title: Contrast induced nephropathy in vascular surgery.
abstract: Contrast induced nephropathy (CIN) is traditionally associated with outpatient imaging studies. More recently, patients afflicted with vascular pathologies are increasingly undergoing endovascular treatments that require the use of iodinated contrast media (CM) agents, thus placing them as risk of developing CIN. As perioperative physicians, anaesthetists should be aware of the risk factors and measures that might minimize acute kidney injury caused by CM. This review evaluates recent data regarding preventive measures against CIN and where possible, places the evidence in the context of the patient receiving endovascular surgical treatment. Measures including the use of peri-procedural hydration, N-acetylcysteine, statins, remote ischaemic preconditioning, renal vasodilators and renal replacement therapy and the use of alternatives to iodinated contrast agents are discussed. It should be noted that most of the available data regarding CIN are from non-surgical patients.
authors: Department of Anaesthesiology, University of Hong Kong, Room 424, K Block, Queen Mary Hospital, Pokfulam, Hong Kong gordon@hku.hk.
authors: G T C
authors: GT
authors: Wong
authors: Department of Radiology, University of Hong Kong, Hong Kong.
authors: E Y P
authors: EY
authors: Lee
authors: Department of Anaesthesiology, University of Hong Kong, Room 424, K Block, Queen Mary Hospital, Pokfulam, Hong Kong.
authors: M G
authors: MG
authors: Irwin
mesh_terms: D000111:Acetylcysteine / Q000627:therapeutic use; D003287:Contrast Media / Q000009:adverse effects*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D019194:Ischemic Preconditioning; D007674:Kidney Diseases / Q000139:chemically induced* / Q000517:prevention & control; D017582:Renal Replacement Therapy; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
chemical_list: D003287:Contrast Media; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000111:Acetylcysteine
keywords: acute kidney injury; contrast media; endovascular procedures