Findings on intraprocedural non-contrast computed tomographic imaging following hepatic artery embolization are associated with development of contrast-induced nephropathy
Open Access
- 29 November 2020
- journal article
- Published by Baishideng Publishing Group Inc. in World Journal of Nephrology
- Vol. 9 (2), 33-42
- https://doi.org/10.5527/wjn.v9.i2.33
Abstract
Contrast-induced nephropathy (CIN) is a reversible form of acute kidney injury that occurs within 48-72 h of exposure to intravascular contrast material. CIN is the third leading cause of hospital-acquired acute kidney injury and accounts for 12% of such cases. Risk factors for CIN development can be divided into patient- and procedure-related. The former includes pre-existing chronic renal insufficiency and diabetes mellitus. The latter includes high contrast volume and repeated exposure over 72 h. The incidence of CIN is relatively low (up to 5%) in patients with intact renal function. However, in patients with known chronic renal insufficiency, the incidence can reach up to 27%. To examine the association between renal enhancement pattern on non-contrast enhanced computed tomographic (CT) images obtained immediately following hepatic artery embolization with development of CIN. Retrospective review of all patients who underwent hepatic artery embolization between 01/2010 and 01/2011 (n = 162) was performed. Patients without intraprocedural CT imaging (n = 51), combined embolization/ablation (n = 6) and those with chronic kidney disease (n = 21) were excluded. The study group comprised of 84 patients with 106 procedures. CIN was defined as 25% increase above baseline serum creatinine or absolute increase ≥ 0.5 mg/dL within 72 h post-embolization. Post-embolization CT was reviewed for renal enhancement patterns and presence of renal artery calcifications. The association between non-contrast CT findings and CIN development was examined by Fisher’s Exact Test. CIN occurred in 11/106 (10.3%) procedures (Group A, n = 10). The renal enhancement pattern in patients who did not experience CIN (Group B, n = 74 with 95/106 procedures) was late excretory in 93/95 (98%) and early excretory (EE) in 2/95 (2%). However, in Group A, there was a significantly higher rate of EE pattern (6/11, 55%) compared to late excretory pattern (5/11) (P < 0.001). A significantly higher percentage of patients that developed CIN had renal artery calcifications (6/11 vs 20/95, 55% vs 21%, P = 0.02). A hyperdense renal parenchyma relative to surrounding skeletal muscle (EE pattern) and presence of renal artery calcifications on immediate post-HAE non-contrast CT images in patients with low risk for CIN are independently associated with CIN development.Keywords
This publication has 30 references indexed in Scilit:
- Persistent renal enhancement after intra-arterial versus intravenous iodixanol administrationEuropean Journal of Radiology, 2011
- Incidence and risk factors for radiocontrast-induced nephropathy in patients with hepatocellular carcinoma undergoing transcatheter arterial chemoembolizationClinical and Experimental Nephrology, 2011
- Renal Insufficiency After Contrast Media Administration Trial II (REMEDIAL II)Circulation, 2011
- Prevention of Contrast-Induced Nephropathy (CIN) in Interventional Radiology PracticeSeminars in Interventional Radiology, 2010
- Risk Prediction of Contrast-Induced NephropathyThe American Journal of Cardiology, 2006
- Contrast-Induced NephropathyAmerican Journal of Roentgenology, 2004
- A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary interventionJournal of the American College of Cardiology, 2004
- Causes of acute renal dysfunction after percutaneous coronary intervention and comparison of late mortality rates with postprocedure rise of creatine kinase-MB versus rise of serum creatinineThe American Journal of Cardiology, 2004
- Contrast Material-Induced Renal Failure in Patients with Diabetes Mellitus, Renal Insufficiency, or BothNew England Journal of Medicine, 1989
- Hospital-acquired renal insufficiency: A prospective studyAmerican Journal Of Medicine, 1983