Acil Servise Başvuran Hastalarda Tanı Amaçlı Çekilen Bilgisayarlı Tomografi Sonrası Kontrast Madde Nefropatisi

Gulhan Kurtoglu Celik

Clinical Research

Acil Servise Başvuran Hastalarda Tanı Amaçlı Çekilen Bilgisayarlı Tomografi Sonrası Kontrast Madde Nefropatisi

Year 2016, Volume: 8 Issue: 2, 61 - 67, 24.07.2016

Gulhan Kurtoglu Celik

Abstract

Amaç: Kontrast madde nefropatisi hastanede gelişen akut böbrek hasarı sebeplerinin 3. sıklıkta görülenidir. Hastaneye yatış, hastanede kalış süresinde artış ve de yüksek mortalite oranları ile ilişkilidir. Çalışmamızın amacı acil serviste tanı amaçlı kontrastlı bilgisayarlı tomografi (BT) çekilen hastalarda kontrast madde nefropatisi (KMN) oluşum sıklığını ve risk faktörlerini araştırmaktır.
Materyal ve Metot: Mart 2013 - Mart 2014 tarihleri arasında Eğitim ve Araştırma Hastanesi Acil servisine başvuran, travmatik ve non-travmatik sebeplerle KMN önleyici tedavi almaksızın kontrastlı BT çekilen hastalar çalışmaya alınmıştır. Bu hastaların demografik özellikleri, kontrast madde nefropatisi görülme sıklığı ve risk faktörleri araştırılmıştır.Çalışmamız için etik kurul onayı alınmıştır.

Bulgular: Bazal kreatinin değeri normal (<1,2 mg/dl) ve bazal kreatinin değeri yüksek (>1,2 mg/dl) olan toplam 283 hasta çalışmaya dahil edilmiştir. Bu hastaların %64’ünü erkek, %36’sını kadın hastalar oluşturmuştur. Hastaların %11.7’sinde KMN gelişmiştir. KMN gelişen hastaların %13.1’si bazal kreatinin değeri normal (<1,2 mg/dl) olan hasta grubunda, %86.9’u ise bazal kreatinin değeri yüksek (>1,2 mg/dl) olan hasta grubundaydı. 18-30 arasındaki hastalarda KMN görülme oranı %3, 80 yaş ve üstü hasta grubunda ise bu oran %23.8 olarak bulunmuştur. Hastalarımızın %51.9 (147)’unda glomeruler filtrasyon hızı (GFH) < 60 ml/dak iken, %48.1 (136)’inde GFH > 60 ml/dak olarak bulunmuştur. Bazal GFH < 60 ml/dak olan hastaların %18.4’sinde, bazal GFH > 60 ml/dak olan hastaların %4.4’ünde KMN gelişmiştir. Çalışmaya dahil edilen hastalar arasında en sık görülen ek hastalık hipertansiyon (HT) idi. Kronik böbrek hastalığı (KBH) kontrast madde verilmesinden sonra kreatin yüksekliği ve diğer komorbiditelerle en yakından ilşkili hastalıktı. Hastalarımızın %92,9’una 100 mİ, kalan %7.1’ine de 200 mİ kontrast madde (KM) verilmiştir. Yüz mİ KM verilen hastaların %10.3 (27)’ünde, 200 mİ KM verilen hastaların %18.2’sinde KM gelişmiştir.

Sonuç: KBH, HT, koroner arter hastalığı (KAH), konjestif kalp yetmezliği (KKY) hikayesi olan ve GFH < 60 ml/dk olan hasta grubunda kontrast nefropati gelişme riskinin arttığını belirledik. Bu nedenle kontrast nefropati gelişme riski olan hastalar acil serviste daha dikkatli değerlendirilmelidir.

