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Bilateral Sustained Nephrograms After Parenteral Administration of Iodinated Contrast Material: A Potential Biomarker
Jennifer S McDonald1, Erik M Steckler1, Robert J McDonald1
1Department of Radiology, Mayo Clinic, Rochester, MN.
Insights
Persistent bilateral global nephrograms after contrast imaging are linked to a higher risk of acute kidney injury (AKI), dialysis, and mortality. This finding highlights the importance of monitoring kidney function post-contrast exposure.
Area of Science:
- Nephrology
- Radiology
- Critical Care Medicine
Background:
- Persistent bilateral global nephrograms on imaging may indicate contrast-induced nephropathy.
- Understanding the association between nephrograms and adverse outcomes is crucial for patient management.
Purpose of the Study:
- To investigate the association between persistent bilateral global nephrograms and the risk of acute kidney injury (AKI).
- To determine if nephrograms correlate with the need for dialysis and patient mortality.
Main Methods:
- Retrospective analysis of patients undergoing contrast-enhanced CT or cardiac catheterization and subsequent noncontrast CT.
- Nephrogram identification via radiologist review and CT attenuation measurements.
- Comparison of AKI, dialysis, and mortality rates between patients with and without bilateral global nephrograms.
Main Results:
- 37.4% of patients developed nephrograms, with higher rates after interventional procedures.
- Significant risk factors for nephrogram development included age, chronic kidney disease, and hypotension/shock.
- Patients with nephrograms showed significantly higher rates of AKI (37.0% vs 5.2%), dialysis (17.4% vs 1.3%), and mortality (15.2% vs 1.3%).
Conclusions:
- Persistent bilateral global nephrograms are associated with increased risks of AKI, dialysis, and mortality.
- The presence of a nephrogram serves as a potential indicator of adverse kidney outcomes post-contrast administration.
Objective:
To determine whether persistent bilateral global nephrograms are associated with acute kidney injury (AKI), dialysis, and mortality.
Patients And Methods:
All patients who underwent (1) contrast-enhanced computed tomography (CT) or cardiac catheterization with iohexol between January 1, 2000, and December 31, 2014, and (2) noncontrast abdominal CT in the subsequent 24±6 hours were identified. Patients without preprocedure and postprocedure creatinine measurements or who received additional contrast material were excluded. Nephrograms were identified by radiologist review and CT attenuation measurements. Univariate and multivariate analyses were performed to determine nephrogram risk factors. Acute kidney injury (defined as a creatinine level of ≥0.5 mg/dL or Kidney Disease: Improving Global Outcomes stages 1-3), dialysis, and mortality proportions were compared between patients with and without bilateral global nephrograms using the Fisher's exact test.
Results:
A total of 123 patients met all inclusion criteria. The proportion of patients with a nephrogram was 37.4% (n=46), with a higher proportion following interventional (67% [18 of 30]) vs diagnostic (27.3% [9 of 33]) catheterization or contrast-enhanced computed tomography (31.7% [19 of 60]). Age (P=.002), chronic kidney disease (P=.05), and acute hypotension or shock (P=.02) were significant risk factors for nephrogram development. Patients with nephrogram had significantly higher rates of AKI (37.0% [17 of 46] vs 5.2% [4 of 77]; odds ratio [OR], 10.7 [95% CI, 3.31-34.5]; P<.001), dialysis (17.4% [8 of 46] vs 1.3% [1 of 77]; OR, 16.0 [95% CI, 1.93-133]; P=.001), and mortality (15.2% [7 of 46] vs 1.3% [1 of 77]; OR, 13.6 [1.62-115]; P=.003) than patients without nephrogram.
Conclusion:
The presence of persistent bilateral global nephrograms suggests an increased risk of AKI, dialysis, and mortality when compared with patients whose kidneys fully eliminated the contrast material.
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