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Updated: Sep 8, 2025

A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion
09:02

A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion

Published on: February 2, 2021

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Marked bilateral global persistent CT nephrogram 48 h after percutaneous coronary intervention with contrast-induced

Norihito Moniwa1,2, Ayumu Kimura3, Ryo Nishikawa4

  • 1Department of Nephrology, Teine Keijinkai Hospital, 1-40, 1 jo 12 chome Maeda Teine-ku, Sapporo, 006-8555, Japan. moniwa@sapmed.ac.jp.

CEN Case Reports
|June 13, 2022
PubMed

Insights

Patients with very low ejection fraction (EF) face a high risk of contrast-induced nephropathy (CIN). Persistent retention of iodinated contrast media in the kidney cortex after procedures like percutaneous coronary intervention exacerbates this risk.

Area of Science:

  • Nephrology
  • Cardiology
  • Radiology

Background:

  • Iodinated contrast media (CM) are typically rapidly excreted by the kidneys.
  • Persistent nephrograms after CM administration are linked to contrast-induced nephropathy (CIN).
  • Patients with pre-existing chronic kidney disease (CKD) and heart failure are vulnerable populations.

Observation:

  • A 74-year-old woman with severe heart failure (ejection fraction 11%) and CKD underwent percutaneous coronary intervention (PCI) for left anterior descending artery occlusion.
  • The procedure involved a large volume of iodinated CM (iohexol) despite preventive saline hydration.
  • Following PCI, the patient developed severe CIN requiring hemodialysis.

Findings:

  • Post-PCI non-contrast CT revealed a persistent bilateral nephrogram 48 hours after CM administration.
  • Significant CM retention was observed in the renal cortex (168 HU).
  • Vicarious CM excretion occurred in the gastrointestinal tract (small bowel and colon).

Implications:

  • Very low ejection fraction is a significant risk factor for severe CIN, potentially due to impaired CM excretion.
  • Persistent nephrograms may indicate a higher risk of CIN development and progression.
  • This case highlights the need for careful CM volume management and risk assessment in high-risk cardiac patients.

Keywords:
Contrast-induced nephropathyHeart failurePersistent nephrogram

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