title: CT angiography for intracerebral hemorrhage does not increase risk of acute nephropathy.
abstract: 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."
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Oleinik
authors.forename: Javier M
authors.initials: JM
authors.lastname: Romero
authors.forename: Kristin
authors.initials: K
authors.lastname: Schwab
authors.forename: Michael H
authors.initials: MH
authors.lastname: Lev
authors.forename: Nupur
authors.initials: N
authors.lastname: Jhawar
authors.forename: Josser E
authors.initials: JE
authors.lastname: Delgado Almandoz
authors.forename: Eric E
authors.initials: EE
authors.lastname: Smith
authors.forename: Steven M
authors.initials: SM
authors.lastname: Greenberg
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rosand
authors.forename: Joshua N
authors.initials: JN
authors.lastname: Goldstein
mesh_terms: 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
chemical_list: D003287:Contrast Media; D003404:Creatinine