REVIEW – September 2007

Contrast media-related adverse events, contrast-induced nephropathy


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The evolution of radiocontrast media has minimized adverse events, but with the increasing use of contrast media (CM) in diagnostic and interventional procedures over the last 30 years, contrast-induced nephropathy (CIN) has become one of the leading cause of hospital-acquired acute renal failure. CIN is usually defined as an increase of 25% or more in serum creatinine from baseline value at 48–72 h following exposure to CM. Identification of patients at high risk for development of CIN is of major importance. The cornerstone for prevention of CIN is volume supplementation, while a combination  of intravenous and oral volume supplementation effectively prevents CIN in low- and moderate-risk patients. High-risk patients should be considered for pharmacologic prophylaxis with N-acetylcysteine and follow-up serum creatinine should be obtained following contrast exposure.
In recent years nephrogenic systemic fribrosis was linked to exposure to gadolinium based contrast media used for magnetic resonance. High risk for this adverse event exists for dialysis patients and for patients with chronic kidney disease 4 and 5.