1.9 Contrast induced Nephropathy

Question 1

Define CIN

Answer 1

Temporal link between renal function deterioration and admin of IV contrast (absence other aetiology)

absolute increase serum creat 44umol/L
or
25% increase baseline

Question 2

Pathophysiology

Answer 2

Medullary hypoxia
- prolong vasoconstriction
2’ - adenosine, endothelin tgfback, direct action on VSM

altered autoregulation of vasculature

Reperfusion injury - free radical attack

direct tubular cytotoxicity

pre existing / exacerbate systemic factors contribute

Question 3

Risk facrors CIN

Answer 3

Elderly

premorbid renal dysfunction (incl sepsis)

comorbid: dm chf

periprocedural

• hypovolaemia
• anaemia

concom use nephrotoxin

volume and type contrast

Question 4

Prophylaxis

Answer 4

1. ID @ risk pt
2. Periprocedural hydration
   crystalloid / saline
   fluid load before procedure

Avoid nephrotoxic

Some evidence
Antioxidants
NAC - free rad scav and vasodilator

Statin modify endothelial fxn and inflamm

Prophylactic HDF ICU reduce incidence / moraitliy
invasive/ impractical/ expensive/training