CONTRAST-ASSOCIATED NEPHROPATHY - PRESENTATION, PATHOPHYSIOLOGY AND MANAGEMENT

Contrast-associated nephropathy, a significant rise in serum creatinin e 1-5 days following intervascular contrast injection, remains one of the most serious complications of contrast imaging. The reported incid ence varies widely; in consecutive random cases ranges from 2 to 7%, b ut it can increase 5- to 10-fold in high risk patients with serum crea tinine > 1.5 mg/dl. Postulated mechanisms of renal damage include vaso constriction and direct tubular cell injury. The usual clinical presen tation is an asymptomatic increase in serum creatinine without oliguri a. Residual loss of renal function occurs in principle in patients wit h preexisting renal impairment. Aggressive prestudy hydration along wi th selective use of low osmolar contrast media can significantly reduc e the risk of contrast nephropathy for patients with either chronic re nal failure or diabetic nephropathy.