Contrast Induced Nephropathy, Risk, Prevention, and Imaging Alternatives

Authors

  • Sarfraz Ahmed
  • Hafeez Ur Rehman
  • Saima Rabbani
  • Adnan Yousaf
  • Najmuddin
  • Shahid Rizwan Safeer
  • Danyal Najam

DOI:

https://doi.org/10.63682/jns.v14i32S.10125

Keywords:

Contrast-induced nephropathy, prevention, imaging alternatives, renal function

Abstract

Background: Contrast-induced nephropathy (CIN) is a leading cause of acute kidney injury, primarily induced by iodinated contrast agents used in diagnostic imaging. CIN is associated with poor patient outcomes, including increased morbidity, prolonged hospitalization, and long-term kidney damage, particularly in high-risk populations with pre-existing kidney dysfunction.

Objectives: To assess the risk factors, prevention strategies, and alternative imaging techniques to reduce contrast-induced nephropathy in patients undergoing contrast-enhanced imaging procedures, focusing on kidney function and patient outcomes.

Methods: This prospective study conducted at Radiology Bacha Medical Complex Gajju Khan Medical College swabi from jan 2024 to jan 2025.involved 150 patients undergoing contrast-enhanced imaging procedures, evaluating risk factors such as pre-existing renal disease, diabetes, and dehydration. Hydration protocols and pre-procedure medications were used for prevention. Renal function was assessed before and after the procedure using serum creatinine levels and eGFR. Alternative imaging options, such as MRI and non-contrast CT, were explored for high-risk patients. Data were analyzed using statistical tests with significance set at p < 0.05.

Results:Of the 150 patients, 20 (13.3%) developed CIN post-procedure. The mean pre-procedure serum creatinine level was 1.2 ± 0.4 mg/dL, while it increased to 1.6 ± 0.6 mg/dL after the procedure (p < 0.05). The standard deviation for serum creatinine levels was 0.5. Patients with pre-existing renal dysfunction and diabetes had a higher incidence of CIN (p < 0.01). Hydration and pre-procedure medications significantly reduced the incidence of CIN (p < 0.05). Non-contrast imaging methods were effective alternatives in 12% of cases.


Conclusion: Contrast-induced nephropathy remains a major complication in high-risk patients undergoing contrast-enhanced imaging. Preventive strategies, such as hydration and the use of pre-procedure medications, significantly reduce the risk. Alternative imaging methods, including MRI and non-contrast CT, offer safe options for patients at high risk of CIN, enhancing patient safety and reducing renal complications. Further studies are needed to optimize CIN prevention.

 

Downloads

Download data is not yet available.

References

[1] Amet S, Deray G. [Renal toxicity of contrast agents in oncologic patients]. Bulletin du cancer. 2012;99:295-307. https://doi.org/10.1684/bdc.2011.1477.

[2] Antoń B, Kaszczewski P, Nazarewski S, Małyszko J, Gałązka Z. Advancements in preventing post-contrast acute kidney injury in EVAR: clinical strategies and future directions. Wiadomosci lekarskie (Warsaw, Poland : 1960). 2024;77:1769-74. https://doi.org/10.36740/WLek/193211.

[3] Bahrainwala JZ, Leonberg-Yoo AK, Rudnick MR. Use of Radiocontrast Agents in CKD and ESRD. Seminars in dialysis. 2017;30:290-304. https://doi.org/10.1111/sdi.12593.

[4] Best PJ, Holmes DR, Jr. Prevention and management of contrast-induced acute kidney injury. Current treatment options in cardiovascular medicine. 2012;14:1-7. https://doi.org/10.1007/s11936-011-0162-5.

[5] .Bodard S, Kharroubi-Lakouas D, Guinebert S, Dariane C, Gillard P, Sakhi H, et al. [Cancer imaging and prevention of renal failure]. Bulletin du cancer. 2024;111:663-74. https://doi.org/10.1016/j.bulcan.2022.09.011.

[6] Busutti M, Sensoni A, Vacirca A, Abenavoli C, Donadei C, Croci Chiocchini AL, et al. Renal Benefits of CO2 as a Contrast Media for EVAR Procedures: New Perspectives on 1 Year Outcomes. Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists. 2024;31:1180-9. https://doi.org/10.1177/15266028231162258.

[7] Caradu C, Coatsaliou Q, Colacchio EC, Ducasse E, Lareyre F, Raffort J. Incidence of Contrast-Induced Nephropathy and Post-Operative Outcomes in Patients Undergoing Chimney Endovascular Aortic Aneurysm Repair. Angiology. 2022;73:852-62. https://doi.org/10.1177/00033197221075852.

[8] de Campos RO, Heredia V, Ramalho M, De Toni MS, Lugo-Somolinos A, Fuller ER, 3rd, et al. Quarter-dose (0.025 mmol/kg) gadobenate dimeglumine for abdominal MRI in patients at risk for nephrogenic systemic fibrosis: preliminary observations. AJR American journal of roentgenology. 2011;196:545-52. https://doi.org/10.2214/ajr.10.4500.

