Acil Servise Başvuran Hastalarda Kontrastlı Bilgisayar Tomografi Sonrası Opak Nefropatisi Olasılığı

Yıl 2025, Cilt: 47 Sayı: 5, 766 - 773, 04.09.2025

Ruşengül Koruk , Engin Özakın , Gökhan Temiz , Nurdan Acar , Mustafa Emin Çanakçı , Mine Gülşin , Çağlar Kuas , Osman Çetinkaya Volkan Ercan , Filiz Baloğlu Kaya

https://doi.org/10.20515/otd.1685969

Öz

Kontrast kaynaklı nefropati (CIN), iyotlu kontrast madde uygulanmasını takiben gelişen ciddi bir komplikasyon olup, hastane kökenli akut böbrek hasarına (AKI) önemli ölçüde katkıda bulunur. CIN, kontrast madde uygulamasından 48–72 saat sonra bazal kreatinin değerine göre %25’lik bir artış veya ≥0.5 mg/dL’lik mutlak bir artış olarak tanımlanır. Bu çalışma, acil serviste (AS) kontrastlı BT uygulanan hastalarda CIN insidansını ve ilişkili risk faktörlerini değerlendirmiştir. Haziran 2013 – Eylül 2014 tarihleri arasında üçüncü basamak bir AS’te prospektif gözlemsel çalışma yürütülmüştür. BT çekilen ≥18 yaş erişkin hastalar çalışmaya dahil edilmiştir. Başlangıç kreatinin değeri >1.2 mg/dL olanlar, akut böbrek yetmezliği veya hemodinamik instabilitesi olanlar hariç tutulmuştur. Kontrastlı BT yapılan grupta (n=171), 14 hasta (%8.1) CIN geliştirmiş; kontrastsız BT grubunda (n=171) ise 12 hasta (%7.0) nefropati geliştirmiştir. Hastaneye yatış (n=11, p=0.030), ileri yaş (p=0.026), anemi (p=0.045), lökositoz (p=0.005) ve düşük GFR (p=0.028), kontrast maddeye bağlı nefropati gelişimiyle ilişkili risk faktörleri olarak belirlenmiştir. Kontrastsız BT grubunda ise anemi (p=0.003), hastaneye yatış (n=9; p=0.039) ve lökositoz (p=0.007) nefropati için anlamlı risk faktörleri olarak bulunmuştur. Her iki grupta da acil servisten taburcu edilen hastalarda nefropati tespit edilmemiştir. Normal böbrek fonksiyonlarına sahip AS hastalarında kontrast maddesi nefropati riskini anlamlı ölçüde artırmamıştır. Bununla birlikte, ileri yaş, anemi ve hastaneye yatış, yüksek riskli alt grupları tanımlamıştır. Zaman kısıtlılığı nedeniyle profilaktik önlemlerin belirgin bir yararı gözlenmemiştir. Özellikle yaşlı ve hospitalize hastalarda kontrast maruziyeti sonrası böbrek fonksiyonlarının yakından izlenmesi önerilmektedir.

Anahtar Kelimeler

Kontrast kaynaklı nefropati , acil servis , BT , risk faktörleri , profilaksi

Incidence and Risk Factors of Contrast-Induced Nephropathy in Emergency Department Patients Undergoing Contrast-Enhanced CT

Öz

Contrast-induced nephropathy (CIN) is a serious complication following the administration of iodinated contrast media, contributing significantly to hospital-acquired acute kidney injury. Contrast-induced nephropathy is defined as either a ≥25% increase from baseline creatinine levels or an absolute increase >0.5 mg/dL, within 48–72 hours after contrast media administration. This study evaluated CIN incidence and associated risk factors in emergency department (ED) patients undergoing contrast-enhanced CT. A prospective observational study was conducted at a tertiary-care ED (June 2013–September 2014). Adults (≥18 years) undergoing CT were enrolled, excluding those with baseline creatinine >1.2 mg/dL, acute kidney injury, or hemodynamic instability. Of the contrast-enhanced CT group (n=171), 14 patients (8.1%) developed CIN, whereas in the non-contrast CT group (n=171), 12 patients (7.0%) developed nephropathy. Hospitalization (p=0.030), advanced age (p=0.026), anemia (p=0.045), leukocytosis (p=0.005), and reduced GFR (p=0.028) were identified as risk factors for contrast-induced nephropathy. In the non-contrast group, anemia (p=0.003), hospitalization (n=9; p=0.039), and leukocytosis (p=0.007) were identified as risk factors for nephropathy. No cases of nephropathy was observed in patients discharged from the ED in either group. Contrast media did not significantly increase nephropathy risk in ED patients with normal renal function. However, older age, anemia, and hospitalization identified high-risk subgroups. Prophylactic measures showed no clear benefit, possibly due to ED time constraints. Vigilance is recommended for elderly and hospitalized patients, with renal monitoring following contrast administration.

Anahtar Kelimeler

Contrast-induced nephropathy , emergency department , CT , risk factors , prophylaxis.

