Contrast Media Induced Nephropathy in Diabetic Renal Disease

  • Indra D. Daniels
  • Eli A. Friedman

Abstract

Diabetes mellitus has been incriminated as a risk factor for radiocontrast-induced nephropathy (CIN) since the 1960’s [39]. Two decades later, the precise risk to the diabetic kidney is still debated with incidence rates ranging from less than 1% to over 30% [31,50,52], especially when complicated by chronic renal failure (CRF). Almost 100% of diabetics with a serum creatinine level (SCr) greater than 400 μmol/l (4.5 mg/dl) can develop CIN after contrast exposure [22,52]. Dialysis is needed in 25–50% of all patients who develop CIN [23,29,49] but in 40–50% of diabetics [16,54], a few permanently [54]. Few studies are confined to diabetic patients and most do not report on diabetic subtypes yet differences in outlook between older and younger diabetics and various subtypes of diabetes almost certainly exist — perhaps Type II diabetic patients are less likely to develop CIN than type 1 patients [22,46]. Methodologic differences between studies and variability in contrast dosages exist. Diagnostic increases in SCr vary between 20% [26] and 50% [12,19,37] over baseline, whereas absolute increases may be as little as 26 μmol/l (0.3 mg/dl) [26] or as liberal as 177 μmol/1 (2.0 mg/dl) [8,9]. A rise in SCr of at least 50% [12,19,38] or 88 μmol/1 (1 mg/dl) [14,19,22,51,52,54] within 48 hours of contrast administration seems acceptable. Furthermore, the applicability of »low osmolality« or »nonionic« radiocontrast materials to the diabetic kidney is unclear. These issues will be addressed in this chapter.

