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J Am Coll Cardiol, 2008; 51:1419-1428, doi:10.1016/j.jacc.2007.12.035
© 2008 by the American College of Cardiology Foundation
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STATE-OF-THE-ART PAPER

Contrast-Induced Acute Kidney Injury

Peter A. McCullough, MD, MPH, FACC, FACP, FAHA, FCCP*

Divisions of Cardiology, Nutrition, and Preventive Medicine, William Beaumont Hospital, Royal Oak, Michigan.

Manuscript received August 29, 2007; revised manuscript received December 10, 2007, accepted December 10, 2007.

* Reprint requests and correspondence: Dr. Peter A. McCullough, Divisions of Cardiology, Nutrition, and Preventive Medicine, William Beaumont Hospital, 4949 Coolidge Highway, Royal Oak, Michigan 48073. (Email: pmc975{at}yahoo.com).

Cardiac angiography and coronary/vascular interventions depend on iodinated contrast media and consequently pose the risk of contrast-induced acute kidney injury (AKI). This is an important complication that accounts for a significant number of cases of hospital-acquired renal failure, with adverse effects on prognosis and health care costs. The epidemiology and pathogenesis of contrast-induced AKI, baseline renal function measurement, risk assessment, identification of high-risk patients, contrast medium use, and preventive strategies are discussed in this report. An advanced algorithm is suggested for the risk stratification and management of contrast-induced AKI as it relates to patients undergoing cardiovascular procedures. Contrast-induced AKI is likely to remain a significant challenge for cardiologists in the future because the patient population is aging and chronic kidney disease and diabetes are becoming more common.

Abbreviations and Acronyms
  AKI = acute kidney injury
  CIN = contrast-induced nephropathy
  CKD = chronic kidney disease
  CK-MB = creatine kinase-myocardial band
  Cr = creatinine
  DM = diabetes mellitus
  eGFR = estimated glomerular filtration rate
  HOCM = high-osmolal contrast media
  IOCM = iso-osmolal contrast media
  LOCM = low-osmolal contrast media
  MI = myocardial infarction
  NAC = N-acetylcysteine
  PCI = percutaneous coronary intervention




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