He was appointed Consultant Radiologist at the Institute of Radiology, University of Trieste in 1990 and became Head of the Ultrasound Unit in 1998.

Dr Stacul has written more than 150 publications on diagnostic radiology, specializing in contrast media, uroradiology, vascular radiology, ultrasonography and interventional radiology. He has spoken at more than 140 national and international meetings.

Currently Secretary of the journal of the Italian Society of Medical Radiology, Dr Stacul has been a member of a number of scientific societies including the European Society of Urogenital Radiology, the Contrast Media Safety Committee and the Scientific Editorial Board of European Radiology.

Contrast media-induced nephropathy:
risk assessment and reduction

Fulvio Stacul
Department of Radiology University of Trieste, Italy
Address for correspondence:
Dr Fulvio Stacul
Department of Radiology, University of Trieste
Cattinara Hospital, Strada di Fiume, 44
34149 Trieste, Italy
Tel: +39-040-3994372 Fax: +39-040-3994500
E-mail: fulvio.stacul@aots.sanita.fvg.it

Abstract
Contrast media-induced nephropathy (CIN) is a problem that is often under-recognised in clinical practice. The renal impairment is usually temporary, but in some patients acute renal failure can develop and dialysis may be necessary. Several independent patient-related and contrast-related risk factors contribute to the likelihood of CIN. Patients with both diabetes and pre-existing renal impairment are at the highest risk. Practices to identify patients at risk vary: it may be possible to identify patients who may be at risk using screening questionnaires. The prevalence of CIN correlates with contrast media (CM) dose: therefore the amount of CM has to be minimised in at-risk patients. Non-ionic monomers (low osmolar CM) are beneficial in comparison with ionic monomers (high osmolar CM) in patients with pre-existing renal impairment. Encouraging results have been obtained recently with a non-ionic, dimeric, isosmolar compound, iodixanol, possibly underscoring the relationship between lower CM osmolality and lower nephrotoxicity. Adequate hydration is recommended in at-risk patients.

Various drugs that have been used in attempts to prevent CIN have provided contradictory results in clinical trials and therefore their effectiveness remains to be proven.

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