Abstract
Despite increasing reports on nonionic contrast media-induced nephropathy (CIN) in hospitalized adult patients during cardiac procedures, the studies in pediatrics are limited, with even less focus on possible predisposing factors and preventive measures for patients undergoing cardiac angiography. This prospective study determined the incidence of CIN for two nonionic contrast media (CM), iopromide and iohexol, among 80 patients younger than 18 years and compared the rates for this complication in relation to the type and dosage of CM and the presence of cyanosis. The 80 patients in the study consecutively received either iopromide (group A, n = 40) or iohexol (group B, n = 40). Serum sodium (Na), potassium (K), and creatinine (Cr) were measured 24 h before angiography as baseline values, then measured again at 12-, 24-, and 48-h intervals after CM use. Urine samples for Na and Cr also were checked at the same intervals. Risk of renal failure, Injury to the kidney, Failure of kidney function, Loss of kidney function, and End-stage renal damage (RIFLE criteria) were used to define CIN and its incidence in the study population. Accordingly, among the 15 CIN patients (18.75%), 7.5% of the patients in group A had increased risk and 3.75% had renal injury, whereas 5% of group B had increased risk and 2.5% had renal injury. Whereas 33.3% of the patients with CIN were among those who received the proper dosage of CM, the percentage increased to 66.6% among those who received larger doses, with a significant difference in the incidence of CIN related to the different dosages of CM (p = 0.014). Among the 15 patients with CIN, 6 had cyanotic congenital heart diseases, but the incidence did not differ significantly from that for the noncyanotic patients (p = 0.243). Although clinically silent, CIN is not rare in pediatrics. The incidence depends on dosage but not on the type of consumed nonionic CM, nor on the presence of cyanosis, and although CIN usually is reversible, more concern is needed for the prevention of such a complication in children.
Similar content being viewed by others
References
Alwall N, Johnsson S, Tornberg A et al (1955) Acute renal failure following angiography. Acta Chir Scand 109:11–19
Assadi F (2006) Acetazolamide for prevention of contrast induced nephropathy: a new use for an old drug. Ped Cardiol 27:238–242
Bellomo R, Kellum JA, Mehta R et al (2002) Acute dialysis quality initiative II: the Vicenza conference. Curr Opin Crit Care 8:505–508 available on Medline
Bellomo R, Ronco C, Kellum JA et al (2004) Acute renal failure-definition, outcome measures, animal models, fluid therapy and information technology needs: the second international consensus conference of the Acute Dialysis Quality Initiative (ADQI) group. Crit Care 8:R204–R212 Epub 24 May 2004 (available on Medline)
Brasch RC (2008) Contrast media toxicity in children. Pediatr Radiol 38:S281–S284
Buyan N, Arab M, Hasanoglu E et al (1995) The effects of contrast media on renal function in children: comparison of ionic and nonionic agents. Turkish J Pediatr 37:305–313
Detrenis S, Meschi M, Musini S et al (2005) Lights and shadows on the pathogenesis of contrast-induced nephropathy: state of the art. Nephrol Dial Transplant 20:1542–1550
Dittrich S, Kurschat K, Dahnert I et al (2000) Cyanotic nephropathy and use of nonionic contrast agents during cardiac catheterization in patients with cyanotic congenital heart disease. Cardiol Young 10:8–14
Duncan L, Heathcote J, Djurdjev O et al (2001) Screening for renal disease using serum creatinine: who are we missing? Nephrol Dial Transplant 16:1042–4046
Fang LS, Sirota RA, Ebert TH et al (1980) Low fractional excretion of sodium with contrast media-induced acute renal failure. Arch Intern Med 140:531–533
Feldkamp T, Baumgart D, Elsner M et al (2006) Nephrotoxicity of iso-osmolar versus low-osmolar contrast media is equal in low-risk patients. Clin Nephrol 66:322–330
Fox KM, Patel RG, Bonvicini M et al (1977) Safe amount of contrast medium for angiography in neonates and infants. Eur J Cardiol 5:373–380
Herts BR, Schineider E, Poggio ED et al (2008) Identifying out patients with renal insufficiency before contrast-enhanced CT by using estimated glomerular filtration rates versus serum creatinine levels. Radiology 248:106–113
