Frequency of Contrast Induced Nephropathy after Angiography in Children with Congenital Heart Disease

Document Type : Original Article


1 Assistant Professor of Pediatric Cardiology

2 Department of Pediatric Cardiology, School of Medicine, Cardiovascular Research Center, University of Medical Sciences, Ahvaz, Ahvaz, Iran.

3 Department of Pediatric Nephrology, School of Medicine, University of Medical Sciences, Ahvaz, Ahvaz, Iran.

4 Department of Pediatric Neurology, School of Medicine, University of Medical Sciences, Ahvaz, Ahvaz, Iran.

5 Department of Pediatric, School of Medicine, University of Medical Sciences, Ahvaz, Ahvaz, Iran


Background and Objectives: Administration of contrast media (CM) results to an iatrogenic complication named contrast-induced nephropathy (CIN). CIN, defined as an increase in serum creatinine >25% of the baseline or (>0.5 mg/dL) within 2-3 days of intravascular contrast media, using in the absence of another renal disease. Incidence of CIN in the general population is reported overall to be 0.6-2.3%. Incidence of CIN is 10-20% in adults who underwent cardiac angiography and catheterization. Results from other studies in children are limited. The purpose of this study was to determine the frequency of CIN in children with congenital heart disease.
Subjects and Methods:One hundred children (ages ranging from 1 months to 20 years) during a period of 15 months (July 2011 and September 2012) were enrolled. Blood urea nitrogen (BUN), serum creatinine (Cr), sodium (Na+) and potassium (K+) were measured before angiography. These measurements were repeated 24 and 72 hours after angiography.
Results: Twenty four patients had >25% rising of creatinine from their baseline level. Base line level of BUN in patients with CIN were  12.04 mg/dl before the procedure that increased to 13.6 mg/dl at 24 hour and 13.88 mg/dl at 72 hours after procedure (P = 0.022).
Conclusion: Results of this study showed that the frequency of CIN is relatively high in children with congenital heart disease who underwent cardiac catheterization and is comparable to other reports in adults


