Contrast media and nephrotoxity

Dr Brendan Barrett is a Professor of Medicine in nephrology and clinical epidemiology at Memorial University of Newfoundland. His current research is focused on clinical care for patients with chronic kidney disease. He has published studies related to the general and kidney-related adverse effects of contrast media.

Dr BJ Barrett
Division of Nephrology and Clinical Epidemiology Unit Memorial University of Newfoundland St. John's, Newfoundland, Canada

Key words: contrast media; nephrotoxicity; contrast-induced nephropathy

Address for correspondence:
Dr BJ Barrett
Division of Nephrology, Health Sciences Center
St. John's, Newfoundland, Canada, A1B 3V6
Tel: +1-(709)-777-8073
Fax: +1-(709)-777-6995
E-mail: bbarrett@mun.ca

Abstract
Contrast-induced nephropathy (CIN), an acute decline in renal function after administration of an iodinated contrast medium, remains an important problem that can prolong hospitalisation, and increase morbidity and mortality. The pathogenesis probably involves a combination of ischaemic and direct tubulotoxic effects. Impairment of renal function is normally mild and transient, but in some patients, such as those with pre-existing renal impairment (especially when coupled with diabetes mellitus), clinically significant renal impairment can develop and dialysis may be required. The exact incidence of clinically significant CIN is not clear, partly owing to variations in definition and co-morbidity in study populations. The risk of renal failure averages about 3% in prospective studies of patients without risk factors; dialysis is required in <1% of patients after percutaneous coronary intervention. Risk factors should be corrected where possible and patients in whom they cannot should receive the smallest possible dose of contrast medium. Management of severe CIN is no different from that

for acute renal failure of any aetiology. No beneficial pharmacological treatment for established CIN has been identified. Renal function normally recovers after CIN. However, up to 30% of patients have some degree of permanent renal impairment but this may not be due solely to CIN.

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