Contrast-induced acute kidney injury: specialty-specific protocols for interventional radiology, diagnostic computed tomography radiology, and interventional cardiology.
Contrast-induced acute kidney injury (AKI) (also known as contrast-induced nephropathy) is an abrupt deterioration in renal function that can be associated with use of iodinated contrast medium. Although the increase in serum creatinine concentration is transient in most cases, contrast-induced AKI may lead to increased morbidity and mortality rates in selected at-risk populations. This review summarizes the findings of a multidisciplinary panel composed of computed tomography radiologists, interventional radiologists, cardiologists, and nephrologists convened to address the specialty-specific issues associated with minimizing the incidence of contrast-induced AKI. As part of this initiative, the panel developed specialty-specific protocols for preventing contrast-induced AKI, taking into account, for example, the variations in patient risk profile, inpatient or outpatient status, and staffing resources that characterize various clinical settings. The 3 protocols, each reflecting a consensus of expert opinion, address the prevention of contrast-induced AKI in interventional radiology, diagnostic computed tomography radiology, and interventional cardiology settings. The protocols are presented in the context of a review of recent guidelines and published reports of trials that discuss contrast-induced AKI and its prevention. The panel reviewed materials retrieved by a PubMed search covering the period January 1990 through January 2008 and used combinations of key words associated with the prevention and treatment of contrast-induced AKI. In addition, the panel reviewed the reference lists of selected articles and the tables of contents posted on the Web sites of selected journals for relevant publications not retrieved in the PubMed searches.
Goldfarb
Stanley
S
Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, 19104, USA. Stanley.Goldfarb@uphs.upenn.edu
McCullough
Peter A
PA
McDermott
John
J
Gay
Spencer B
SB
D000111:Acetylcysteine / Q000627:therapeutic use; D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000517:prevention & control*; D015906:Angioplasty, Balloon, Coronary; D002985:Clinical Protocols; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D016166:Free Radical Scavengers / Q000627:therapeutic use; D005919:Glomerular Filtration Rate; D006801:Humans; D008511:Medicine; D017410:Practice Guidelines as Topic; D015641:Radiography, Interventional; D018570:Risk Assessment; D013038:Specialization; D014057:Tomography, X-Ray Computed
D003287:Contrast Media; D016166:Free Radical Scavengers; D003404:Creatinine; D000111:Acetylcysteine