Contrast-Induced Acute Kidney Injury: Review and Practical Update

Ramez Morcos, Michael Kucharik, Pirya Bansal, Haider Al Taii, Rupesh Manam, Joel Casale, Houman Khalili, Brijeshwar Maini, Ramez Morcos, Michael Kucharik, Pirya Bansal, Haider Al Taii, Rupesh Manam, Joel Casale, Houman Khalili, Brijeshwar Maini

Abstract

Contrast-induced acute kidney injury (CI-AKI) is an important consideration in patients undergoing cardiac catheterization. There has been a continuous strive to decrease morbidity and improve procedural safety. This review will address the pathophysiology, predictors, and clinical management of CI-AKI with a concise overview of the pathophysiology and a suggested association with left atrial appendage closure. Minimizing contrast administration and intravenous fluid hydration are the cornerstones of an effective preventive strategy. A few adjunctive pharmacotherapies hold promise, but there are no consensus recommendations on prophylactic therapies.

Keywords: Contrast-induced acute kidney injury; cardiac catheterization; clinical management; pathophysiology; predictors.

Conflict of interest statement

Declaration of conflicting interests:The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

© The Author(s) 2019.

Figures

Figure 1.
Figure 1.
The proposed mechanism of contrast-media-mediated nephrotoxicity. Contrast media mediates renal toxicity via the interplay of (1) direct cytotoxicity to the renal endothelial and tubular cells, leading to a cycle of oxidative stress, hypoxia, and further tubular damage, and (2) viscous properties of contrast-triggering vasoconstriction, reduced urinary flow rate, and medullary hypoperfusion.
Figure 2.
Figure 2.
Changes in renal pathophysiology with age. A gradual decline in nitric oxide leads to vasoconstriction of the afferent and efferent arterioles, increased mesangial cell growth and fibrosis, and an irreversible decline in renal function.
Figure 3.
Figure 3.
Proposed algorithm for CI-AKI prevention in cardiac Cath patients. Minimizing contrast administration and intravenous fluid hydration for effective preventive strategies. CI-AKI indicates contrast-induced acute kidney injury; GFR, glomerular filtration rate; LVEDP, left ventricular end-diastolic pressure. aNo guideline recommendations on statin initiation for CI-AKI prevention.

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