Contrast induced nephropathy definition

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamed Moubarak, M.D. [2]

Overview

Definition

There are three necessary components for the definition of CIN:[1]

  • Elevated serum creatinine compared to the baseline values.
  • Temporal relationship between the rise in serum creatinine and exposure to a contrast agent.
  • Exclusion of alternative explanations for renal impairment.

Contrast-induced nephropathy is defined as either a greater than 25% increase of serum creatinine or an absolute increase in serum creatinine of 0.5 mg/dL that occur 48–72 hours following the exposure to CM.[1][2] According to a study that aimed to describe the course of creatinine rise and its determinants after exposure to contrast media, the first 24 hours post-exposure appear to be crucial in the development of CIN.[1][3] The same study showed that patients with less than 0.5 mg/dl rise in serum creatinine within the first 24 h were unlikely to have any clinically meaningful form of CIN.

2012 KDIGO Clinical Practice Guideline for Acute Kidney Injury

Definition and staging of AKI

Not Graded
"1. AKI is defined as any of the following:
a. Increase in SCr by ≥0.3 mg/dl (≥26.5 μmol/l) within 48 hours; or
b. Increase in SCr to ≥1.5 times baseline, which is known or presumed to have occurred within the prior 7 days; or
c. Urine volume <0.5 ml/kg/h for 6 hours. (Level of Evidence: Not Graded)"
"2. AKI is staged for severity according to the following criteria (Table 2). (Level of Evidence: Not Graded)"

Table 2: Staging of AKI

Stage Serum creatinine Urine output
1 1.5–1.9 times baseline OR ≥0.3 mg/dl (≥26.5 μmol/l) increase <0.5 ml/kg/h for 6–12 hours
2 2.0–2.9 times baseline <0.5 ml/kg/h for ≥12 hours
3 3.0 times baseline OR Increase in serum creatinine to ≥4.0 mg/dl (≥353.6 μmol/l) OR Initiation of renal replacement therapy OR In patients <18 years, decrease in eGFR to <35 ml/min per 1.73 m2 <0.3 ml/kg/h for ≥24 hours OR Anuria for ≥12 hours

Definition and staging of CI-AKI

Not Graded
"1. Define and stage AKI after administration of intravascular contrast media as per Recommendations 2.1.1–2.1.2. (Level of Evidence: Not Graded)"
"2. In individuals who develop changes in kidney function after administration of intravascular contrast media, evaluate for CI-AKI as well as for other possible causes of AKI. (Level of Evidence: Not Graded)"

References

  1. 1.0 1.1 1.2 Mehran R, Nikolsky E (2006). "Contrast-induced nephropathy: definition, epidemiology, and patients at risk". Kidney Int Suppl (100): S11–5. doi:10.1038/sj.ki.5000368. PMID 16612394.
  2. Barrett BJ, Parfrey PS (2006). "Clinical practice. Preventing nephropathy induced by contrast medium". N. Engl. J. Med. 354 (4): 379–86. doi:10.1056/NEJMcp050801. PMID 16436769.
  3. Guitterez NV, Diaz A, Timmis GC, O'Neill WW, Stevens MA, Sandberg KR; et al. (2002). "Determinants of serum creatinine trajectory in acute contrast nephropathy". J Interv Cardiol. 15 (5): 349–54. PMID 12440177.


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