title: High-risk situations and procedures.
abstract: With the wider use of imaging and interventional techniques that require the use of iodinated contrast media in seriously ill patients, many clinical situations occur where patients may be at increased risk for contrast-induced nephropathy (CIN). There is little guidance for clinicians in these areas. The aim of this review is to assess the available literature. Acute renal failure is a common complication following coronary artery bypass surgery, and exposure to contrast medium may increase the risk for this condition, although there is insufficient evidence to make a definitive statement. Evidence is also limited for patients with liver disease: in those undergoing transarterial chemoembolization, cirrhosis may be a risk factor for renal failure. There is some evidence that periprocedural hypotension may be a risk factor for CIN after percutaneous coronary intervention, but no published information was identified on the significance of shock or hypotension in other groups of patients. The published evidence on the risk of CIN in renal transplant recipients is inconsistent. In emergency situations, the course of action is usually dictated by clinical circumstances; the renal status of a patient is likely to be unknown and it is important to ensure adequate volume expansion, especially after the procedure. In all clinical situations that are potentially associated with a high risk for CIN, the decision to administer contrast medium is a matter for clinical judgment, based on the clinical status of the patient and the expected benefits of the investigation or procedure.
authors.affiliation: Department of Clinical Radiology, University Hospital Grosshadern, Munich, Germany. christoph.becker@med.uni-muenchen.de
authors.forename: Christoph R
authors.initials: CR
authors.lastname: Becker
authors.forename: Charles
authors.initials: C
authors.lastname: Davidson
authors.forename: Norbert
authors.initials: N
authors.lastname: Lameire
authors.forename: Peter A
authors.initials: PA
authors.lastname: McCullough
authors.forename: Fulvio
authors.initials: F
authors.lastname: Stacul
authors.forename: James
authors.initials: J
authors.lastname: Tumlin
authors.forename: Andy
authors.initials: A
authors.lastname: Adam
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced*; D003245:Consensus Statements as Topic; D000075202:Contraindications; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects; D001026:Coronary Artery Bypass / Q000009:adverse effects; D004630:Emergencies; D006801:Humans; D007022:Hypotension / Q000150:complications; D016030:Kidney Transplantation / Q000009:adverse effects; D008107:Liver Diseases / Q000150:complications; D009369:Neoplasms / Q000150:complications; D010530:Peritoneal Dialysis / Q000009:adverse effects; D012307:Risk Factors; D012769:Shock / Q000150:complications
chemical_list: D003287:Contrast Media