Radiographic contrast agents

Can result in acute reduction in renal function.

Sensitive kidney tests can indicate mild, transient changes in most individuals exposed to intravascular iodinated contrast medium.

Induced nephropathy defined as a 0.5 mg per d/L or 25% rise in serum creatinine levels after exposure to contrast medium.

Risk factors for contrast-associated reductions in renal function include: preexisting renal disease, particularly diabetic nephropathy, concomitant administration of drugs that regulate renal perfusion, and high volume of contrast administered.

Induce acute reduction in renal function in 9%-40% of diabetics with mild to moderate renal insufficiency and 50%-90% in patients with severe chronic renal insufficiency.

Conventional high-osmolality ionic agents can cause renal damage with as little as 100 ml of agent.

Isoosmolar, nonionic agents cause only minimal increase in creatinine and the limit of use of these agents is 400 ml. However, prospective studies show that high and low osmolality agents have similar, 8%, incidence of contrast nephropathy.

Iodinated contrast media use has increased dramatically with four-eightfold increases in cardiac catheterization and computerized tomography.

Typical dose of iodinated contrast media contains approximately 13,500 µg of free iodide and 15-60 g of bound iodine that may be liberated as free iodide in the body (van der Molen AJ et al).

A typical dose of iodinated contrast media provides a iodide load of 92 several hundred thousand times the recommended daily intake of 150 µg and can disrupt thyroid hormone regulation causing hypothyroidism or hyperthyroidism.

The presence of persistent bilateral global nephrograms following contrast studies suggest an increased risk of acute kidney injury, dialysis, and mortality when compared with patients whose kidneys fully eliminated the contrast material.

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