Contrast induced acute kidney injury

Abstract

Contrast induced acute kidney injury (CI-AKI), also known as CIN, is one of the leading causes of acute kidney injury for hospitalized patients worldwide. The pathophysiology involves ischemic tubular injury in addition to decreased renal perfusion caused by high viscosity of contrast agents. Patients with pre-existing chronic kidney disease are more susceptible to develop CI-AKI. Older contrast agents with higher ionicity and osmolality have an increased incidence of causing injury. Additionally, procedures that involve intra-arterial contrast agent administration are associated with an increased risk of developing CI-AKI. Various risk models are present to predict the likelihood of developing CI-AKI, but to minimize the risk, iso-osmolar or selected low osmolar contrast media is advised with the smallest amount of volume. Pre and post procedure volume expansion with isotonic intravenous fluids is also advised. Management of CI-AKI is supportive.