Keywords

Kontrasta bağlı nefropati, risk faktörleri, acil servis

References

1. Hassen GW, Hwang A, Liu LL, et al. Follow up for emergency department patients after intravenous contrast and risk of nephropathy. West J Emerg Med 2014;15:276-81.
2. Brendan J, Barrett M, Patrick SP. Contrast-induced Nephropathy in Emergency Department Patients Receiving Abdominal Contrast-Enhanced Computed Tomography. Ann Emerg Med 2008;52:136.
3. Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis 2002;39:930-6.
4. McCullough PA, Adam A, Becker CR et al. Epidemiology and prognostic implications of contrast-induced nephropathy. Am J Cardiol 2006;98:5-13. KAYNAKLAR
5. Berns AS. Nephrotoxicity of contrast media. Kidney Int 1989;36:730-40.
6. Jorgensen AL. Contrast-induced nephropathy: pathophysiology and preventive strategies. Crit Care Nurse 2013;33:37-46.
7. Feldkamp T, Kribben A. Contrast media induced nephropathy: definition, incidence, outcome, pathophysiology, risk factors and prevention. Minerva Med 2008;99:177-96.
8. Mueller C, Buerkle G, Buettner HJ, et al. Prevention of contrast media-associated nephropathy: randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty. Arch Intern Med 2002;162:329-36.
9. Parfrey PS1, Griffiths SM, Barrett BJ, et al. Contrast material-induced renal failure in patients with diabetes mellitus, renal insufficiency, or both. A prospective controlled study. N Engl J Med 1989;320:143-9.
10. McCullough PA, Wolyn R, Rocher LL. Acute renal failure after coronary intervention: incidence, risk factors, and relationship to mortality. Am J Med 1997;103:68-75.
11. Muntner P1, Coresh J, Klag MJ, et al. Exposure to radiologic contrast media and an increased risk of treated endstage renal disease. Am J Med Sci 2003;326:353-9.
12. Rudnick MR, Goldfarb S, Wexler L, et al. Nephrotoxicity of ionic and nonionic contrast media in 1196 patients: a randomized trial: the lohexol Cooperative Study. Kidney Int 1995; 47:254-61.
13. Cronin, R.E., Contrast-induced nephropathy: pathogenesis and prevention. Pediatr Nephrol 2009;25:191-204.
14. Persson PB, Hansell P, Liss P. Pathophysiology of contrast medium-induced nephropathy. Kidney Int 2005;68: 14-22.
15. Heinrich MC, Kuhlmann MK, Grgic A, et al. Cytotoxic effects of ionic high-osmolar, nonionic monomeric, and nonionic iso-osmolardimeric iodinated contrast media on renal tubular cells in vitro. Radiology 2005;235:843-9.
16. Briguori C, Visconti G, FocaccioA, etal. Renal Insufficiency After Contrast Media Administration Trial II (REMEDIAL II): Renal Guard System in high-risk patients for contrast-induced acute kidney injury. Circulation 2011;124:1260-9.
17. Pannu N, Manns B, Lee H, et al. Systematic review of the impact of N-acetylcysteine on contrast nephropathy. Kidney Int 2004;65:1366-74.
18. Baker WL, Anglade MW, Baker EL, et al. Use of N-acetylcysteine to reduce post-cardiothoracic surgery complications: a meta-analysis. Eur J Cardiotho-rac Surg 2009;35: 521-7.
19. MacNeill BD, Harding SA, Bazari H, et al. Prophylaxis of contrast-induced nephropathy in patients undergoing coronary angiography. Catheter Cardio-vasc Interv 2003;60:458-61.
20. Miner SE, Dzavik V, Nguyen-Ho P, et al. N-Acetylcysteine reduces contrast-associated nephropathy but not clinical events during long-term follow-up. Am Heart J 2004;148:690-5.
21. Danilo Fliser, Maurice Laville, Adrian Covic, et al. A European Renal Best Practice (ERBP) position statement on the Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guidelines on Acute Kidney Injury: Part 1: Definitions, conservative management and contrast-induced nephropathy. Nephrol Dial Transplant 2012; 27:4263-72.
22. Gleeson, TG, Bulugahapitiya S. Contrast-induced nephropathy. Am J Roentgenol 2004; 183: 1673-89.
23. Mohammed NM, Mahfouz A, Achkar K, et al. Contrast-induced Nephropathy; Heart Views 2013; 14:106-16.
24. Kiski D, Stepper W, Breithardt G, et al. Impact of female gender on frequency of contrast medium-induced nephropathy: post hoc analysis of dialysis versus diuresis trial. J Womens Health (Larchmt) 2010;25:759-64.
25. Mitchell AM, Jones AE, Tumlin JA, et al. Prospective study of the incidence of contrast-induced nephropathy among patients evaluated for pulmonary embolism by contrast-enhanced computed tomography. Acad Emerg Med 2012; 19:618-25.
26. R. Mehran and E. Nikolsky, “Contrast-induced nephropathy: definition, epide- miology, and patients at risk,” Kidney International 2006;69:11-5.
27. Kooiman J, Pasha SM, Zondag W, et al. Meta analysis: Serum creatinine changes following contrast enhanced CT imaging. Eur J Radiol 2012;81:2554-61.
28. Morcos SK, Thomsen HS, Webb JA. Contrast media induced nephrotoxicity: A consensus report. Contrast Media Safety Committee of the European Society of Urogenital Radiology (ESUR) Eur Radiol 1999;9:1602-13.
29. Rudnick MR, Goldfarb S, Wexler L, et al. Nephrotoxicity of ionic and nonionic contrast media in 1196 patients: A randomized trial. The lohexol Cooperative Study. Kidney Int 1995;47:254-61.
30. Pannu NN. Wiebe MT. “Prophylaxis strategies for contrast-induced nephropathy”. Journal of the American Medical Association 2006;295:2765-79.
31. McCullough PA, Adam A, Becker CR, et al. “Risk prediction of contrast-induced nephropathy,” The American Journal of Cardiology 2006; 98: 27-36.
32. Moos SI, van Vemde DN, Stoker J, et al. Contrast induced nephropathy in patients undergoing intravenous (IV) contrast enhanced computed tomography (CECT) and the relationship with risk factors: A meta-analysis, European Journal of Radiology 2013;82:387- 99.
33. Mekan SF, Rabbani MA, Azhar-uddin M, et al. Radiocontrast nephropathy: is it dose related or not? J Pak Med Assoc 2004;54: 372-4.

