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
Contrast-induced nephropathy (CIN) is a reversible form of acute kidney injury that occurs within 48-72 h of exposure to intravascular contrast material. A higher 1-mo and 1-year mortality rates have been reported in these patients, particularly following arterial angiography.
The cornerstone of CIN management is prevention.
To help with early identification and timely initiation of preventive measures in patients otherwise considered low risk for development of CIN after transarterial hepatic artery embolization.
Retrospective review of all patients who underwent hepatic artery embolization between 2010 and 2011 (n = 162) was performed. After removing exclusions, 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 computed tomographic (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.
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).
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.
Prospective studies are required to further assess the findings of this study.