Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. Nov 29, 2020; 9(2): 33-42
Published online Nov 29, 2020. doi: 10.5527/wjn.v9.i2.33
Findings on intraprocedural non-contrast computed tomographic imaging following hepatic artery embolization are associated with development of contrast-induced nephropathy
Mohamed M Soliman, Debkumar Sarkar, Ilya Glezerman, Majid Maybody
Mohamed M Soliman, Debkumar Sarkar, Majid Maybody, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
Ilya Glezerman, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
Author contributions: Soliman MM contributed to analysis and interpretation of data, drafting of manuscript, critical revision; Sarkar D contributed to acquisition of data, analysis and interpretation of data, critical revision; Glezerman I contributed to study conception and design, analysis and interpretation of data, critical revision; Maybody M contributed to study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, critical revision.
Supported by the NIH/NCI Cancer Center, No. P30 CA008748.
Institutional review board statement: The local Institutional Review Board approved this retrospective review (Protocol 16-402) of all patients who underwent hepatic artery embolization (HAE) between January 2010 and January 2011.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Majid Maybody, MD, Associate Professor, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, M276C, New York, NY 10065, United States. maybodym@mskcc.org
Received: May 27, 2020
Peer-review started: May 27, 2020
First decision: June 5, 2020
Revised: August 19, 2020
Accepted: September 14, 2020
Article in press: September 14, 2020
Published online: November 29, 2020
Processing time: 181 Days and 17.1 Hours
Abstract
BACKGROUND

Contrast-induced nephropathy (CIN) is a reversible form of acute kidney injury that occurs within 48-72 h of exposure to intravascular contrast material. CIN is the third leading cause of hospital-acquired acute kidney injury and accounts for 12% of such cases. Risk factors for CIN development can be divided into patient- and procedure-related. The former includes pre-existing chronic renal insufficiency and diabetes mellitus. The latter includes high contrast volume and repeated exposure over 72 h. The incidence of CIN is relatively low (up to 5%) in patients with intact renal function. However, in patients with known chronic renal insufficiency, the incidence can reach up to 27%.

AIM

To examine the association between renal enhancement pattern on non-contrast enhanced computed tomographic (CT) images obtained immediately following hepatic artery embolization with development of CIN.

METHODS

Retrospective review of all patients who underwent hepatic artery embolization between 01/2010 and 01/2011 (n = 162) was performed. Patients without intraprocedural CT imaging (n = 51), combined embolization/ablation (n = 6) and those with chronic kidney disease (n = 21) were excluded. The study group comprised of 84 patients with 106 procedures. CIN was defined as 25% increase above baseline serum creatinine or absolute increase ≥ 0.5 mg/dL within 72 h post-embolization. Post-embolization CT was reviewed for renal enhancement patterns and presence of renal artery calcifications. The association between non-contrast CT findings and CIN development was examined by Fisher’s Exact Test.

RESULTS

CIN occurred in 11/106 (10.3%) procedures (Group A, n = 10). The renal enhancement pattern in patients who did not experience CIN (Group B, n = 74 with 95/106 procedures) was late excretory in 93/95 (98%) and early excretory (EE) in 2/95 (2%). However, in Group A, there was a significantly higher rate of EE pattern (6/11, 55%) compared to late excretory pattern (5/11) (P < 0.001). A significantly higher percentage of patients that developed CIN had renal artery calcifications (6/11 vs 20/95, 55% vs 21%, P = 0.02).

CONCLUSION

A hyperdense renal parenchyma relative to surrounding skeletal muscle (EE pattern) and presence of renal artery calcifications on immediate post-HAE non-contrast CT images in patients with low risk for CIN are independently associated with CIN development.

Keywords: Hepatic artery embolization; Non-contrast computed tomographic; Contrast-induced nephropathy; Renal enhancement pattern; Intra-arterial; Renal artery calcification

Core Tip: Contrast-induced nephropathy (CIN) is a reversible form of acute kidney injury that occurs within 48-72 h of exposure to intravascular contrast material. CIN is the third leading cause of hospital-acquired acute kidney injury and accounts for 12% of such cases. Identification of early indicators of CIN development is important in taking timely management strategies. There is no known mechanism for early identification and timely initiation of preventive measures in patients otherwise considered low risk for development of CIN after transarterial hepatic artery embolization. This work helps clinicians identify patients at risk of CIN at the time of hepatic artery embolization.