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• W2146397785 abstract "Contrast-induced nephropathy (CIN) also called con-trast-induced acute kidney injury (CI-AKI) has been onthe agenda since the 1970s. In the early 1970s (beforecomputed tomography [CT], magnetic resonance ima-ging [MRI], and ultrasound were used for diagnosticpurposes) researchers found that so-called high-doseurography, often performed with conventional tomog-raphy of the kidneys, could visualize the outline of thekidney: (i) whether it was small, enlarged, or normal-sized; (ii) whether the outline of the kidney was smoothor not; and (iii) whether there was dilatation of thepelvic cavity (hydronephrosis) or not. A lot of high-osmolar contrast medium was required and at thesame time, the amount of radiation was high. It waseven performed in patients with a transplanted kidney(1). The images were considered beautiful and a majordiagnostic step. High-dose urography opened a new erafor radiology (2). It took some time before the radiolo-gists became aware of the fact that high doses of high-osmolar contrast media might harm the kidneyfunction.The first case of CIN was published in 1954 (3). Itwas a case of acute anuria in a patient with myeloma-tosis. The radiologists started to restrict the use of con-trast media in patients with multiple myeloma andinitially overlooked that hydration and decreasedrenal function were important factors. However, ifdehydration is avoided, contrast-medium administra-tion rarely leads to acute renal failure in patients withmyeloma (4). Until we got the non-ionic agents, it was aroutine to ask the patient to stop intake of fluid for atleast 6h before an intravenous urography in orderto avoid dilution of the contrast in the pelvis andthe ureter.In the late 1970s, radiologists stopped usingincreased doses of the contrast media in patients withreduced renal function. Some even stopped adminis-trating contrast media to these patients. This may beone of several reasons why it took so many years beforeit was documented that the prevalence of CIN is higherafter ionic high-osmolar contrast media than non-ionicagents (5), since the ‘‘high-risk’’ patients were deniedcontrast medium. Another explanation is the lownumber of participants in the various studies at thattime; a meta-analysis was necessary to document thatthere is a difference in nephrotoxic potential betweenionic high-osmolar and non-ionic low-osmolar agents.It was not until 2003 that the general interest in CINreally took off. Aspelin et al. (6) showed in a rando-mized trial involving only 129 patients with moderatechronic kidney disease and diabetes mellitus, a signifi-cantly higher incidence of CIN (defined as an absoluteincrease in serum creatinine greater than 44mmol/L)within 72h with intra-arterial iohexol than with iodix-anol (26% vs. 4%). The two groups differed signifi-cantly with regard to interventional procedures andduration of diabetes, but were otherwise comparable.This publication started a commercial fight between thevarious pharmaceutical companies whether the dimerwas really less nephrotoxic than the monomers.Sessions dealing with CIN attracted a lot of partici-pants at congresses. In 2009, Laskey et al. (7) hadrepeated Aspelin et al.’s study (6) in a larger group ofsimilar patients; no difference between the monomer(Iopamidol) and the dimer (Iodixanol) was found. Ittaught us that one should never rely on a singlestudy, at least when it is about adverse reactions tocontrast media. The large majority of studies dealingwith CIN was and is still performed in relation to car-diac angiography; only a small number of studies weredone in patients receiving the contrast medium intra-venously. CT patients are most frequently outpatients;thus it is difficult to check the patient – including takinga blood sample 72h after the scanning. Based on ameta-analysis from the same year, Heinrich et al. (8)concluded that the iso-osmolar non-ionic iodixanol isnot associated with a reduced risk of CIN compared tonon-ionic monomers after intravenous administration.In patients with renal injury given contrast media intra-arterially, low-osmolar iohexol was associated with a" @default.
• W2146397785 created "2016-06-24" @default.
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• W2146397785 date "2014-11-01" @default.
• W2146397785 modified "2023-10-13" @default.
• W2146397785 title "CIN: can we forget it?" @default.
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• W2146397785 doi "https://doi.org/10.1177/0284185114545153" @default.
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