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1. Contrast and The Kidney
The Unjustified Fear
Mohammed Abdel Gawad MD Neph, ESENeph
Lecturer of Nephrology, School of Medicine, NewGiza University
Nephrology Consultant, Alexandria
Founder of NephroTube.com
Chair of AFRAN Web & Media Committee
ISN Education SoMe Team Member
drgawad@gmail.com
@Gawad_Nephro
2nd Integrated Qabbary Specialized Hospital Conference
11, August, 2022

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5. AKI occurring shortly after
administration of iodinated
contrast and that may or may not
be directly caused by the contrast
material.
Contrast-associated acute
kidney injury (CA-AKI)
AKI that is due to contrast
material administration
Contrast-induced acute
kidney injury (CI-AKI)
F1000Research 2019, 8(F1000 Faculty Rev):753 Last updated: 29 MAY 2019

6. Contrast-induced AKI - Talk Outline
• Risk scoring
• Why is contrast toxic?
• Precautions and strategies to prevent
• Unproven interventions
• Clinical features
• Treatment
• Gadolinium and nephrogenic systemic fibrosis

7. Contrast-induced AKI - Talk Outline
• Risk scoring
• Why is contrast toxic?
• Precautions and strategies to prevent
• Unproven interventions
• Clinical features
• Treatment
• Gadolinium and nephrogenic systemic fibrosis

11. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY. MARCH 24, 2020:1311–20

12. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY. MARCH 24, 2020:1311–20

13. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY. MARCH 24, 2020:1311–20

14. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY. MARCH 24, 2020:1311–20

15. Contrast-induced AKI - Talk Outline
• Risk scoring
• Why is contrast toxic?
• Precautions and strategies to prevent
• Unproven interventions
• Clinical features
• Treatment
• Gadolinium and nephrogenic systemic fibrosis

16. JACC Cardiovasc Interv. 2019 Oct 14;12(19):1877-1888.

17. Contrast-induced AKI - Talk Outline
• Risk scoring
• Why is contrast toxic?
• Precautions and strategies to prevent
• Unproven interventions
• Clinical features
• Treatment
• Gadolinium and nephrogenic systemic fibrosis

18. The LAKIN contrast-induced nephropathy algorithm. London AKI network manual (2012)

19. Comprehensive Clinical Nephrology. 7th edition. CHAPTER 74. Page 853.

20. Comprehensive Clinical Nephrology. 7th edition. CHAPTER 74. Page 853.

21. Comprehensive Clinical Nephrology. 7th edition. CHAPTER 74. Page 853.

22. Contrast-induced AKI (CI-AKI) prevention
*Hold hydration in hypervolemic
Int J Nephrol Renovasc Dis. 2022; 15: 253–266.

23. Contrast-induced AKI - Talk Outline
• Risk scoring
• Why is contrast toxic?
• Precautions and strategies to prevent
• Unproven interventions
• Clinical features
• Treatment
• Gadolinium and nephrogenic systemic fibrosis

25. No role for sodium bicarbonate or N-acetyl cysteine

26. No role for HD in prophylaxis

27. Other unproven interventions
• Remote ischemic preconditioning
• Statins
• Oral sodium citrate
• Atrial natriuretic peptide
• Ascorbic acid
• Trimetazidine
• Inhibitors of vasoconstriction

28. Contrast-induced AKI - Talk Outline
• Risk scoring
• Why is contrast toxic?
• Precautions and strategies to prevent
• Unproven interventions
• Clinical features
• Treatment
• Gadolinium and nephrogenic systemic fibrosis

29. - Increase within 24 to 48 hours
after the iodinated contrast
- Starts to decline within 3 to 5
days of the exposure to contrast
Serum creatinine
- Most cases: mild AKI: patients
are nonoliguric
- Severe AKI: Oliguria (if it
occurs) develops immediately
after the procedure
UOP
Int J Nephrol Renovasc Dis. 2022; 15: 253–266.

30. Contrast-induced AKI - Talk Outline
• Risk scoring
• Why is contrast toxic?
• Precautions and strategies to prevent
• Unproven interventions
• Clinical features
• Treatment
• Gadolinium and nephrogenic systemic fibrosis

31. Contrast-induced AKI (CI-AKI) Management
Heart Views. 2013 Jul-Sep; 14(3): 106–116.
• Hydration
• Correction of acid base and electrolytes disturbances
• Avoid nephrotoxins
• Dialysis once indicated

32. Contrast-induced AKI - Talk Outline
• Risk scoring
• Why is contrast toxic?
• Precautions and strategies to prevent
• Unproven interventions
• Clinical features
• Treatment
• Gadolinium and nephrogenic systemic fibrosis

33. Nephrogenic systemic fibrosis (NSF)
A progressive, often fatal
disease affecting skin and
internal organs
Caused using gadolinium in
patients with chronic kidney
disease

34. Nephrogenic systemic fibrosis (NSF)
(a). The skin is thickened and resembles a “peau d'orange” and a cobblestone (forearm and dorsolateral side of the
thumb) or a woody aspect (lower leg) (a,b). Additionally, due to the tautness the skin has focally a shiny surface (front
side of the distal lower leg) (a)

35. Nephrogenic systemic fibrosis (NSF)
Clinical picture of long-standing nephrogenic systemic fibrosis. A patient with NSF of about
3 years: diffuse thickening, induration, and hyperpigmentation of lower legs with inhibition
of joint flexion.

36. JAMA Intern Med. 2020;180(2):223-230

39. Contrast-induced AKI - Home Messages
• Contrast may induce acute kidney injury.
• CI-AKI incidence is not that high.
• Hydration and avoidance of nephrotoxins are the cornerstones for
prevention of CI-AKI.
• Monitor creatinine and UOP daily after contrast exposure.
• Risk of NSF is low in CKD with the use of gadolinium group II and III.

40. Thank You
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