Keywords

Acute Renal Failure Iodinate Contrast Medium Diabetic Kidney Intravenous Pyelography Diabetic Renal Disease 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Almen T. Development of nonionic contrast media. Invest Radiol 1985; 20: Suppl: S2–S9.PubMedCrossRefGoogle Scholar
  2. 2.
    Barrett BJ, Parfrey PS. »Clinical aspects of acute renal failure following use of radiocontrast agents.« In Acute Renal Failure: Diagnosis, Treatment and Prevention, Solez K, Racusen LC, eds. New York: Marcel Dekker Inc., 1991; pp 481–500.Google Scholar
  3. 3.
    Barrett BJ, Parfrey PS, Vavasour HM, McDonald J, Kent G, Hefferton D, O’Dea F, Stone E, Reddy R, McManamon PJ. Contrast nephropathy in patients with impaired renal function: high versus low osmolar media. Kidney Int 1992; 41: 1274–1279.PubMedCrossRefGoogle Scholar
  4. 4.
    Bellin MF, Deray G, Assogba U, Auberton E, Ghany F, Dion-Voirin E, Jacobs C, Grellet J. Gd-GOTA: evaluation of its renal tolerance in patients with chronic renal failure. Magn Reson Imaging 1992; 10:115–118.PubMedCrossRefGoogle Scholar
  5. 5.
    Berkseth RO, Kjellstrand CM. Radiologic contrast-induced nephropathy. Med Clin North Am 1984; 68: 351–370.PubMedGoogle Scholar
  6. 6.
    Brillet G, Dubois M, Beaufils H, Bourbouze R, Deray G. Renal tolerance of AMI 25. Invest Radiol 1991; 26: 879–881.PubMedCrossRefGoogle Scholar
  7. 7.
    Brown R, Youmans R, LiVanec G, Derrick J, Bond Y, Guest M. Cinemicrographic observations of the effects of contrast media on the microcirculation. Vasc Surg 1968; 2: 109–115.PubMedCrossRefGoogle Scholar
  8. 8.
    Byrd L, Sherman RL. Radiocontrast-induced acute renal failure: a clinical and pathophysiologic review. Medicine 1979; 58: 270–279.PubMedCrossRefGoogle Scholar
  9. 9.
    Carvallo A, Rakowski TA, Argy WP Jr, Schreiner GE. Acute renal failure following drip-infusion pyelography. Am J Med 1978; 65: 38–45.PubMedCrossRefGoogle Scholar
  10. 10.
    Cigarroa RG, Lange RA, Williams RH, Hillis LD. Dosing of contrast material to prevent contrast nephropathy in patients with renal disease. Am J Med 1989; 86: 649–652.PubMedCrossRefGoogle Scholar
  11. 11.
    Cochran ST, Wong WS, Roe DJ. Predicting angiography-induced acute renal function impairment: clinical risk model. AJR 1983; 141: 1027–1033.PubMedCrossRefGoogle Scholar
  12. 12.
    Cramer BC, Parfrey PS, Hutchinson TA, Baran D, Melanson DM, Ethier RE, Seely JF. Renal function following infusion of radiologic contrast material: a prospective controlled study. Arch Intern Med 1985; 145: 87–89.PubMedCrossRefGoogle Scholar
  13. 13.
    Cronin RE. »Radiocontrast media-induced acute renal failure.« In Diseases of the Kidney, 3rd ed., Schrier RW, Gottschalk CW, eds. Boston/Toronto: Little, Brown and Co., 1993; pp 1187–1201.Google Scholar
  14. 14.
    D’Elia JA, Gleason RE, Alday M, Malarick C, Godley K, Warram J, Kaldany A, Weinrauch LA. Nephrotoxicity from angiographic contrast material. A prospective study. Am J Med 1982; 72: 719–725.PubMedCrossRefGoogle Scholar
  15. 15.
    Deray G, Dubois M, Baumelou A, Jacobs C. Risques renaux lors de’ daministration de produits de contrast iodes ches les patients diabétiques. Renal tolerance of contrast media in diabetic patients. Diabète Metab 1991; 17: 379–382.PubMedGoogle Scholar
  16. 16.
    Diaz-Buxo JA, Wagoner RD, Hattery RR, Palumbo PJ. Acute renal failure after excretory urography in diabetic patients. Ann Intern Med 1975; 83: 155–158.PubMedCrossRefGoogle Scholar
  17. 17.
    Fischer HW, Spataro RF, Rosenberg PM. Medical and economic considerations in using a new contrast medium. Arch Intern Med 1986; 146: 1717–1721.PubMedCrossRefGoogle Scholar
  18. 18.
    Goldstein HA, Kashanian FK, Blumetti RF, Holyoak WL, Hugo FP, Lumenfield DM. Safety assessment of gadopentate dimeglumine in the United States. Clinical trials. Radiology 1990; 174: 17–23.Google Scholar
  19. 19.
