Review
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. May 6, 2017; 6(3): 86-99
Published online May 6, 2017. doi: 10.5527/wjn.v6.i3.86
Contrast-induced acute kidney injury: A review of practical points
Sercin Ozkok, Abdullah Ozkok
Sercin Ozkok, Department of Radiology, Istanbul Medeniyet University, Goztepe Training and Research Hospital, 34760 Kadikoy, Istanbul, Turkey
Abdullah Ozkok, Department of Nephrology, Saglik Bilimleri University, Umraniye Training and Research Hospital, 34722 Umraniye, Istanbul, Turkey
Author contributions: Ozkok S reviewed the literature and wrote the paper; Ozkok A designed and wrote the paper.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Abdullah Ozkok, MD, Associate Professor, Department of Nephrology, Saglik Bilimleri University, Umraniye Training and Research Hospital, Selimiye Mah. Tibbiye Cad. No:38, 34722 Umraniye, Istanbul, Turkey. abdullahozkok@yahoo.com
Telephone: +90-21-66321818 Fax: +90-21-66327124
Received: January 21, 2017
Peer-review started: January 21, 2017
First decision: March 8, 2017
Revised: March 21, 2017
Accepted: April 18, 2017
Article in press: April 19, 2017
Published online: May 6, 2017
Abstract

Contrast-induced acute kidney injury (CI-AKI) is one of the most common causes of AKI in clinical practice. CI-AKI has been found to be strongly associated with morbidity and mortality of the patients. Furthermore, CI-AKI may not be always reversible and it may be associated with the development of chronic kidney disease. Pathophysiology of CI-AKI is not exactly understood and there is no consensus on the preventive strategies. CI-AKI is an active research area thus clinicians should be updated periodically about this topic. In this review, we aimed to discuss the indications of contrast-enhanced imaging, types of contrast media and their impact on nephrotoxicity, major pathophysiological mechanisms, risk factors and preventive strategies of CI-AKI and alternative non-contrast-enhanced imaging methods.

Keywords: Angiography, Nephrotoxicity, Computed tomography, Contrast-induced acute kidney injury, Contrast media, Cholesterol embolization syndrome, Hemodialysis, Contrast nephropathy

Core tip: The best preventive measure of contrast-induced acute kidney injury is to avoid unnecessary contrast administration which requires a good knowledge of indications and risk factors of contrast-enhanced imaging. Recently, alternative non-contrast-enhanced imaging modalities have been developed which may help us to decrease the frequency of contrast administration. In this review, these alternative modalities are discussed concisely. Type, osmolality, molecular structure and viscosity of contrast media (CM) are important determinants of nephrotoxicity. Major studies and meta-analyses comparing CM in terms of renal safety are also discussed.