Post PCI Contrast Induced Nephropathy - UNC School of MedicinePCI术后造影剂肾病-药物UNC学院.pptVIP

Post PCI Contrast Induced Nephropathy Brandon M. Williams M.D. A.M. Report 9/9/08 Acute Renal Failure Post Cath/PCI Renal atheroemboli Hemodynamic instability with decreased renal perfusion Contrast induced nephropathy Renal Atheroemboli Other signs of embolization (blue toes, livedo reticularis, Hollenhorst plaques, abdominal pain) Transient eosinophilia and hypocomplementemia Renal failure which persists greater than 7 days Evidence of Renal Atheroemboli Renal Hypoperfusion Oliguria/anuria Postischemic acute tubular necrosis (increasing Cr, normal to reduced uop, granular casts, FeNa 1 Contrast Induced Nephropathy (CIN) Definition: “new-onset or an exacerbation of renal dysfunction after contrast administration in the absence of other causes” Cr Increase of 25% or absolute increase of 0.5mg/dl CIN Timeline Symptoms initially seen 24-48 hours after exposure Cr peaks at 5-7 days Normalizes usually within 7-10 days CIN Incidence 3rd most common hospital acquired renal failure 5% of patients with cath experience transient increase Cr 1.0 from baseline Outcomes of CIN Prognosis of patients with CIN significantly worse than those without Case control study 1600 pts with contrast, mortality rate with CIN (n=183) 5.5 times of matched controls (n=174) Increased risk of mortality if require hemodialysis Increase in cost of $10,345 for hospital stay CIN and Coronary Procedures Higher mortality than other types of CIN 3% primary PCI for ACS (Marenzi et al 2004) McCullough et al. 1997 1800 pts with coronary interventions with contrast - ARF 14%, dialysis 0.8% - In house mortality for those to HD 36% (1% for those without HD) - 2 yr survival 19% in those needing HD Patient CIN Risk Factors RENAL INSUFFICIENCY DIABETES MELLITUS WITH CRI Volume depletion Age 75 Hypotension CHF Other renal toxins Renal transplant Hypoalbuminemia Procedure CIN Risk Factors Multiple studies in 72 hour period Intra-arterial injection site High volume of contrast High osmola