Hou SH, Bushinsky DA, Wish JB, Cohen JJ, Harrington JT. Hospital acquired renal insufficiency: A prospective study. Am J Med 1983;74: 243-8.
2-Morcos SK. Contrast media-induced nephrotoxicity-questions and answers. Br J Radiol 1998 Apr;71(844): 357-65.
3-Morcos SK, Thomsen HS, Webb JA. Contrast-media-induced nephrotoxicity: A consensus report. Contrast Media Safety Committee, European Society of Urogenital Radiology (ESUR). Eur Radiol 1999; 9(8): 1602-13.
4-Pollock DM, Polakowski JS, Wegner CD, Opgenorth TJ. Beneficial effect of ETA receptor blockade in a rat model of radiocontrastinduced nephropathy. Ren Fail 1997 Nov;19(6): 753-61.
5-Oymak O. Contrast media induced irreversible acute renal failure in a patient treated with intraperitoneal cisplatin. Clin Nephrol 1995Agu; 44(2): 135-6.
6-Raynal-Raschilas N, Deray G, Bagnis C, Jacobs C. Severe acute renal failure after administration of contrast media in a patient treated with cisplatin. Nephrol Dial Transplant 1996 Dec;11(12): 2522-3.
7-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;103:368-75.
8-Taliercio CP, Vlietstra RE, Fisher LD, Burnett JC. Risks for renal dysfunction with cardiac angiography. Ann Intern Med 1986 Apr;104(4): 501-4.
9-Cigarroa RG, Lange RA, Williams RH, Hillis LD. Dosing of contrast material to prevent contrast nephropathy in patients with renal disease. Am J Med 1989 Jun; 86(6): 649-52.
10-Barrett BJ, Carlisle EJ. Metaanalysis of the relative nephrotoxicity of high and low-osmolality iodinated contrast media. Radiology 1993 Jul;188(1): 171-8.
11-Aspelin P, Aubry P, Fransson SG, Strasser R, Willenbrock R, Berg KJ. Nephrotoxicity in high-risk patients study of iso-osmolar and lowosmolar non-ionic contrast media study investigators. Nephrotoxic effects in high-risk patients undergoing angiography. N Engl J Med 2003Feb; 348(6): 491-9.
12-Eisenberg RL, Bank WO, Hedgock MW. Renal failure after major angiography can be avoided with hydration. AJR Am J Roentgenol 1981May; 136(5): 859-61.
13-Jo SH, Youn TJ, Koo BK, Park JS, Kang HJ, Cho YS, "et al". Renal toxicity evaluation and comparison between visipaque (iodixanol) and hexabrix (ioxaglate) in patients with renal insufficiency undergoing coronary angiography: The recover study: A randomized controlled trial. J Am Coll Cardiol 2006 Sep; 48(5): 924-30.
14-McCullough PA, Bertrand ME, Brinker JA, Stacul F. A meta-analysis of the renal safety of isosmolar iodixanol compared with lowosmolar contrast media. J Am Coll Cardiol 2006Agu; 48(4): 692-9.
15-Detrenis S, Meschi M, Musini S, Savazzi G. Lights and shadows on the patnogenesis of contrast-inducea nephropathy: State of the art. Nephro Dial Transplant 2005Sep; 20:1542-50.
16-Pakfetrat M, Nikoo MH, Malekmakan L, Tabandeh M, Roozbeh J, Nasab MH, "et al". A comparison of sodium bicarbonate infusion versus normal saline infusion and its combination with oral acetazolamide for prevention of contrast-induced nephropathy: A randomized, double blind trial. Int Urol Nephrol 2009; 41:629-34.
17-Maioli M, Toso A, Leoncini M, Gallopin M, Tedeschi D, Micheletti C, "et al". Sodium bicarbonate versus saline for the prevention of contrast-induced nephropathy in patients with renal dysfunction undergoing coronary angiography or intervention. J Am Coll Cardiol 2008Agu; 52(8): 599-604.
18-Emin E, Ozcan, Sema Guneri, Bahri Akdeniz. Sodium bicarbonate, N-acetylcysteine, and saline for prevention of radiocontrastinduced nephropathy. A comparison of 3 regimens for protecting contrast-induced nephropathy in patients undergoing coronary procedures. A single-center prospective controlled trial. American Heart Journal 2007; 154: 539-44.
19-Kelly AM, Dwamena B, Cronin P, Bernstein SJ, Carlos RC. Metaanalysis: Effectiveness of drugs for preventing contrast-induced nephropathy. Ann Intern Med 2008; 148: 284-94.
20-Mehran R, Aymong ED, Nikolsky E, Lasic Z, lakovou L, Fahy M, "et al". A simple risk score for   rediction of contrast-induced nephropathy after percutaneous coronary intervention: Development and initial validation. J Am Coll Cardiol 2004; 44(7):1393-9.
21-Katholi RE, Taylor GJ, Woods WT, Womack KA, Katholi CR, McCann WP, "et al". Nephrotoxicity of nonionic low-osmolarity versus ionic high-osmolarity contrast media: A prospective double-blind randomized comparison in human beings. Radiology 1993Jan; 186(1): 183-7.
22-Harris KG, Smith TP, Cragg AH, Lemke JH. Nephrotoxicity from contrast material in renal insufficiency: Ionic versus nonionic agents. Radiology 1991Jun; 179(3): 849-52.
23-Bolognese L, Falsini G, Schwenke C, Grotti S, Limbruno U, Liistro F, "et al". Impact of iso-osmolar versus low-osmolar contrast agents on contrast-induced nephropathy and tissue reperfusion in unselected patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (from the contrast media and nephrotoxicity following primary angioplasty for acute myocardial infarction [CONTRAST-AMI] Trial). Am J Cardiol 2012Jan;109(1): 67-74.
24-Schwab SJ, Hlatky MA, Pieper KS, Davidson CJ, Morris KG, Skelton TN, "et al". Contrast nephrotoxicity: A randomized controlled trial of a nonionic and an ionic radiographic contrast agent. N Engl J Med 1989; 320: 149-53.
25-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; 103:368-75.
26-Kini AS, Mitre CA, Kim M, Kamran M, Reich D, Sharma SK. A protocol for prevention of radiographic contrast nephropathy during percutaneous coronary intervention: Effect of selective dopamine receptor agonist fenoldopam. Catheter Cardiovasc Interv 2002; 55:169-73.
27-Albert SG, Shapiro MJ, Brown WW, Goodgold H, Zuckerman D, Durham R, "et al". Analysis of radiocontrast-induced nephropathy by dual-labeled radionuclide clearance. Invest Radiol 1994; 29:618-23.
28-Diaz-Sandoval LJ, Kosowsky BD, Losordo DW. Acetylcysteine to prevent angiography-related renal tissue injury (the APART trial). Am J Cardiol 2002;89:356-8.
29-Rosovsky MA, Rusinek H, Berenstein A, Basak S, Setton A, Nelson PK. High-dose administration of nonionic contrast media: A retrospective review. Radiology 1996; 200:119-22.
30-Kahn JK, Rutherford BD, McConahay DR, Johnson WL, Giorgi LV, Shimshak TM, "et al". High-dose contrast agent administration during complex coronary angioplasty. Am Heart J 1990 Sep; 120(3): 533-6.
31-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 Agu; 94(3): 300-5.
32-Stevens MA, McCullough PA, Tobin KJ, Speck JP, Westveer DC, Guido-Allen DA, "et al". A prospective randomized trial of prevention measures in patients at high risk for contrast nephropathy: Results of the P.R.I.N.C.E. Study. Prevention of radiocontrast induced nephropathy clinical evaluation. J Am Coll Cardiol 1999 Feb; 33(2): 403-11.
33-Guitterez NV, Diaz A, Timmis GC, O’Neill WW, Stevens MA, Sandberg KR, "et al". Determinants of serum creatinine trajectory in acute contrast nephropathy. J Interv Cardiol 2002Oct; 15(5): 349-54.
34-Taki K, Oogushi K, Hirahara K, Gai X, Nagashima F, Tozuka K. Preventional acetazolamide-induced vasodilation based on vessel size and organ: Confirmation of peripheral vasodilation with use of colored microscopheres. Angiography 2001Jul;52(7): 483-8.
35-Baker CS, Baker LR. Prevention of contrast nephropathy after cardiac catheterization. Heart 2001; 85:361-2.
36-Marenzi G, Marana I, Lauri G, Assanelli E, Grazi M, Campodonico J, "et al". The prevention of radiocontrast-agent-induced nephropathy by hemofiltration. N Engl J Med 2003; 349:1333-40.