Incidence of contrastant acute kidney injury for short-term imaging examination

At present, most patients with acute ischemic stroke choose CTA rapid screening of etiology, and then DSA imaging of some patients, to make a decision on thrombosis or thrombosis therapyIn a short period of time the arterial injection of approximately 200mL contrast agent may increase the incidence of postcontrast agent acute renal injury (postcontrast renal injury, PC-AKI)Jin Ho Beom of the Emergency Department of Yonsei University School of Medicine in Seoul, South Korea, conducted retrospective observational studies to assess the incidence of PC-AKI in CTA and cerebrovascular amenosis after acute ischemic stroke, published in the April 2020 issue of american Journal of Neuroradiologyresearch methodsincluded in the study in 601 cases of ischemic stroke patients who underwent CTA and cerebrovascular angiography between October 2010 and September 2018Patients excluded from CTA tests in other hospitals, death within 48 hours after CTA, transfer or discharge within 48 hours of CTA, longer than 48 hours between CTA and cerebrovascular angiography, history of end-stage renal disease and use of angiography for 72 hours without serum creatinine dataAccording to current guidelines, the rate of glomerular filterfiltration (estimated glomerular rate, eGFR) is estimated using the Chronic Kidney Disease Epidemiology Collaboration equationPC-AKI refers to the absolute value of serum creatinine or serum creatinine levels of 0.5 mg/dL or serum creatinine increased by 25% over the baseline within 72 hours after injection of the contrast agentThe researchers assessed the incidence of PC-AKI based on baseline eGFR and analyzed the effects of different variables on PC-AKI incidence through multivariate logistic regressionResults showed that PC-AKI occurred in 57 (9.5%) of 601 patientsThe incidence of PC-AKI varies significantly between different baseline eGFR groups (P 0.001) (Table 1)Table 1PC-AKI incidence based on baseline eGFRfurther analysis of the resultsresults showed a higher incidence of acute kidney injury in patients with baseline eGFR 30mL/min/1.73m2 (Table 2)Table 2Comparison of PC-AKI incidence rates between baseline eGFR groupsmultivariate analysis, age, chronic nephropathy history, antidote after injection of drugs (including nonsteroidal anti-inflammatory drugs, angiotensin conversion enzyme inhibitors, angiotensin II blockers, beta blockers, statins and insulin, etc.) and serum albumin levels, significantly affecting the incidence of PC-AKIIn addition, the incidence of PC-AKI increased when the baseline estimated glomerular filtration rate of 43mL/min/1.73m2 increasedConclusionThe study showed that the incidence of PC-AKI in patients with ctA and cerebrovascular angiography in a short period of time increased significantly in patients with a baseline eGFR of 30mL/min/1.73m2; Therefore, non-enhanced CTA and MRI or MRA tests may be considered for such patientsIn summary, patients with baseline renal dysfunction had the highest incidence of angiography acute renal injury after CTA and cerebrovascular angiography, but no fatal adverse reactions associated with PC-AKI occurredTherefore, according to the analysis of risk and benefit, the author thinks that patients suspected of stroke due to cerebrovascular lesions should actively carry out radiation imaging tests for screening the causes of the disease, and strive for timely treatment.