Contrast-induced nephropathy in patients with aneurysmal subarachnoid hemorrhage

Patients with aneurysmal subarachnoid hemorrhage (SAH) frequently undergo multiple angiographic studies within a 48-h period. We sought to evaluate the impact of these repeated contrast loads on renal function.

We reviewed the records of a consecutive series of 104 patients with aneurysmal subarachnoid hemorrhage, most of whom underwent at least an initial CT angiogram and digital subtraction angiography. Six patients had baseline renal disease. Initial creatinine levels were compared to maximum levels over a subsequent 48-h period after their last angiographic study. We defined contrast-induced nephropathy (CIN) as an increase in creatinine of at least 0.3 from baseline.

The mean change in creatinine following treatment was 0.05 ± 0.23, with three patients developing CIN (2.9%). In 2 cases of CIN, the creatinine increase was inconsequential (0.39 and 0.44). All patients with CIN had an early return of their creatinine to baseline; none required dialysis or suffered permanent sequelae as a result of these creatinine increases. There was no statistically significant difference in the rate of CIN in patients treated with microsurgical clipping (n = 85) as compared to those who underwent coiling (n = 19).

Our results underscore the relative safety of the usage of multiple angiographic studies performed in patients with aneurysmal SAH, particularly in patients without baseline renal disease.