Kim Jae, Male Shailesh, Jagadeesan Bharathi D, Streib Christopher, Tummala Ramachandra P
Department of Neurology, University of Minnesota Medical School and Hennepin County Medical Center, Minneapolis, MN, USA.
Department of Neurosurgery, University of Minnesota Medical School and Hennepin County Medical Center, MMC 96, 420 Delaware St. SE, Minneapolis, MN, 55455, USA.
Neuroradiology. 2018 May;60(5):529-533. doi: 10.1007/s00234-018-1996-2. Epub 2018 Mar 1.
Contrast-induced nephropathy is a common clinical concern in patients undergoing neuroendovascular procedures, especially in those with pre-existent kidney disease. We aimed to define the incidence of contrast-induced nephropathy in these high-risk patients in our practice.
We analyzed data retrospectively from patients undergoing neuroendovascular procedures at two academic medical centers over a 4-year period. Contrast-induced nephropathy was determined by an absolute increase in serum creatinine of 0.5 mg/dL or a rise from its baseline value by ≥ 25%, at 48-72 h after exposure to contrast agent after excluding other causes of renal impairment. High-risk patients were identified as those with pre-procedural estimated glomerular filtration rate < 60 mL/min irrespective of creatinine level, corresponding to stages 3-5 of chronic kidney disease.
One hundred eighty-five high-risk patients undergoing conventional cerebral angiography and neuroendovascular interventions were identified. Only 1 out of 184 (0.54%) high-risk patients developed contrast-induced nephropathy. That one patient had stage 5 chronic kidney disease and multiple other risk factors.
We have observed a very low rate of renal injury in patients with chronic kidney disease, traditionally considered high risk for neuroendovascular procedures. Multiple factors may be responsible in the risk reduction of contrast-induced nephropathy in this patient population.
对比剂肾病是接受神经血管内介入手术患者常见的临床问题，尤其是那些已有肾脏疾病的患者。我们旨在确定在我们的临床实践中，这些高危患者中对比剂肾病的发生率。
我们回顾性分析了两个学术医疗中心4年内接受神经血管内介入手术患者的数据。排除其他肾功能损害原因后，在接触对比剂48 - 72小时时，血清肌酐绝对值增加0.5mg/dL或较基线值升高≥25%，则判定为对比剂肾病。高危患者被定义为术前估计肾小球滤过率<60mL/min的患者，无论肌酐水平如何，对应慢性肾脏病3 - 5期。
共确定了185例接受传统脑血管造影和神经血管内介入治疗的高危患者。184例高危患者中只有1例（0.54%）发生了对比剂肾病。该患者患有5期慢性肾脏病且有多种其他危险因素。
我们观察到，传统上被认为神经血管内介入手术高危的慢性肾脏病患者中，肾损伤发生率非常低。多种因素可能导致该患者群体中对比剂肾病风险降低。
