contrast induce acute renal injury

1. 1

2. Contrast-Induced Acute
Kidney Injury (CI-AKI)
Gamal Fahim, MD
Cardiology department
Mansoura university
24 October 2019
Annual Nephrology Meeting
ggomaa.blogspot.com

3. Contrast-Induced Acute Kidney
Injury (CI-AKI)
• CASE SCENORIO
• EPIDEMIOLOGY
• PATHOPHYSIOLOGY
• PROGNOSIS
• MANAGEMENT
• CONCLUSIONS

4. Contrast-Induced Acute Kidney
Injury (CI-AKI)
• CASE SCENORIO

7. Clinical data
• Male
• 57 years
• Heavy smoker
• Acute severe prolonged chest pain
• STEMI: inferolateral MI
• CARDIAC ARREST: rec. VF, CPR, 12 DC , 45 min
• Invasive ventilation

9. VF with Defibrillation (12-lead ECG)

10. Ventricular Flutter
Spontaneous conversion to NSR (12-lead ECG)

11. Clinical data
• Stable cardiac rhythm
• Weaning from ventilation
• DAP
• IV Fluids
• UFH
• Diagnostic coronary angiography: right radial
• Primary angioplasty

12. Anatomy of major epicardial coronaries

24. Primary angioplasty
• Right radial
• Full dose integrlin
• XB 3.5 6 F
• FLOPPY WIRE
• LAD Stenting
• LCX/OM PCI and stenting

46. 10/25/2019 46
FINAL RESULT
BASELINE FINAL

47. CLINICAL COURCE
• Stable
• Discharged after 5 days
• Regular follow up visits
• Last 1 month ago

48. Contrast-Induced Acute Kidney
Injury (CI-AKI)
• CASE SCENORIO
• EPIDEMIOLOGY

51. Contrast-Induced Acute Kidney
Injury (CI-AKI)
• CASE SCENORIO
• EPIDEMIOLOGY
• PATHOPHYSIOLOGY

54. Contrast-Induced Acute Kidney
Injury (CI-AKI)
• CASE SCENORIO
• EPIDEMIOLOGY
• PATHOPHYSIOLOGY
• PROGNOSIS

56. Contrast-Induced Acute Kidney
Injury (CI-AKI)
• CASE SCENORIO
• EPIDEMIOLOGY
• PATHOPHYSIOLOGY
• PROGNOSIS
• MANAGEMENT

57. Intravascular Iodinated Contrast Agents: Characteristics
Modified from Manual on Contrast Media of the American College of Radiology (ACR) Committee on Drugs
and Contrast Media. Version 10.2, 2016.
GENERIC NAME
OSMOLALITY RANGE
(mOsm/kg H2O)
VISCOSITY RANGE
(cp or mPa.s) 37°C
IONICITY
High osmolarity Diatrizoate/meglumine
Diatrizoate/sodium
1500-2000 4.1-10.5
Ionic
Iothalamate 600-1400 1.5-4
Low osmolarity Ioxaglate 600 7.5
Iodipamide 664 5.6
Iohexol 322-488 1.5-10.4 Nonionic
Iopamidol 413-796 3.0-9.4
Iopromide 330-770 1.5-10
Ioversol 502-792 3-9
Ioxilan 610-721 5.1-8.1
Iso-osmolarity Iodixanol 270-320 6.3-11.8

65. Contrast-Induced Acute Kidney
Injury (CI-AKI)
• CASE SCENORIO
• EPIDEMIOLOGY
• PATHOPHYSIOLOGY
• PROGNOSIS
• MANAGEMENT
• CONCLUSIONS