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Education in Heart
Invasive imaging, cardiac catheterisation and angiography
Contrast-induced nephropathy following angiography and cardiac interventions
  1. Roger Rear1,
  2. Robert M Bell1,
  3. Derek J Hausenloy1,2,3,4
  1. 1The Hatter Cardiovascular Institute, University College London, London, UK
  2. 2The National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK
  3. 3National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
  4. 4Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore, Singapore
  1. Correspondence to Professor Derek Hausenloy, The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, NIHR University College London Hospitals Biomedical Research Centre, University College London Hospital & Medical School, 67 Chenies Mews, London WC1E 6HX, UK; d.hausenloy{at}ucl.ac.uk

https://doi.org/10.1136/heartjnl-2014-306962

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    European Society of Cardiology (ESC) curriculum section and guidelines referenced

    • 2.4 Invasive imaging: cardiac catheterisation and angiography.

    • ESC: updated contrast-induced nephropathy (CIN) prevention guidelines 2014.

    • European Society of Urogenital Radiology: updated contrast media safety committee guidelines 2011.

    Learning objectives

    • Define CIN and recognise this as a common and serious complication in susceptible patients receiving intravascular contrast media.

    • Understand the possible pathological mechanisms underlying CIN.

    • Describe the clinical and periprocedural risk factors for CIN and perform a risk assessment for patients receiving contrast media.

    • Appreciate the established strategies used to prevent CIN and be aware of novel therapies.

    • Recognise the onset of CIN and manage this complication appropriately.

    Introduction

    Contrast-induced nephropathy (CIN), also known as contrast-induced acute kidney injury, is an iatrogenic renal injury that follows intravascular administration of radio-opaque contrast media (CM) in susceptible individuals. CIN was first described during the 1950s in case reports of fatal acute renal failure that had occurred following intravenous pyelography in patients with renal disease arising from multiple myeloma.1 ,2 Despite technological advances, CIN remains responsible for a third of all hospital-acquired acute kidney injury (AKI)3 ,4 and affects between 1% and 2% of the general population and up to 50% of high-risk subgroups following coronary angiography (CA) or percutaneous coronary intervention (PCI).5

    The proliferation of imaging methods and interventional procedures involving administration of intravascular CM in both non-cardiac modalities (eg, vascular CT angiography and interventional vascular angiography) and in established (eg, CA and PCI) and emerging cardiac modalities (eg, CT coronary angiography (CTCA) and transcatheter aortic valve implantation (TAVI)) has significantly increased the number of patients exposed to CM and thus the number at risk of CIN. The widespread adoption of primary PCI for the treatment of acute myocardial infarction (AMI), despite significantly improving cardiovascular outcomes, has increased the incidence of CIN due to the inherent difficulties in rapidly assessing CIN …

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