If contrast dye were nephrotoxic, then it would have to be an extremely weak nephrotoxin of no real clinical significance. Overall, given the massive amount of study which has been spent on this issue, it's highly reassuring that no definitive evidence of harm has been found.
The renal effects of contrast dye have probably been more intensely investigated than the renal effect of any other drug or substance in medical history. Clinicians are often tasked with balancing the risk-vs-benefit of the administration of IV contrast for CT scanning. Currently, this calculation would seem to be as follows:. From an evidentiary standpoint, avoidance of contrast dye is difficult to justify.
Physicians are often risk-averse, as we certainly want to avoid causing harm. However, the best available evidence suggests that our patients will benefit the most if we don't shy away from using contrast dye in scenarios where it is indicated.
Still avoiding iodinated contrast in sick patients going for CT scan? Hinson et al. Given how much we worry about contrast nephropathy, you might think that contrast dye is the only potentially nephrotoxic substance in the hospital. In fact, contrast dye is probably among the least nephrotoxic things that we prescribe. The following list includes commonly used drugs which are definitely nephrotoxic:.
We worry a lot about contrast nephropathy because it has its own special name. Meanwhile, we often don't think much about other drugs, which are proven nephrotoxins. This is entirely illogical. Avoiding nephrotoxins among critically ill patients is obviously important. Our efforts along this vein should be aimed at drugs which are known nephrotoxins.
We need to stop worrying about IV contrast dye and focus more on drugs which are actually causing harm. We're wasting our time chasing a ghost, while true card-carrying nephrotoxins often pass by without much attention.
Renal injury can occur following intra-arterial procedures e. It's unclear why this occurs, with possible causes including the following:. This is hard to sort out because it's impossible to perform a non-contrast cardiac catheterization. Therefore, it's even harder to investigate this topic than it is to investigate IV contrast for CT scans.
No clear statement can be made on this topic currently. Unlike CT scans, this issue is less ubiquitous among critically ill patients. It may be best to defer management of this issue to interventional cardiologists who will invariably be involved in the management of any patient going to the cardiac catheterization lab. Want to Download the Episode? We are the EMCrit Project , a team of independent medical bloggers and podcasters joined together by our common love of cutting-edge care, iconoclastic ramblings, and FOAM.
However, upon closer examination, this chain of reasoning doesn't hold up… 1 does contrast dye cause an increase in creatinine? Currently, this calculation would seem to be as follows: Risk of using contrast dye: There is no high-quality evidence that this risk exists. Benefit of using contrast dye: This is often quite real although it will certainly vary, depending on the clinical scenario. Pallone, C. Cao, A.
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CIN is a rare disorder and occurs when kidney problems are caused by the use of certain contrast dyes. In most cases contrast dyes used in tests, such as CT computerized tomography and angiograms, have no reported problems. About 2 percent of people receiving dyes can develop CIN. However, the risk for CIN can increase for people with diabetes, a history of heart and blood diseases, and chronic kidney disease CKD. CIN is associated with a sharp decrease in kidney function over a period of hours.
The symptoms can be similar to those of kidney disease, which include feeling more tired, poor appetite, swelling in the feet and ankles, puffiness around the eyes, or dry and itchy skin. In many cases, CIN is reversible and people can recover. However, in some cases, CIN can lead to more serious kidney problems and possible heart and blood vessel problems.
NSF is a rare but serious disease affecting skin and other organs that has been found in some patients with advanced CKD after exposure to gadolinium-containing contrast dyes that are used in magnetic resonance imaging MRI.
People with acute kidney injury AKI are also at higher risk. NSF has not been reported in people with mild kidney damage or normal kidney function. NSF can be painful, debilitating, or even fatal. Symptoms and signs of NSF can include burning and itching of the skin, red or dark patches on the skin, joint stiffness, or muscle weakness. The disease can develop within 24 hours up to around 3 months.
MRIs are routinely used in patients to visualize internal organs and limbs to help detect and monitor many different diseases or injuries.
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