Contrast Induced Nephropathy Due To Diagnostic Computerized Tomography In Emergency Department

Year 2016, Volume: 8 Issue: 2, 61 - 67, 24.07.2016

Gulhan Kurtoglu Celik

Abstract

Objectives: Contrast induced nephropathy is the third most frequent cause of hospital-acquired acute kidney injury. It is associated with prolonged hospitalization, higher rates of complications and increased mortality. The aim of this study is to evaluate the frequency of diagnostic contrast enhanced computed tomography induced contrast nephropathy in patients in the emergency department and to investigate the risk factors.

Materials and Methods: The demographic characteristics, incidence of contrast induced nephropathy and risk factors of the patients who were admitted to Ankara Atatürk Training and Research Hospital Emergency Department (ED) between 1 March 2013-1 March 2014 were studied. These patients were admitted to ED because of both traumatic and non-traumatic diseases, contrast enhanced computed tomographies were performed but no prevention techniques for contrast induced nephropathy were applied.

Results: A total of 283 adult patients who had normal (<1,2 mg/dL ) or high (>1,2 mg/dL) basal creatinin levels were included in our study; 64% of these patients were male and 36% were female. Contrast induced nephropathy developed in 11.7% of patients. In patients who had contrast induced nephrophathy, 13.1% had normal (<1,2 mg/dl) creatinin level in the beginning, whereas 86.9% of them had high (>1,2 mg/dl) basal creatinin level. In patients, the incidence of contrast induced nephropathy was 3% 23.8% respectively in patients between 18-30 years and >80 years old. GFR was < 60 ml/min in 51.9% (147) and GFR was > 60 ml/min in 48.1% (136) of our patients. The incidence of contrast induced nephropathy in the patients was 18.4% and 4.4%, respectively in patients whose GFR <60 ml/min and > 60 ml/min. The most frequent comorbid disease was hypertension and chronic renal disease was the most strongly associated disease with regard to the increase of creatinin levels after contrast media administration and other comorbidities. During computerized tomography, 92.9 % of our patients received 100 ml, 7.1% received 200 ml contrast media. Contrast induced nephropathy developed in 10.3% of the patients who received 100 ml and 18.2% of the patients who received 200 ml contrast media.

