CT angiography for intracerebral hemorrhage does not increase risk of acute nephropathy.
OBJECTIVE
CT angiography (CTA) is receiving increased attention in intracerebral hemorrhage (ICH) for its role in ruling out vascular abnormalities and potentially predicting ongoing bleeding. Its use is limited by the concern for contrast induced nephropathy (CIN); however, the magnitude of this risk is not known.


METHODS
We performed a retrospective analysis of a prospectively collected cohort of consecutive patients with ICH presenting to a single tertiary care hospital from 2002 to 2007. Demographic, clinical, and radiographic data were prospectively collected for all patients. Laboratory data and clinical course over the first 48 hours were retrospectively reviewed. Acute nephropathy was defined as any rise in creatinine of >25% or >0.5 mg/dL, such that the highest creatinine value was above 1.5 mg/dL.


RESULTS
539 patients presented during the study period and had at least 2 creatinine measurements. 348 (65%) received a CTA. Acute nephropathy developed in 6% of patients who received a CTA and in 10% of those who did not (P=0.1). Risk of nephropathy was 14% in those receiving no contrast (130 patients), 5% in those receiving 1 contrast study (124 patients), and 6% in those receiving >1 contrast study (244 patients). Neither CTA nor any use of contrast predicted nephropathy in univariate or multivariate analysis.


CONCLUSIONS
The risk of acute nephropathy after ICH was not increased by use of CTA. Studies of CIN that do not include a control group may overestimate the influence of contrast. Patients with ICH appear to have an 8% risk of developing "Hospital-Acquired Nephropathy."
Oleinik
Alexandra
A
Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA.
Romero
Javier M
JM
Schwab
Kristin
K
Lev
Michael H
MH
Jhawar
Nupur
N
Delgado Almandoz
Josser E
JE
Smith
Eric E
EE
Greenberg
Steven M
SM
Rosand
Jonathan
J
Goldstein
Joshua N
JN
D058186:Acute Kidney Injury / Q000097:blood / Q000453:epidemiology*; D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography / Q000009:adverse effects*; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging*; D003287:Contrast Media / Q000009:adverse effects; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors
D003287:Contrast Media; D003404:Creatinine