Contrast Medium Induced Nephropathy in Urological Practice

Purpose

Contrast medium induced nephropathy is the third cause of in-hospital acute renal failure. The first studies in this area were done with reference to urological practice only. Although various guidelines on the management of contrast medium induced nephropathy were provided by the European Society of Urogenital Radiology, more recently many investigators have focused their attention on contrast medium use in interventional vascular radiology and cardiology. We critically reviewed the literature to clarify the impact of contrast medium induced nephropathy in urology and the possible prophylactic measures against it.

Materials and Methods

A MEDLINE®/PubMed®, EMBASE and Cochrane Library search for 1971 to 2006 was performed. All articles related to the use of contrast medium in urological practice and contrast medium induced nephropathy were reviewed.

Results

Many pathological conditions frequently seen by urologists are diagnosed by imaging requiring contrast medium. A basic understanding of the risk factors for contrast medium induced nephropathy and the strategies for its prevention are useful to prepare urological patients for these procedures. Prophylaxis includes the discontinuation of potentially nephrotoxic drugs and the use of protocols for periprocedural hydration.

Conclusions

The general approach to the recognition and prevention of contrast medium induced nephropathy in patients at risk should be extended to urological clinical practice since no definitive evidence based data are available regarding contrast medium induced nephropathy management in urological patients. Moreover, these patients can frequently present with the most significant risk factor for contrast medium mediated kidney damage, that is preexisting acute or chronic renal failure. Controlled trials are needed to establish the incidence of contrast medium induced nephropathy in diagnostic or interventional procedures in uroradiology.

Key Words: kidney, kidney failure, risk, contrast media, radiology

Abbreviations and Acronyms: ACEI, angiotensin-converting enzyme inhibitor, CM, contrast medium, CMIN, CM induced nephropathy, CrCl, creatinine clearance, CT, computerized tomography, DM, diabetes mellitus, GFR, glomerular filtration rate, GR, grade of recommendation, HOCM, high osmolality CM, IOCM, iso-osmolality CM, IVP, excretory urography, LE, level of evidence, LOCM, low osmolality CM, MS, metabolic syndrome, MSCTU, multislice CT urography, NAC, N-acetylcysteine, SCr, serum creatinine, TGFB, tubuloglomerular feedback