Lameire NH (2006) Contrast-induced nephropathy: prevention and risk reduction. Nephrol Dial Transplant. 21(Suppl):11–23
Mehran R, Nikolosky E (2006) Contrast-induced nephropathy: definition, epidemiology, and patients at risk. Kidney Int 69(Suppl 100):S11–S15
Mehran R, Aymong ED, Nikolsky E et al (2004) A simple risk score for prediction of contrast-induced nephropathy after precutaneous coronary intervention: development and initial validation. J Am Coll Cardiol 44:1393–1399
Merten GJ, Burgess WP, Gray LV et al (2004) Prevention of contrast-induced nephropathy with sodium bicarbonate: a randomized controlled trial. JAMA 291:2328–2334
Morcos SK, Thomsen HS, Webb JA (1999) Contrast media-induced nephrotoxicity: a consensus report. Eur Radiol 9:1602–1613
Murphy SW, Barret BJ, Parfrey PS (2000) Contrast nephropathy. J Am Soc Nephrol 11:177–182
Newhouse JH, Kho D, Rao QA et al (2008) Frequency of serum creatinine changes in the absence of iodinated contrast material: implications for studies of contrast nephrotoxicity. AJR Am J Roentgenol 191:376–382
Niboshi A, Nishida M, Itoi T et al (2006) Renal function and cardiac angiography. Indian J Pediatr 73:49–53
Noyan A, Kücükosmannoglu O, Yildizdas D et al (1998) Evaluation of renal function in children with congenital heart disease before and after cardiac angiography. Turk J Pediatr 40:97–101
Nyman U, Almen T, Aspelin P et al (2005) Contrast medium-induced nephropathy correlated to the ratio between dose in gram iodine and estimated GFR in ml/min. Acta Radiol 46:830–842
Pakfetrat M, Nikoo MH, Malekmakan L et al (2009) A comparison of sodium bicarbonate infusion versus normal saline infusion and its combination with oral acetazolamide for prevention of contrast-induced nephropathy: a randomized, double-blind trial. Int Urol Nephrol. 41:629–634
Patzer L (2008) Nephrotoxicity as a cause of acute kidney injury in children. Pediatr Nephrol 23:2159–2173
Pelech A, Allard S, Hurd R et al (1991) A comparison of iohexol and diatrizoate meglumine in children undergoing cardiac catheterization. Invest Radiol 29:665–670
Persson PB, Hansell P, Liss P (2005) Pathophysiology of contrast medium-induced nephropathy. Kidney Int 68:14–22
Rihal CS, Textor SC, Grill DE et al (2002) Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention. Circulation 105:2259–2264
Rudnick MR, Goldfarb S, Wexler L et al (1995) Nephrotoxicity of ionic and nonionic contrast media in 1, 196 patients: a randomized trial. The Iohexol Cooperative Study. Kidney Int 47:254–261
Schwartz GI, Briton LP, Spitzer A (1987) The use of plasma creatinine concentration for estimating glomerular infiltration rate in infants, children, and adolescents. Pediatr Clin North Am 34:571–590
Senthilnathan S, Gauvreau K, Marshall AC et al (2009) Contrast administration in pediatric cardiac catheterization: dose and adverse events. Cathet Cardiovasc Intervent 73:814–820
Sterner G, Nyman U (2007) Contrast medium-induced nephropathy: aspects on incidence, consequences, risk factors, and prevention. Libyan J Med V2:1–17
Treitl M, Rupprecht H, Writh S et al (2009) Assessment of renal vasoconstriction in vivo after intraarterial administration of isosmotic contrast medium iodixanol compared to the low-osmotic contrast medium iopamidol. Nephro Dial Transplant 24:1478–1485
Zoltan H, Pickering E, Pickering JW (2010) Outcome definitions in nondialysis intervention and prevention trials in acute kidney injury (AKI). Nephrol Dial Transplant 25:107–118. NDT advance access published online on October 7
Acknowledgments
We thank Mrs. Farahmandi for preparation and typing of the manuscript. This work was financially supported by the Vice Chancellor for Research of Shiraz University of Medical Sciences.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ajami, G., Derakhshan, A., Amoozgar, H. et al. Risk of Nephropathy After Consumption of Nonionic Contrast Media by Children Undergoing Cardiac Angiography: A Prospective Study. Pediatr Cardiol 31, 668–673 (2010). https://doi.org/10.1007/s00246-010-9680-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00246-010-9680-2