Abstract: FR-PO0470
When Hydration Fails: Iodinated Contrast-Associated Acute Interstitial Nephritis
Session Information
- AKI: Case Reports - TMA, Vasculitis, Immune-Mediated Injury, and Systemic Disease
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Author
- Zhang, Ai-hua, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
Introduction
We present a case of biopsy-confirmed subacute tubulointerstitial nephritis following contrast exposure.
Case Description
A 62-year-old male patient was diagnosed with T2DM in 2025. Urine protein was negative and Scr was 97.3 μmol/l.
On March 5, 2026, coronary CTA was performed. He developed nausea and vomiting twice, accompanied by fever, which resolved spontaneously after 1 day. On March 19, laboratory tests showed Scr 566.1 μmol/L and NT-proBNP 515 ng/l. BP was 130/80 mmHg, and intravenous fluid was administered . However Scr continued to rise to 805.71 μmol/l on March 31, and NT-proBNP increased to 5986 ng/l.
On March 31, he was transferred to the Nephrology Department. Urinalysis: blood (-), protein (+). Urinaryα1-microglobulin 5.71 mg/dl. 24-hour urine protein: 0.87 g. Hemoglobin 104 g/l, platelets 320/μl. ESR: 119 mm/h. Ultrasound: both kidneys were normal in size with increased echogenicity and abundant blood flow signals.
On March 31, a renal biopsy was performed. Pathologic diagnosis: Subacute tubulointerstitial nephritis; early diabetic nephropathy.
Intravenous methylprednisolone 40 mg daily was initiated on March 31. The next day, Scr was 658.9 μmol/l. Serum creatinine declined to 579.6 μmol/l on April 10, , and further to 361.4 μmol/l on April 22.
Discussion
Iodinated contrast-associated AKI most commonly manifests as renal tubular injury. Adequate hydration can reduce both the risk and the severity. In the present case, despite aggressive fluid resuscitation, his Scr rose relentlessly. Timely renal biopsy revealed subacute tubulointerstitial nephritis superimposed on early diabetic nephropathy. Corticosteroid therapy yielded a favorable response.
Acknowledgment
My partners in our department.