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Renal failure following radiologic procedures.

¹University of Texas Southwestern Medical Center, Dallas, Texas.

The American Journal of the Medical Sciences

|November 1, 1989

Summary

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Radiologic procedures using contrast media can cause kidney damage. Contrast-induced nephropathy may result from direct toxicity or cholesterol emboli, especially during angiography.

Area of Science:

Nephrology
Radiology
Toxicology

Background:

Radiologic procedures utilizing intravascular contrast media, with or without angiography, pose a risk of renal failure.
The precise mechanism of contrast-induced nephropathy from intravenous contrast alone is not fully elucidated, but direct renal tubular cell toxicity is a probable cause.

Observation:

Both ionic and nonionic contrast agents can precipitate adverse renal reactions.
Renal failure during angiography may be attributed to radiocontrast effects or, alternatively, to micro-cholesterol emboli dislodged from atherosclerotic plaques.

Findings:

Direct toxicity to renal tubular cells is a likely mechanism for contrast-induced nephropathy when using intravenous contrast agents.
The development of renal failure alongside livido reticularis, hypertension, and multiple organ dysfunction suggests a diagnosis of cholesterol microembolism syndrome.

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Implications:

Understanding these mechanisms is crucial for mitigating contrast-induced nephropathy risks.
Distinguishing between contrast toxicity and cholesterol emboli is vital for appropriate patient management and prognosis.