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Preventing contrast-associated nephropathy.

Article Excerpt
Some radiology procedures require the use of a contrast material. The contrast may be called radiopaque because it can be seen on x-rays. Dye is injected into the patient's vein as a safe and effective way of visualizing organs and vessels of the body. Radiology procedures that use IV dye include coronary angiography, computed tomography scan, and intravenous pyelogram (Merten et al., 2004).

Complications from the use of IV dye may include allergic reaction or kidney damage. Contrast-induced nephropathy (CIN) is defined typically as a fixed rise in serum creatinine levels of 25% over baseline, or an absolute increase of at least 0.5 mg/dL within 48 hours after exposure to contrast medium that is maintained for 2-5 days and can not be attributed to other causes. Normal levels of creatinine are approximately 0.70-1.20 mg/dL. Age, gender, and body composition influence serum creatinine, making it an inaccurate gauge of kidney function. A more accurate measure of kidney function is creatinine clearance or glomerular filtration rate (Barrett & Parfrey, 2006). The Cockcroft-Gault formula is useful for calculating creatinine clearance based on a patient's age, gender, weight, and race.

Prevention of CIN is imperative as it influences morbidity and mortality rates significantly in hospitalized patients (Marenzi et al., 2006). CIN is the third most common cause of acute renal failure in hospitalized patients, after surgery and hypotension (Nash, Hafeez, & Hou, 2002). Contrast causes damage by impairing blood flow to the renal cortex and medulla. First, it stimulates vasoconstriction and decreases local prostaglandin-mediated and nitric oxide-mediated vasodilation. Second, contrast...

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