    Gomes AS, Baker JD, Martin-Paredero V et al. Acute renal dysfunction after major arteriography. AJR 1985; 145: 1249–1253.PubMedCrossRefGoogle Scholar
  20. 20.
    Gomes AS, Lois JF, Baker JD, McGlade CT, Bunnell DH, Hartzman S. Acute renal dysfunction in high-risk patients after angiography: comparison of ionic and nonionic contrast media. Radiology 1989; 170: 65–68.PubMedGoogle Scholar
  21. 21.
    Gussenhoven MJ, Ravensbergen J, van Bockel JH, Feuth JD, Aarts JC. Renal dysfunction after angiography; a risk factor analysis in patients with peripheral vascular disease. J Cardiovasc Surg 1991; 32: 81–86.Google Scholar
  22. 22.
    Harkonen S, Kjellstrand CM. Exacerbation of diabetic renal failure following intravenous pyelography. Am J Med 1977; 63: 939–946.PubMedCrossRefGoogle Scholar
  23. 23.
    Harris KG, Smith TP, Cragg AH, Lemke JH. Nephrotoxicity from contrast material in renal insufficiency: ionic versus nonionic agents. Radiology 1991; 179: 849–852.PubMedGoogle Scholar
  24. 24.
    Heyman SN, Brezis M, Reubinoff CA, Greenfield Z, Lechene C, Epstein FH, Rosen S. Acute renal failure with selective medullary injury in the rat. J Clin Invest 1988; 82: 401–412.PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Kumar S, Hull JD, Lathi S, Cohen AJ, Pletka PG. Low incidence of renal failure after angiography. Arch Intern Med 1981; 141: 1268–1270.PubMedCrossRefGoogle Scholar
  26. 26.
    Lautin EM, Freeman NJ, Schoenfeld AH, Bakal CW, Haramati N, Friedman AC, Lautin JL, Braha S, Kadish AG, Sprayregen S, Belizon I. Radiocontrast-associated renal dysfunction: incidence and risk factors. AJR 1991; 157: 49–58.PubMedCrossRefGoogle Scholar
  27. 27.
    Lautin EM, Freeman NJ, Schoenfeld AH, Bakal CW, Haramati N, Friedman AC, Lautin JL, Braha S, Kadish AG, Sprayregen S, Belizon I. Radiocontrast-associated renal dysfunction: a comparison of lower-osmolality and conventional high-osmolality contrast media. AJR 1991; 157: 59–65.PubMedCrossRefGoogle Scholar
  28. 28.
    Lawrence V, Matthai W, Hartmaier S. Comparative safety of high-osmolality radiographic contrast agents. Report of a multidisciplinary working group. Invest Radiol 1992; 27: 2–28.PubMedCrossRefGoogle Scholar
  29. 29.
    Manske CL, Sprafka JM, Strony JT, Wang Y. Contrast nephropathy in azotemic patients undergoing coronary angiography. Am J Med 1990; 89: 615–620.PubMedCrossRefGoogle Scholar
  30. 30.
    Martin-Paredero V, Dixon SM, Baker JD, Takiff H, Gomes AS, Busuttil RW, Moore WS. Risk of renal failure after major angiography. Arch Surg 1983; 118: 1417–1420.PubMedCrossRefGoogle Scholar
  31. 31.
    Mason RA, Arbeit LA, Giron F. Renal dysfunction after arteriography. JAMA 1985;253: 1001–1004.PubMedCrossRefGoogle Scholar
  32. 32.
    McMillan DE. Diabetic angiopathy — its lesions in vascular physiology. Am Heart J 1978; 96: 401–406.PubMedCrossRefGoogle Scholar
  33. 33.
    McMillan DE. Deterioration of the microcirculation in diabetes mellitus. Diabetes 1975; 24: 944–957.PubMedCrossRefGoogle Scholar
  34. 34.
    Moore RD, Steinberg EP, Powe NR, Brinker JA, Fishman EK, Graziano S, Gopalan R. Nephrotoxicity of high-osmolality versus low-osmolality contrast media: randomized clinical trial. Radiology 1992; 182: 649–655.PubMedGoogle Scholar
  35. 35.
    Moreau JF, Lasavre P, Timsit J. Iodinated contrast media and diabetes mellitus. J Radiol 1992; 73: 83–87.PubMedGoogle Scholar
  36. 36.
    Niendorf HP, Haustein J, Cornelius I, Alhassan A, Clauss W. Safety of gadolinium-DTPA: extended clinical experience. Magn Reson Med 1991; 22: 222–228; 229-232.PubMedCrossRefGoogle Scholar
  37. 37.
    Parfrey PS, Griffiths SM, Barrett BJ, Paul MD, Genge M, Withers J, Farid N and McManamon PJ. Contrast material-induced renal failure in patients with diabetes mellitus, renal insufficiency, or both. N Engl J Med 1989; 320: 143.Google Scholar
  38. 38.
