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Kidney Week

Abstract: TH-PO130

Contrast Nephropathy: Associated or Induced?

Session Information

  • AKI: Mechanisms - I
    November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

  • 103 AKI: Mechanisms

Authors

  • Kaur, Ramandeep, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
  • Block, Clay A., Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
  • Pettus, Jason R., Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
Introduction

Acute Kidney Injury (AKI) secondary to radiographic contrast exposure has been challenged in recent years. Contrast Associated Nephropathy (CAN) often occurs in the presence of other risk factors for AKI. We report a case in which AKI developed following radiocontrast exposure but also in the presence of other risk factors for AKI. A kidney biopsy established the diagnosis.

Case Description

A 64-year-old woman presented with acute confusion and falls suspicious for CNS vasculitis. She was admitted and treated with pulse methylprednisolone and intravenous vancomycin, ampicillin, ceftriaxone, acyclovir and omeprazole while performing studies for infection and autoimmunity. The creatinine rose from 0.6 mg/dL on day 1 to 2.3 mg/dL on day 3. The urine protein - creatinine ratio was 0.55 g/g. UPEP, SPEP, serum free light chains, and immunological studies including C-ANCA, P-ANCA, MPO Ab, ANA, PR3 Ab, C3 and C4 complements, Cryoglobulins, anti-ds DNA, anti-CCP antibodies were negative. A kidney biopsy was done. It demonstrated severe, diffuse tubular isometric vacuolization compatible with osmotic nephrosis. There was no evidence of acyclovir toxicity, AIN, or conventional ATN. With supportive care, the renal function normalized by day 6.

Discussion

Radiocontrast is commonly used in hospitalized patients and has a strong potential for nephrotoxicity. CAN is considered when the patient receives a radiocontrast either intravenously or intra-arterially with a subsequent elevation of serum creatinine of either 0.5 mg/dL or 25% increase above the baseline over the next 24-72 hours. In AKI following radiocontrast exposure and competing explanations, kidney biopsy may point to a specific diagnosis.

H&E, 40 X

Transmission EM