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  • Review Article
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Contrast-induced acute kidney injury and diabetic nephropathy

Nature Reviews Nephrology volume 6, pages 679–688 (2010)Cite this article

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Abstract

Contrast-induced acute kidney injury (CIAKI) is a leading cause of iatrogenic renal failure. Multiple studies have shown that patients with diabetic nephropathy are at high risk of CIAKI. This Review presents an overview of the pathogenesis of CIAKI in patients with diabetic nephropathy and discusses the currently available and potential future strategies for CIAKI prevention.

Key Points

  • Contrast-induced acute kidney injury (CIAKI) is caused by the intra-arterial and intravenous administration of contrast media and is associated with a high risk of mortality

  • Diabetes, even in the absence of renal impairment, might increase the risk of CIAKI, and CIAKI might favor progression of diabetic nephropathy

  • CIAKI prophylaxis should be considered in all patients with diabetes who require intra-arterial or intravenous administration of contrast medium

  • Intravenous hydration is the cornerstone of CIAKI prophylaxis, whereas the administration of sodium bicarbonate is of unclear benefit and might be harmful in patients with diabetes owing to its pro-oxidant properties

  • N-acetylcysteine administration might have protective effects and has low toxicity and should be considered for CIAKI prevention in patients with diabetes

  • Adenosine A1 receptor antagonists seem to be promising agents for CIAKI prophylaxis, but additional studies in humans are needed

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Figure 1: The pathways potentially underlying the pathogenesis of CIAKI in patients with diabetes.
Figure 2: Both contrast media and diabetes affect dilation of the renal vasculature.

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Acknowledgements

A. D. Calvin's research is supported by the Mayo Clinic Clinician–Investigator Training Program. The authors gratefully acknowledge D. Mackenburg and E. Pflueger, who contributed to this Review with editorial support, including help with references and figures. Both D. Mackenburg and E. Pflueger are affiliated with the Mayo Clinic College of Medicine, Rochester, MN, USA.

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Authors and Affiliations

  1. Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, 55905, MN, USA

    Andrew D. Calvin

  2. Division of Interventional Radiology, Department of Radiology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, 55905, MN, USA

    Sanjay Misra

  3. Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, 55905, MN, USA

    Axel Pflueger

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  1. Andrew D. Calvin
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A. D. Calvin and A. Pflueger researched data for the article, made substantial contributions to the discussion of content, wrote the article and reviewed/edited the manuscript before submission. S. Misra made substantial contribution to the discussion of content and wrote the article.

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Correspondence to Axel Pflueger.

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Calvin, A., Misra, S. & Pflueger, A. Contrast-induced acute kidney injury and diabetic nephropathy. Nat Rev Nephrol 6, 679–688 (2010). https://doi.org/10.1038/nrneph.2010.116

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