Contrast uses-Contrast induced Nephropathy.pptx

Contrast uses and safety-Contrast Induced Nephropathy Tsitskari Maria, MD,PhD,EBIR Consultant of Vascular and Interventional Radiology Contrast media The word contrast media means chemical substance that due to its high attenuation of X-ray or differential absorption of X-rays from the surrounding t...

Contrast uses and safety-Contrast Induced Nephropathy Tsitskari Maria, MD,PhD,EBIR Consultant of Vascular and Interventional Radiology Contrast media The word contrast media means chemical substance that due to its high attenuation of X-ray or differential absorption of X-rays from the surrounding tissues permit clear demonstration of an organs or tubular structure CONTRAST MEDIA used to: enhance subject contrast or render high subject contrast in a tissue that normally has low subject contrast Types of contrast media : 1. Intravascular : A. High osmolar or ionic. B. Low osmolar or nonionic. 2. Oral/Per rectum A. Gastrografin B. Barium Sulphate Contrast Media Negative contrast (AIR OR CO2) Radiolucent Low atomic # material Black on film Positive contrast (all others) Radiopaque High atomic # material White on film Contrast Media Types Radio- Contrast Agents(CT, X-Ray) Iodine Gastrograffin Barium Sulphate MRI Contrast Agents Paramagnetic(Gadolinium based) Superparamagnetic(USPIO,SPIO) US Contrast Agents Microbubbles Contrast Media Used In M.R.I They enhance the inherent tissue contrast causing T1 and T2 shortening Type : A. Paramagnetic EX : Gadolinium D.TPA. Causes T1 shortening signal appear bright. B. Super paramagnetic EX : Iron oxide manganese for causes T2 shortening signal appear dark. Ultrasound Contrast agents Small microbulles Leovist. Most commonly used IndicationVascular US (Doppler) Harmonic imaging Sonohysterosalphingography Clinical Applcations Urinary system: IVU \ EU. Ascending Uretnrography. Cystography. Micturating cystouretnorography. Antegraded Retbograde Pyelograph. Biliary system: Intravenous cholangiography. T.Tube cholangiography. P.T.C E.R.C.P Cardiovascular system : Arteriography. Venography. Angiocardiography. Contrast enhanced CT. Contrast enhanced M.R.I. knee arthrography Myelogram Cerebral Angiogram ALWAYS GET PATIENT’S HISTORY AND CONSENT BEFORE BEGINNING OR GIVING ANY CONTRAST MEDIA Adverse Reactions of iodine based agents 1. Chemotoxic reactions (2%-7%) - dose dependent mainly nephrotoxic effects - Contrast Induced Nephropathy - Risk Factors CRF, sehydration,CF,metformin - hyperthyroidism - risk of thyrotoxic storm 2. Anaphylactoid reactions (1%-2%) - dose independent !! mild: nausea,vomiting,diziness,urticaria, flushing, pruritus moderate: bronchospasm, dyspnoea,chest pain,hypotnesion severe: laryngeal edema,CPA,arrythmias delayed(>1h) - risk factors previous allergic reaction to I drug requiring allergies Radio- Contrast agents Barium Sulphate Exclusive use in GI imaging high attenuation coefficiency insoluble adverse reactions - Chemical peritonitis Contraindications - perforation suspected - severe GI obstruction Adverse effect of MRI contrast Metallic taste in mouth Nephrogenic fibrosis - contraindicated when GFR25%, or absolute >0.25 or 0.5 mg/dl. Baseline renal disease increases risk as assessed by eGFR or CrCl; age, sex , and obesity factors in estimating eGFR/CrCl. Renal dysfunction is identifiable by 48 hrs and most often returns to baseline by 7-10 days. Acute Kidney Injury AKIN /KDIGO Classification Stage 1 1.5 to 1.9 fold increase in Cr Absolute increase >0.3 mg/dl Stage 2 2-2.9 fold increase in Cr Stage 3 >3 fold increase in serum Cr Absolute increase >4 mg/dl Acute increase >0.5 mg/dl AKIN-Acute Kidney Injury Network KDIGO-Kidney Disease: Improvement in Global Outcomes Recommendations for Decreasing Risk of Contrast Induced Acute Renal Injury/CIN Manage Medications Withhold, if clinically appropriate, potentially nephrotoxic drugs including aminoglycoside antibiotics, anti-rejection medications and nonsteroidal anti-inflammatory drugs (NSAID). Manage Intravascular Volume (Avoid Dehydration) Administer a total of at least 1L of isotonic (normal) saline beginning at least 3 hrs before and continuing at least 6-8 hrs after the procedure. i. initial infusion rate 100 to 150 ml/hr adjusted post procedure as clinically indicated Radiographic Contrast Media Minimize volume Low- or iso-osmolar contrast agents Post-Procedure: Discharge/Follow-Up Obtain follow-up SCr 48 hrs post procedure Consider holding appropriate medications until renal function returns to normal, i.e. metformin, NSAID