Conclusion: We found that; the risk of contrast nephropathy significantly increased in patients with chronic renal disease, hypertension, coronary artery disease, congestive heart failure and in those whose GFR <60 ml / min. Therefore, the patients with the risk of developing contrast-induced nephropathy should be evaluated more carefully in the ED.

Keywords

Contrast-induced nephropathy, risk factors, emergency department

References

1. Hassen GW, Hwang A, Liu LL, et al. Follow up for emergency department patients after intravenous contrast and risk of nephropathy. West J Emerg Med 2014;15:276-81.
2. Brendan J, Barrett M, Patrick SP. Contrast-induced Nephropathy in Emergency Department Patients Receiving Abdominal Contrast-Enhanced Computed Tomography. Ann Emerg Med 2008;52:136.
3. Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis 2002;39:930-6.
4. McCullough PA, Adam A, Becker CR et al. Epidemiology and prognostic implications of contrast-induced nephropathy. Am J Cardiol 2006;98:5-13. KAYNAKLAR
5. Berns AS. Nephrotoxicity of contrast media. Kidney Int 1989;36:730-40.
6. Jorgensen AL. Contrast-induced nephropathy: pathophysiology and preventive strategies. Crit Care Nurse 2013;33:37-46.
7. Feldkamp T, Kribben A. Contrast media induced nephropathy: definition, incidence, outcome, pathophysiology, risk factors and prevention. Minerva Med 2008;99:177-96.
8. Mueller C, Buerkle G, Buettner HJ, et al. Prevention of contrast media-associated nephropathy: randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty. Arch Intern Med 2002;162:329-36.
9. Parfrey PS1, Griffiths SM, Barrett BJ, et al. Contrast material-induced renal failure in patients with diabetes mellitus, renal insufficiency, or both. A prospective controlled study. N Engl J Med 1989;320:143-9.
10. McCullough PA, Wolyn R, Rocher LL. Acute renal failure after coronary intervention: incidence, risk factors, and relationship to mortality. Am J Med 1997;103:68-75.
11. Muntner P1, Coresh J, Klag MJ, et al. Exposure to radiologic contrast media and an increased risk of treated endstage renal disease. Am J Med Sci 2003;326:353-9.
12. Rudnick MR, Goldfarb S, Wexler L, et al. Nephrotoxicity of ionic and nonionic contrast media in 1196 patients: a randomized trial: the lohexol Cooperative Study. Kidney Int 1995; 47:254-61.
13. Cronin, R.E., Contrast-induced nephropathy: pathogenesis and prevention. Pediatr Nephrol 2009;25:191-204.
14. Persson PB, Hansell P, Liss P. Pathophysiology of contrast medium-induced nephropathy. Kidney Int 2005;68: 14-22.
15. Heinrich MC, Kuhlmann MK, Grgic A, et al. Cytotoxic effects of ionic high-osmolar, nonionic monomeric, and nonionic iso-osmolardimeric iodinated contrast media on renal tubular cells in vitro. Radiology 2005;235:843-9.
16. Briguori C, Visconti G, FocaccioA, etal. Renal Insufficiency After Contrast Media Administration Trial II (REMEDIAL II): Renal Guard System in high-risk patients for contrast-induced acute kidney injury. Circulation 2011;124:1260-9.
17. Pannu N, Manns B, Lee H, et al. Systematic review of the impact of N-acetylcysteine on contrast nephropathy. Kidney Int 2004;65:1366-74.
18. Baker WL, Anglade MW, Baker EL, et al. Use of N-acetylcysteine to reduce post-cardiothoracic surgery complications: a meta-analysis. Eur J Cardiotho-rac Surg 2009;35: 521-7.