    Permal S, Verny C, Bellin MF, Grellet J, Grimaldi A. Nephropathy caused by iodinated contrast media and diabetes mellitus. J D’Urologie 1992; 98: 466–469.Google Scholar
  39. 39.
    Pillay VKG, Robbins PC, Schwartz FD, Kark RM. Acute renal failure following intravenous urography in patients with long-standing diabetes mellitus and azotemia. Radiology 1970; 95: 633–636.PubMedGoogle Scholar
  40. 40.
    Rasmussen HH, Ibels LS. Acute renal failure: multivariate analysis of causes and risk factors. Am J Med 1982; 72: 211–218.CrossRefGoogle Scholar
  41. 41.
    Rich MW, Crecelius CA. Incidence, risk factors, and clinical course of acute renal insufficiency after cardiac catheterization in patients 70 years of age or older. A prospective study. Arch Intern Med 1990; 150: 1237–1242.PubMedCrossRefGoogle Scholar
  42. 42.
    Schiantarelli P, Peroni F, Rosati G. Effects of iodinated contrast media on erythrocytes. Invest Radiol 1973; 8: 199.PubMedCrossRefGoogle Scholar
  43. 43.
    Schwab SJ, Hlatky MA, Pieper KS, Davidson CJ, Morris KG, Shelton TN, Bashore TM. Contrast nephrotoxicity: a randomized controlled trial of a nonionic and an ionic radiographic contrast agent. N Engl J Med 1989; 320: 149.PubMedCrossRefGoogle Scholar
  44. 44.
    Shafi T, Chou S, Porush JG, Shapiro WB. Infusion intravenous pyelography and renal function effects in patients with chronic renal insufficiency. Arch Intern Med 1978; 138: 1218–1221.PubMedCrossRefGoogle Scholar
  45. 45.
    Shyh TP, Friedman EA. Uninephrectomy does not potentiate contrast media nephrotoxicity in the streptozotocin-induced diabetic rat. Nephron 1990; 55: 170–175.PubMedCrossRefGoogle Scholar
  46. 46.
    Shieh SD, Hirsch SR, Boshell BR, Pino JA, Alexander LJ, Witten DM, Friedman EA. Low risk of contrast media-induced acute renal failure in nonazotemic type 2 diabetes mellitus. Kidney Int 1982; 21: 739.PubMedCrossRefGoogle Scholar
  47. 47.
    Spataro RF. Newer contrast agents for urography. Radiol Clin North Am 1984; 22: 365–379.PubMedGoogle Scholar
  48. 48.
    Spinler SA, Goldfarb S. Nephrotoxicity of contrast media following cardiac angiography: pathogenesis, clinical course, and preventive measure, including the role of low-osmolality contrast media. Ann Pharmacother 1992; 26: 56–64.PubMedGoogle Scholar
  49. 49.
    Taliercio CP, McCallister SH, Holmes DR, Ilstrup DM, Vlietstra RE. Nephrotoxicity of nonionic contrast media after cardiac angiography. Am J Cardiol 1989; 64: 815–816.PubMedCrossRefGoogle Scholar
  50. 50.
    Taliercio CP, Vlietstra RE, Ilstrup DM, Burnett JC, Menke KK, Stensrud SL, Holmes DR Jr. A randomized comparison of the nephrotoxicity of iopamidol and diatrizoate in high risk patients undergoing cardiac angiography. J Am Coll Card 1991; 17: 384–390.CrossRefGoogle Scholar
  51. 51.
    Teruel JL, Marcen R, Onaindia JM, Serrano A, Quereda C, Ortuno J. Renal functional impairment caused by intravenous urography: a prospective study. Arch Intern Med 1981; 141: 1268–1270.CrossRefGoogle Scholar
  52. 52.
    Van Zee BE, Hoy WE, Talley TE, Jaenike JR: Renal injury associated with intravenous pyelography in nondiabetic and diabetic patients. Ann Intern Med 1978; 89: 51–54.CrossRefGoogle Scholar
  53. 53.
    Vari RC, Natarajan LA, Whitescarver SA, Jackson BA, Ott CE. Induction, prevention and mechanisms of contrast media-induced acute renal failure. Kidney Int 1988; 33: 699–707.PubMedCrossRefGoogle Scholar
  54. 54.
    Weinrauch LA, Healy RW, Leland OS Jr, Goldstein HH, Kassissieh SD, Fibertino JA, Takacs FJ, D’Elia JA. Coronary angiography and acute renal failure in diabetes azotemic nephropathy. Ann Intern Med 1977; 86: 56–59.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1996

Authors and Affiliations

  • Indra D. Daniels
    • 1
  • Eli A. Friedman
    • 1
  1. 1.Department of MedicineState University of New York Health Science Center at BrooklynBrooklynUSA

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