Contrast Medium Induced Nephropathy: Animal Experiments

Abstract

Contrast medium induced nephropathy may be defined as an acute impairment of renal function that follows exposure to radiographic contrast materials, and for which alternative etiologies have been excluded. Acute renal insufficiency has been reported following exposure to contrast media administered by intravenous and intra-arterial routes. Contrast media may account for as many as 12% of episodes of hospital-acquired acute renal failure, thus exceeding aminoglycoside antibiotics in nephrotoxic potential (Hou et al. 1983). The incidence of contrast medium induced nephropathy is difficult to establish with certainty from the literature, since incidence figures in various reports vary depending on the population studied, the definition of acute renal failure, and differences in methodology (Jevnikar et al. 1988). Furthermore, the true incidence of nonoliguric contrast medium induced nephropathy is not known because it is not routine to systematically monitor renal function following contrast medium administration. Clinically, the glomerular filtration rate is usually assessed indirectly by measuring serum creatinine concentrations or, more precisely, by measuring creatinine clearance. This operational definition may greatly underestimate toxicity that is not severe enough to affect these rather insensitive markers of renal function. Serum creatinine concentration, the measure most often used as indicator of renal dysfunction, may not be elevated above the normal range until glomerular filtration rate falls below 50% of normal values because of its nonlinear relation to glomerular filtration rate.