Contrast-Induced Nephropathy.

Contrast-induced nephropathy(CIN) is defined as

 a rise in serum creatinine 25% above baseline,or more than 0.5 mg/dL
 within 3 days following exposure tocontrast media,
 in the absence of an alternative cause.

The precise cause of CIN continues to elude investigators but is believed to be

a combination of tubular injury and renal ischemia .

High doses of IRCM can impair renal function in some

patients for 3 to 5 days
CIN is the thirdmost common cause of acute kidney failure in the hospitalized
patients
The most common patient-relatedrisk factors are

 chronic kidney disease (creatinine clearance<60 mL/min),

 diabetes mellitus,
 dehydration,
 congestive heart failure,
 age,
 hypertension,
 low hematocrit,
 ventricular ejection fraction less than 40%.

The patients at highest risk for developing CIN are thosewith both diabetes
and preexisting renal insufficiency.

The most common non–patient-related causes are

 Highosmolar contrast agents,

 ionic contrast,
 increased contrast viscosity, and
 large-contrast volume infusion

The summary of the meta-analysis for the preventionof CIN after contrast
media use supports using hydration,bicarbonate, iso- or low-osmolar
contrast media, andN-acetylcysteine.
In one review article, N-acetylcysteinewas determined to be more
protective than hydrationalone.
N-acetylcysteine is inexpensive, readily available, administeredorally, and
associated with few drug interactions or side effects.

Its mechanism of protection against CIN is not understood but mayserve as a

scavenger of oxygen-free radicals and/or augment thevasodilatory effects of
nitric oxide in the

Doses used in the different studies ranged from 600 to 1200 mg orally twice a
day for 2 doses before the contrastenhanced study and 2 doses after the
procedure