“Contrast nephropathy” in renal transplantation: Is it real?

Abstract

The risk of contrast-induced nephropathy (CIN) in renal transplant recipients is increased in diabetics, patients with impaired basal kidney function, patients in shock, patients presenting with acute emergency and in old age recipients. Approximately one-third of all hospitalized patients with acute kidney injury is attributed to CIN. In the United States, it is the third leading cause of hospital-acquired renal failure. Therefore, efforts should be directed to minimize CIN-related morbidity and mortality as well as to shorten hospital stay. While the role of peri-procedural prophylactic hydration with saline is unequivocal; the use of acetyl cysteine is not based on robust evidence. The utility of theophylline, aminophylline, calcium channel blockers, natriuretic peptide, and diuretics does not have proven role in attenuating CIN incidence. We aim to analyze the evidence for using various protocols in published literature to limit CIN-associated morbidity and mortality, particularly during surveillance of the renal allograft survival.

Keywords: Contrast; Renal; Transplantation; Nephropathy

Core tip: The renal transplant is usually a solitary kidney with diverse hemodynamic changes and exposed to the immunosuppressive agents for a long period. Any superadded stress such as contrast-induced nephropathy (CIN), will definitely affect allograft function. We provide in this article a comprehensive review of the current evidence on the true incidence, the mechanism of damage induced by CIN and available preventive measures to counteract the possible effect induced by CIN.