Kaynakça

• 1. Sinert R, Brandler E, Subramanian RA, Miller AC. Does the current definition of contrast-induced acute kidney injury reflect a true clinical entity? Acad Emerg Med Off J Soc Acad Emerg Med. 2012 Nov;19(11):1261–7.
• 2. Owen RJ, Hiremath S, Myers A, Fraser-Hill M, Barrett BJ. Canadian Association of Radiologists consensus guidelines for the prevention of contrast-induced nephropathy: update 2012. Can Assoc Radiol J J Assoc Can Radiol. 2014 May;65(2):96–105.
• 3. Finn WF. The clinical and renal consequences of contrast-induced nephropathy. Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc - Eur Ren Assoc. 2006 Jun;21(6):i2-10.
• 4. Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis Off J Natl Kidney Found. 2002 May;39(5):930–6.
• 5. Finn WF. The clinical and renal consequences of contrast-induced nephropathy. Nephrol Dial Transplant. 2006 Jun 1;21(suppl_1):i2–10.
• 6. Mitchell AM, Kline JA. Contrast nephropathy following computed tomography angiography of the chest for pulmonary embolism in the emergency department. J Thromb Haemost. 2007 Jan;5(1):50–4.
• 7. Kim KS, Kim K, Hwang SS, Jo YH, Lee CC, Kim TY, et al. Risk stratification nomogram for nephropathy after abdominal contrast-enhanced computed tomography. Am J Emerg Med. 2011 May 1;29(4):412–7.
• 8. Hopyan JJ, Gladstone DJ, Mallia G, Schiff J, Fox AJ, Symons SP, et al. Renal Safety of CT Angiography and Perfusion Imaging in the Emergency Evaluation of Acute Stroke. AJNR Am J Neuroradiol. 2008 Nov;29(10):1826–30.
• 9. Aykaç Ö, Özakın E, Özdemir AÖ, Karakılıç ME, Sezer Eryıldız E. The effect of contrast agent used during vascular imaging and endovascular treatment on nephropathy and prognosis in acute stroke patients admitted to the emergency department. Turk J Cerebrovasc Dis. 2023;29(2):68–76.
• 10. Rihal CS, Textor SC, Grill DE, Berger PB, Ting HH, Best PJ, et al. Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention. Circulation. 2002 May 14;105(19):2259–64.
• 11. Pannu N, Wiebe N, Tonelli M, Alberta Kidney Disease Network for the. Prophylaxis Strategies for Contrast-Induced Nephropathy. JAMA. 2006 Jun 21;295(23):2765–79.
• 12. Mehran R, Aymong ED, Nikolsky E, Lasic Z, Iakovou I, Fahy M, et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: Development and initial validation. J Am Coll Cardiol. 2004 Oct 6;44(7):1393–9.
• 13. Nikolsky E, Mehran R, Turcot D, Aymong ED, Mintz GS, Lasic Z, et al. Impact of chronic kidney disease on prognosis of patients with diabetes mellitus treated with percutaneous coronary intervention. Am J Cardiol. 2004 Aug 1;94(3):300–5.
• 14. Durukan P, Ozkan S, Ikizceli I, Vardar A, Ipekci A, Duman A. Contrast-induced nephropathy risk due to emergency contrast-enhanced computed tomography. Eur J Emerg Med Off J Eur Soc Emerg Med. 2012 Feb;19(1):20–3.
• 15. Barrett BJ, Carlisle EJ. Metaanalysis of the relative nephrotoxicity of high- and low-osmolality iodinated contrast media. Radiology. 1993 Jul;188(1):171–8.
• 16. Tepel M, Giet M van der, Schwarzfeld C, Laufer U, Liermann D, Zidek W. Prevention of Radiographic-Contrast-Agent–Induced Reductions in Renal Function by Acetylcysteine. N Engl J Med. 2000 Jul 20;343(3):180–4.
• 17. Pannu N, Wiebe N, Tonelli M, Alberta Kidney Disease Network for the. Prophylaxis Strategies for Contrast-Induced Nephropathy. JAMA. 2006 Jun 21;295(23):2765–79.
• 18. Thomsen HS, Morcos SK. Contrast media and the kidney: European Society of Urogenital Radiology (ESUR) guidelines. Br J Radiol. 2003 Aug;76(908):513–8.
• 19. Nikolsky E, Mehran R, Turcot D, Aymong ED, Mintz GS, Lasic Z, et al. Impact of chronic kidney disease on prognosis of patients with diabetes mellitus treated with percutaneous coronary intervention. Am J Cardiol. 2004 Aug 1;94(3):300–5.
• 20. Gruberg L, Mintz GS, Mehran R, Gangas G, Lansky AJ, Kent KM, et al. The prognostic implications of further renal function deterioration within 48 h of interventional coronary procedures in patients with pre-existent chronic renal insufficiency. J Am Coll Cardiol. 2000 Nov 1;36(5):1542–8.
• 21. McDonald RJ, McDonald JS, Bida JP, Carter RE, Fleming CJ, Misra S, et al. Intravenous Contrast Material–induced Nephropathy: Causal or Coincident Phenomenon? Radiology. 2013 Apr;267(1):106–18.
• 22. McCullough PA, Wolyn R, Rocher LL, Levin RN, O’Neill WW. Acute Renal Failure After Coronary Intervention: Incidence, Risk Factors, and Relationship to Mortality. Am J Med. 1997 Nov 1;103(5):368–75.
• 23. Freeman RV, O’Donnell M, Share D, Meengs WL, Kline-Rogers E, Clark VL, et al. Nephropathy requiring dialysis after percutaneous coronary intervention and the critical role of an adjusted contrast dose. Am J Cardiol. 2002 Nov 15;90(10):1068–73.