[9] Gallitto E, Faggioli G, Vacirca A, Pini R, Mascoli C, Fenelli C, et al. The benefit of combined carbon dioxide automated angiography and fusion imaging in preserving perioperative renal function in fenestrated endografting. Journal of vascular surgery. 2020;72:1906-16. https://doi.org/10.1016/j.jvs.2020.02.051.

[10] Khaw MS, Yap CW, Lee P, Ong SJ. What you need to know about: imaging in patients with renal failure. British journal of hospital medicine (London, England : 2005). 2023;84:1-9. https://doi.org/10.12968/hmed.2022.0544.

[11] Mariani J, Jr., Guedes C, Soares P, Zalc S, Campos CM, Lopes AC, et al. Intravascular ultrasound guidance to minimize the use of iodine contrast in percutaneous coronary intervention: the MOZART (Minimizing cOntrast utiliZation With IVUS Guidance in coRonary angioplasTy) randomized controlled trial. JACC Cardiovascular interventions. 2014;7:1287-93. https://doi.org/10.1016/j.jcin.2014.05.024.

[12] Mathur M, Weinreb JC. Imaging patients with renal impairment. Abdominal radiology (New York). 2016;41:1108-21. https://doi.org/10.1007/s00261-016-0709-8.

[13] Mizowaki T, Fujita A, Imahori T, Uyama A, Inoue S, Kohta M, et al. Duplex-assisted carotid artery stenting without administration of contrast medium for patients with chronic kidney disease or allergic reaction. Neuroradiology. 2016;58:679-86. https://doi.org/10.1007/s00234-016-1678-x.

[14] Nicholas BA, Vricella GJ, Smith M, Passalacqua M, Gulani V, Ponsky LE. Contrast-induced nephropathy and nephrogenic systemic fibrosis: minimizing the risk. The Canadian journal of urology. 2012;19:6074-80.

[15] Onuigbo MAC, Sharma V, Balogun OO, Ghimire A. Post-Renal Biopsy Acute Kidney Injury and Page Kidney from Intra-Renal Hematoma Aggravated by Reversible Contrast-Induced Nephropathy Following Renal Arterial Embolization. The American journal of case reports. 2020;21:e919701. https://doi.org/10.12659/ajcr.919701.

[16] Ozkok S, Ozkok A. Contrast-induced acute kidney injury: A review of practical points. World journal of nephrology. 2017;6:86-99. https://doi.org/10.5527/wjn.v6.i3.86.

[17] Poff JA, Hecht EM, Ramchandani P. Renal imaging in patients with renal impairment. Current urology reports. 2011;12:24-33. https://doi.org/10.1007/s11934-010-0158-9.

[18] Renard R, Coscas R, Sylvestre R, Javerliat I, Goëau-Brissonnière O, Coggia M. A Simple Technique to Perform Endovascular Repair of Abdominal Aortic Aneurysms with a Very Low Dose of Iodine Contrast Media. Annals of vascular surgery. 2021;71:507-12. https://doi.org/10.1016/j.avsg.2020.09.062.

[19] Rodriguez JF, Pachón-Londoño MJ, Areiza LA, Rodriguez WG. Zero-contrast left atrial appendage closure, a feasible alternative for patients with a high risk of contrast-induced nephropathy: Systematic literature review and meta-analysis. Heart rhythm. 2024;21:2136-47. https://doi.org/10.1016/j.hrthm.2024.05.016.

[20] Snaith B, Harris MA, Shinkins B, Jordaan M, Messenger M, Lewington A. Point-of-care creatinine testing for kidney function measurement prior to contrast-enhanced diagnostic imaging: evaluation of the performance of three systems for clinical utility. Clinical chemistry and laboratory medicine. 2018;56:1269-76. https://doi.org/10.1515/cclm-2018-0128.

[21] Stegemann E, Tegtmeier C, Bimpong-Buta NY, Sansone R, Uhlenbruch M, Richter A, et al. Carbondioxide-Aided Angiography Decreases Contrast Volume and Preserves Kidney Function in Peripheral Vascular Interventions. Angiology. 2016;67:875-81. https://doi.org/10.1177/0003319715614701.

[22] Weisbord SD, Palevsky PM. Strategies for the prevention of contrast-induced acute kidney injury. Current opinion in nephrology and hypertension. 2010;19:539-49. https://doi.org/10.1097/MNH.0b013e32833d42e3

Downloads

Published

2025-09-20

How to Cite

1.
Ahmed S, Rehman HU, Rabbani S, Yousaf A, Najmuddin N, Safeer SR, et al. Contrast Induced Nephropathy, Risk, Prevention, and Imaging Alternatives. J Neonatal Surg [Internet]. 2025 Sep. 20 [cited 2026 May 22];14(32S):10752-7. Available from: https://jneonatalsurg.com/index.php/jns/article/view/10125

Issue

Vol. 14 No. 32S (2025): Journal of Neonatal Surgery

Section

Original Article

License

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

You are free to:

  • Adapt — remix, transform, and build upon the material for any purpose, even commercially.

Terms:

  • Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
  • No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.