Contrast-induced nephropathy

Abstract

Interventional radiological procedures involving anaesthesia are generally increasing. Contrast-induced nephropathy (CIN), usually defined as an increase in serum creatinine of 44 μmol litre-1 (0.5 mg dl-1) or a 25% increase from the baseline value 48 h after intravascular injection of contrast media, is a common and potentially serious complication of the use of iodinated contrast media in patients at risk of acute renal injury. It is an important cause of hospital-acquired renal failure, may be a difficult differential diagnosis and the incidence does not appear to have changed over the last few decades. In the general population, the incidence of CIN is estimated to be 1-2%. However, the risk for developing CIN may be as high as 50% in some patient subgroups, such as those with diabetes mellitus and pre-existing renal impairment. The impact of CIN on clinical outcomes has been evaluated most extensively in patients undergoing percutaneous coronary intervention where it is associated with increased mortality both in hospital and at 1 yr. As treatment is limited to supportive measures while awaiting the resolution of the renal impairment, emphasis needs to be directed at prevention. © The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved.