Does intravenous contrast medium administration result in altered renal biomarkers? A study in clinically stable cats with and without azotemia

Objectives The aim of this study was to determine the prevalence of post-contrast acute kidney injury or comparable side effects on kidney function in cats receiving the non-ionic, iodinated agent ioversol and/or paramagnetic agent gadoteric acid. Methods Fifty-two animals were divided into four groups on the basis of contrast medium administration for imaging: ioversol (n = 27), gadoteric acid (n = 12), dual contrast media (n = 4) or control, which received an infusion of isotone intravenous fluids only during anaesthesia (n = 9). Blood and urine samples were obtained three times after contrast administration and compared with values obtained prior to administration of the contrast medium. Creatinine (<1.60 mg/dl), symmetric dimethylarginine (SDMA; ⩽14 μg/dl), urine protein:creatinine ratio (UPC; <0.2) and critical differences for creatinine (<0.3 mg/dl) and SDMA (<5.98 μg/dl) were measured. Results No significant short-term effects on mean creatinine, SDMA and UPC measurements were seen. Borderline proteinuria (UPC, 0.2–0.4) was detected in 11.4% of cases after contrast media administration. A UPC of more than 0.2 in five cases indicated that contrast media may affect kidney function, leading to (transient) proteinuria. Conclusions and relevance This study found no side effect on renal function following the administration of ioversol or gadoteric acid, provided patients were adequately hydrated. However, the clinical relevance of proteinuria in some cats needs to be evaluated in future studies.

Risk of Contrast-Induced Nephropathy after Repeated Contrast Medium Administration

Objective: Non-invasive coronary computed tomography angiography is frequently used to exclude coronary artery disease in patients with low-to-intermediate pre-test probability because of the high negative predictive value. The strategy of coronary computed tomography angiography and subsequent invasive coronary angiography in case of positive findings has risks owing to repeated contrast medium administration and the possibility of contrast-induced nephropathy. Methods: We retrospectively evaluated the changes in the serum creatinine level and estimated glomerular filtration rate (at baseline, 24 h, and 48 h after contrast administration) in patients with repeated contrast medium administration in order to evaluate contrast-induced nephropathy development. All patients were intravenously hydrated with 1000 ml sodium chloride (0.9%) per day during hospitalization. Results: The study included 17 patients. Of these patients, 7 (41.2%) had prior impaired renal function (estimated glomerular filtration rate <60 ml/min/1.73 m2). The mean coronary computed tomography angiography contrast medium (iopromide 769 mg/ml) volume was 114.11 ± 7.75 ml and the mean invasive coronary angiography contrast medium (iohexol 755 mg/ml) volume was 129.7 ± 19.24 ml. The serum creatinine level was significantly higher and the estimated glomerular filtration rate was significantly lower at 48 hours after the second contrast medium administration than at baseline (p = 0.05 and p = 0.03, respectively). None of the patients had contrast-induced nephropathy. Conclusion: Repeated contrast medium administration was not associated with contrast-induced nephropathy development at 48 hours after the second contrast medium administration, even in patients with prior impaired renal function.

Contrast-enhanced computed tomography of the liver, gall bladder and urogenital tract in female red-eared terrapins (Trachemys scripta elegans)

The aim of the present study was to evaluate the feasibility of contrast-enhanced computed tomography for organ morphology and perfusion in five captive terrapins. Native scans were performed and afterwards an iodinated non-ionic contrast media was manually administered through the jugular vein catheter. Post-contrast CT scans were taken 20 (T₂₀), 60 (T₆₀) and 180 (T₁₈₀) seconds after the contrast medium administration. Maximum contrast enhancement of the kidneys and the liver was detected at T₂₀ and T₆₀, respectively. The gall bladder content, the urinary bladder content and ovarian follicles were all without contrast enhancement in all five terrapins. Gall bladder wall thickness was 0.9 mm in all terrapins. Enhancement of the gall bladder wall in post-contrast studies was considered excellent, good or poor in two terrapins, two terrapins and one terrapin, respectively, with a mean score of 1.8 ± 0.84 over all contrast studies. Enhancement of the ureters in post-contrast studies was considered excellent in all terrapins in all contrast studies. Peak aortic enhancement was reached 20 seconds after contrast medium administration with the peak enhancement of 213.5 ± 41 HU in four terrapins and 560 HU in one terrapin. Peak hepatic vein enhancement after contrast medium administration was recorded 20 and 60 seconds in two and three terrapins, respectively. In conclusion, contrast-enhanced computed tomography proved to be a valuable method for clinical examination of the liver, gall bladder, kidneys, ureters, urinary bladder and ovarian follicles in red-eared terrapins.