Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ KEY FEATURES +++ ESSENTIALS OF DIAGNOSIS ++ The peak rise in serum creatinine occurs within 2–5 days after the diagnostic procedure using IV contrast, and it returns to baseline in most cases Increase in serum creatinine of > 50% represents clinically important acute renal failure +++ GENERAL CONSIDERATIONS ++ Most commonly seen after cardiac catheterization, especially if left ventricular angiography is carried out May be seen after CT scans or other diagnostic tests using contrast agents Hypoxic tubular injury due to vasoconstriction with release of free oxygen radicals is the likely mechanism Major risk factors: – Prior renal insufficiency – Diabetes mellitus Minor risk factors: – Congestive heart failure – Dehydration – Hypotension – Hypoxia – Large amount of contrast – Ionic and high osmolar contrast – Repeated examinations at short intervals +++ CLINICAL PRESENTATION +++ SYMPTOMS AND SIGNS ++ No specific symptoms or signs +++ PHYSICAL EXAM FINDINGS ++ No specific findings +++ DIFFERENTIAL DIAGNOSIS ++ Atheroembolic renal failure Prerenal azotemia secondary to low cardiac output +++ DIAGNOSTIC EVALUATION +++ LABORATORY TESTS ++ Increased serum creatinine over baseline before procedure using contrast Serum electrolytes: may be abnormal +++ ELECTROCARDIOGRAPHY ++ Nonspecific ST-T–wave changes can occur Signs of hyperkalemia may occur +++ TREATMENT +++ HOSPITALIZATION CRITERIA ++ Rising creatinine following procedure +++ MEDICATIONS ++ When contrast nephropathy occurs, treatment is similar to that for any other cause of acute renal insufficiency Most patients improve spontaneously with conservative management +++ THERAPEUTIC PROCEDURES ++ A few patients require temporary dialysis Need for long-term dialysis purely for contrast nephropathy is rare +++ SURGERY ++ Shunt placement if long-term dialysis is needed +++ MONITORING ++ ECG monitoring in hospital +++ DIET AND ACTIVITY ++ As appropriate for renal and cardiac condition +++ ONGOING MANAGEMENT +++ HOSPITAL DISCHARGE CRITERIA ++ Falling serum creatinine Resolution of the problem +++ FOLLOW-UP ++ Visit in 4–8 weeks to confirm stable renal function +++ COMPLICATIONS ++ Persistent renal dysfunction Chronic dialysis +++ PROGNOSIS ++ Good if renal function returns to normal Persistent renal dysfunction decreases survival +++ PREVENTION ++ Adequate hydration (0.45% normal saline at 1 mL/kg/hour for 12 hours before and 12 hours after the procedure): the most important therapy for preventing contrast nephropathy in high-risk patients Statin drugs combined ... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free a profile for additional features.