Uploaded byNephroTube - Dr.Gawad
Contrast and the kidney - Dr. Gawad
The document discusses contrast-induced acute kidney injury (CI-AKI) highlighting its risk factors, clinical features, treatment, and prevention strategies. Key points include the importance of hydration, monitoring serum creatinine, and avoiding nephrotoxins to reduce the risk of CI-AKI. It also addresses nephrogenic systemic fibrosis (NSF) related to gadolinium use in patients with chronic kidney disease.
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Contrast and the kidney - Dr. Gawad
- 1. Contrast and TheKidney 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
- 2. To download thelecture contact me drgawad@gmail.com For more Nephrology lectures visit www.NephroTube.com
- 3.
- 5. AKI occurring shortlyafter 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 THEAMERICAN COLLEGE OF CARDIOLOGY. MARCH 24, 2020:1311–20
- 12. JOURNAL OF THEAMERICAN COLLEGE OF CARDIOLOGY. MARCH 24, 2020:1311–20
- 13. JOURNAL OF THEAMERICAN COLLEGE OF CARDIOLOGY. MARCH 24, 2020:1311–20
- 14. JOURNAL OF THEAMERICAN 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-inducednephropathy 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 forsodium bicarbonate or N-acetyl cysteine
- 26. No role forHD 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 within24 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 drgawad@gmail.com Twitter: @Gawad_Nephro Facebook:Doctor.Gawad www.NephroTube.com