Iodinated contrast medium: Is there a re(n)al problem? A clinical vignette-based review
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REVIEW
Iodinated contrast medium: Is there a re(n)al problem? A clinical vignette‑based review Karim Lakhal1* , Stephan Ehrmann2 and Vincent Robert‑Edan1
Abstract As we were taught, for decades, that iodinated contrast-induced acute kidney injury should be dreaded, considerable efforts were made to find out effective measures in mitigating the renal risk of iodinated contrast media. Imaging procedures were frequently either downgraded (unenhanced imaging) or deferred as clinicians felt that the renal risk pertaining to contrast administration outweighed the benefits of an enhanced imaging. However, could we have missed the point? Among the abundant literature about iodinated contrast-associated acute kidney injury, recent meaningful advances may help sort out facts from false beliefs. Hence, there is increasing evidence that the nephro‑ toxicity directly attributable to modern iodinated CM has been exaggerated. Failure to demonstrate a clear benefit from most of the tested prophylactic measures might be an indirect consequence. However, the toxic potential of iodinated contrast media is well established experimentally and should not be overlooked completely when making clinical decisions. We herein review these advances in disease and pathophysiologic understanding and the associ‑ ated clinical crossroads through a typical case vignette in the critical care setting. Keywords: Contrast media (MeSH: D003287), Intensive care units (MeSH D007362), Drug-related side effects and adverse reactions (MeSH D064420), Tomography scanners, X-ray computed (MeSH: D015898), Percutaneous coronary interventions (MeSH: D062645), Contrast-induced nephropathy, Post-contrast acute kidney injury Background The use of iodinated contrast media (CM) to enhance the imaging visualization of anatomical structures is very frequent. However, in clinical practice, whether the benefits of iodinated CM administration outweigh its potential harms is often unclear [1, 2]. Indeed, acute kidney injury (AKI) that follows intravascular administration of CM— also referred to as contrast-associated AKI (CA-AKI)—is a major concern since it is associated with negative outcomes [3–5]. It occurs in 10–20% of critically ill patients [6], depending on several clinical factors including the patient’s condition but also depending on the definition used [3]. Therefore, clinicians are often puzzled [7]: how *Correspondence: [email protected] 1 Service d’Anesthésie‑Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, Boulevard Jacques‑Monod, Saint‑Herblain, 44093 Nantes, France Full list of author information is available at the end of the article
to reliably estimate the renal risk of iodinated CM infusion in a patient? How big is the burden of CM renal toxicity? Are there means to attenuate this renal risk? Should the imaging procedure, even urgent, be cancelled or postponed? Within the impressive myriad of scientific articles on the subject [8], several points have been recently reappraised. We herein review these significant advanc
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