Nephropathy in critically Ill patients without preexisting renal disease

Abstract

Contrast-induced nephropathy (CIN) remains a common complication of radiographic procedures. Isovue (lopamidol) is a low-osmolality nonionic monomeric tri-iodinated water soluble agent widely used as a contrast medium in radiographic procedures for intravascular, intrathecal, and body cavity administration. The purpose of this study was to evaluate the effect of lopamidol on renal function in patients without any preexisting renal condition who were undergoing radiographic imaging with the iodine contrast. Seventy-five patients admitted to the Intensive Care Unit (ICU) had CT-scans with intravenous lopamidol contrast. All the patients had a normal serum creatinine before administration of the contrast media. Serum creatinine was recorded for three consecutive days after the CT-scan. The control group consisted of medical ICU patients that were not administered iodine contrast during their stay in the unit. There was no change from the baseline in the control group. A significant increase in serum creatinine was recorded in patients undergoing CT-scan with lopamidol contrast. In 18% of the patients, creatinine was elevated more than 25% from the baseline. This level of creatinine elevation indicated a significant decrease in glomerular filtration, and thus fulfilled the criteria for contrast-induced nephropathy. Our data demonstrates that iodine contrast media for CT in ICU patients without preexisting kidney disease can precipitate clearly measurable nephropathic changes.