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Contrast-Induced Nephropathy Prevention (Current)

ESUR/ACR 2018 guideline: AKICN definition and risk-based prophylaxis

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Radyoloji department. Book Appointment →

What is Contrast-Induced Nephropathy Prevention (Current)?

CIN/AKI-PCI is a 0.3 mg/dL or 50% increase in serum creatinine within 48-72 hours after intravascular contrast use; KDIGO criteria are also applicable. Incidence is 0%-50% depending on patient population and risk factors. The majority resolves; rarely (1%) renal replacement therapy is required.

Pathophysiology: ischemic tubular injury due to renal medullary vasoconstriction, direct tubular toxicity (osmotic stress, oxidative stress), and reduced renal blood flow. Iso-osmolar (290 mOsm/kg) and low-osmolar (600-900 mOsm/kg) contrasts are less nephrotoxic than high-osmolar (>1500); modern non-ionic contrasts (iohexol, iopromide, iodixanol) are preferred.

Mehran risk score and ACR risk classification stratify high-risk patients: eGFR <45, diabetes, age >75, heart failure, dehydration. ESUR 2018 recommends IV isotonic saline hydration (1 mL/kg/h, 6-12 hours pre-post procedure) in eGFR <30 patients; sodium bicarbonate, NAC, statin do not have firm benefit. Metformin should be stopped only in eGFR <30 patients.

Symptoms

Increase in serum creatinine (0.3 mg/dL or 50%, 48-72 hours)
Decrease in urine output (oliguria, occasionally)
Edema (severe AKI)
Asymptomatic in most cases
Hyperkalemia (severe cases)
Uremic symptoms (dialysis-required cases)

Risk Factors

Baseline renal impairment (eGFR <60, especially <30)
Diabetes mellitus (especially with renal impairment)
Dehydration
Advanced age (>75)
Heart failure (NYHA III-IV)
High contrast volume (>100 mL or contrast/eGFR ratio >3)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Pre-procedure renal function evaluation (eGFR)
  • Diabetes + age >75 + planned procedure
  • Heart failure history + planned contrast study
  • Persistent oliguria after procedure
  • Edema and weight gain
  • Multiple contrast administrations within 48 hours

Treatment Methods

01
IV isotonic saline hydration (1 mL/kg/h, 6-12 hours)
02
Iso-osmolar/low-osmolar contrast preference (iodixanol, iohexol)
03
Lowest contrast volume (especially in eGFR <30)
04
Stop nephrotoxic drugs (NSAID, ACEi/ARB - selective)
05
Stop metformin (eGFR <30, 48 hours pre-post)
06
Alternative imaging (US, MR without contrast - severe risk)

Which Department to Visit?

You can visit our Radyoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.