19. MacNeill BD, Harding SA, Bazari H, et al. Prophylaxis of contrast-induced nephropathy in patients undergoing coronary angiography. Catheter Cardio-vasc Interv 2003;60:458-61.
20. Miner SE, Dzavik V, Nguyen-Ho P, et al. N-Acetylcysteine reduces contrast-associated nephropathy but not clinical events during long-term follow-up. Am Heart J 2004;148:690-5.
21. Danilo Fliser, Maurice Laville, Adrian Covic, et al. A European Renal Best Practice (ERBP) position statement on the Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guidelines on Acute Kidney Injury: Part 1: Definitions, conservative management and contrast-induced nephropathy. Nephrol Dial Transplant 2012; 27:4263-72.
22. Gleeson, TG, Bulugahapitiya S. Contrast-induced nephropathy. Am J Roentgenol 2004; 183: 1673-89.
23. Mohammed NM, Mahfouz A, Achkar K, et al. Contrast-induced Nephropathy; Heart Views 2013; 14:106-16.
24. Kiski D, Stepper W, Breithardt G, et al. Impact of female gender on frequency of contrast medium-induced nephropathy: post hoc analysis of dialysis versus diuresis trial. J Womens Health (Larchmt) 2010;25:759-64.
25. Mitchell AM, Jones AE, Tumlin JA, et al. Prospective study of the incidence of contrast-induced nephropathy among patients evaluated for pulmonary embolism by contrast-enhanced computed tomography. Acad Emerg Med 2012; 19:618-25.
26. R. Mehran and E. Nikolsky, “Contrast-induced nephropathy: definition, epide- miology, and patients at risk,” Kidney International 2006;69:11-5.
27. Kooiman J, Pasha SM, Zondag W, et al. Meta analysis: Serum creatinine changes following contrast enhanced CT imaging. Eur J Radiol 2012;81:2554-61.
28. Morcos SK, Thomsen HS, Webb JA. Contrast media induced nephrotoxicity: A consensus report. Contrast Media Safety Committee of the European Society of Urogenital Radiology (ESUR) Eur Radiol 1999;9:1602-13.
29. Rudnick MR, Goldfarb S, Wexler L, et al. Nephrotoxicity of ionic and nonionic contrast media in 1196 patients: A randomized trial. The lohexol Cooperative Study. Kidney Int 1995;47:254-61.
30. Pannu NN. Wiebe MT. “Prophylaxis strategies for contrast-induced nephropathy”. Journal of the American Medical Association 2006;295:2765-79.
31. McCullough PA, Adam A, Becker CR, et al. “Risk prediction of contrast-induced nephropathy,” The American Journal of Cardiology 2006; 98: 27-36.
32. Moos SI, van Vemde DN, Stoker J, et al. Contrast induced nephropathy in patients undergoing intravenous (IV) contrast enhanced computed tomography (CECT) and the relationship with risk factors: A meta-analysis, European Journal of Radiology 2013;82:387- 99.
33. Mekan SF, Rabbani MA, Azhar-uddin M, et al. Radiocontrast nephropathy: is it dose related or not? J Pak Med Assoc 2004;54: 372-4.

There are 33 citations in total.

Details

Primary Language	Turkish
Subjects	Emergency Medicine, Diagnostic Radiography
Journal Section	Research Article
Authors	Gulhan Kurtoglu Celik
Publication Date	July 24, 2016
Published in Issue	Year 2016 Volume: 8 Issue: 2

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APA	Kurtoglu Celik, G. (2016). Acil Servise Başvuran Hastalarda Tanı Amaçlı Çekilen Bilgisayarlı Tomografi Sonrası Kontrast Madde Nefropatisi. Türk Tıp Dergisi, 8(2), 61-67.

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