Contrast-media-induced nephrotoxicity: a consensus report

The purpose of this study was using ton sensus methodology, to document cur rent under-standing of contrast media nephrotoxicity (CMN) ana to identify areas where there is disagreement or confusion. To draw up guidelines for a voiding CMN based on the current understanding of the condition established by the survey One hundred sixty-four 1 statements were mailed to 148 membe rs of the European Society of Urogenital Radiology (ESUR) and to 48 experts in the field of CMN. They were asked about the definition, clinical featur es, predisposing factors and pathophysiology of CMN and about pro-phylactic measures. The importance of the statements was rated on a scale from 1 to 10 (1 least important, 10 most important). Fifty-three members (38 %) and 2 3 experts (48 %) responded. Both groups considered that an increase in seru m creatinine that peaks within 3-4 days and a decrease in creatinine cleara nce are the most important (rating >7) features of CMN. Enzymuria was not c onsidered important (rating < 6). Pre-existing renal insufficiency, diabeti c nephropathy, dehydration, congestive heart fail: concurrent administratio n of nephrotoxic drugs and the dose and type of contrast media were conside red to be risk factors. Reduction in renal perfusion and damage to tubular cells were considered the main factors in the pathophysiology of CMN (ratin g > 6). Hydration and the use of low osmolar con contrast media were though t to minimize the incidence of CMN (rating > 6). The majority of the respon ders, (84.6% of members and 95.5% of experts) believe that the incidence of CMN in patients with normal renal function is less than 5 %. Of the member s, 62.5 %, and 35.3 % of experts, believe that the incidence of CMN is 20-3 0 % in the presence of risk factors. There was disagreement about the defin ition of CMN, the threshold dose of contrast media above which renal implic ations may develop, the safe period between repeat injections, the relevanc e of contrast media renal retention shown on CT and whether contrast media have long-term effects on renal function. The survey showed good understand ing of CMN among those who answered the questionnaires, although areas of d isagreement remain which require further research search. Simple guidelines are proposed.