Childhood Kidney Diseases

Korean Society of Pediatric Nephrology (대한소아신장학회)
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Contrast-Associated Acute Kidney Injury (CA-AKI) in Children: Special Considerations

  • Windpessl, Martin (Department of Internal Medicine IV (Nephrology Section), Klinikum Wels-Grieskirchen) ;
  • Kronbichler, Andreas (Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck)
  • Received : 2019.08.29
  • Accepted : 2019.10.08
  • Published : 2019.10.31
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Abstract

Contrast-associated acute kidney injury (CA-AKI) is a major concern when iodinated contrast material is administered, especially in patients at risk. Efforts have been undertaken to understand the detrimental effects of contrast media (CM). With the use of low-osmolar or iso-osmolar CM the incidence of CA-AKI has steadily decreased within the past decade; however, especially in the pediatric population information is scarce. Incidence rates have been reported to range between 0% to 18.75%, particularly depending on indication, selection of population (i.e. preexisting co-morbidities), and definition of AKI. Different biomarkers have been proposed, but confirmatory studies are either lacking or have contributed to their lack of diagnostic power. Proteomic approaches have been employed and may pave the way to such discovery. Prevention strategies have been tested and proposed, but the recently published AMACING and PRESERVE trials have shown that commonly used strategies (such as systematic hydration or administration of N-acetylcysteine) have no role in the prevention of CA-AKI. We propose that thoughtful assessment of one's fluid state is the most appropriate approach and depending on the hydration status diuretics or fluid administration should be provided to achieve an euvolemic state ahead of contrast exposure.

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References

  1. Goldstein SL. Acute kidney injury in children and its potential consequences in adulthood. Blood Purif 2012;33:131-7. https://doi.org/10.1159/000334143
  2. Katzberg RW, Haller C. Contrast-induced nephrotoxicity: clinical landscape. Kidney Int Suppl 2006:S3-7.
  3. Tandukar S, Rondon-Berrios H, Weisbord SD. Intravascular Iodinated Contrast Is an Independent Cause of Acute Kidney Injury Following Coronary Angiography. South Med J 2019;112:541-6. https://doi.org/10.14423/SMJ.0000000000001029
  4. Windpessl M, Kronbichler A. Pro: Contrast-induced nephropathyshould we try to avoid contrast media in patients with chronic kidney disease? Nephrol Dial Transplant 2018;331317-9.
  5. Ewing MJ, Eidt JF. Con: Contrast-induced nephropathy-should we try to avoid contrast media in patients with chronic kidney disease? Nephrol Dial Transplant 2018;33:1320-2. https://doi.org/10.1093/ndt/gfy153
  6. Akcan-Arikan A, Zappitelli M, Loftis LL, Washburn KK, Jefferson LS, Goldstein SL. Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int 2007;71:1028-35. https://doi.org/10.1038/sj.ki.5002231
  7. Xu X, Nie S, Zhang A, Jianhua M, Liu HP, Xia H, et al. A New Criterion for Pediatric AKI Based on the Reference Change Value of Serum Creatinine. J Am Soc Nephrol 2018;29:2432-42. https://doi.org/10.1681/ASN.2018010090
  8. Sutherland SM, Byrnes JJ, Kothari M, Longhurst CA, Dutta S, Garcia P, et al. AKI in hospitalized children: comparing the pRIFLE, AKIN, and KDIGO definitions. Clin J Am Soc Nephrol 2015;10:554-61. https://doi.org/10.2215/CJN.01900214
  9. Hwang YJ, Hyun MC, Choi BS, Chun SY, Cho MH. Acute kidney injury after using contrast during cardiac catheterization in children with heart disease. J Korean Med Sci 2014;29:1102-7. https://doi.org/10.3346/jkms.2014.29.8.1102
  10. Yim HE. Neutrophil Gelatinase-Associated Lipocalin and Kidney Diseases. Child Kidney Dis 2015;19:79-88. https://doi.org/10.3339/chikd.2015.19.2.79
  11. Hirsch R, Dent C, Pfriem H, Allen J, Beekman RH, 3rd, Ma Q, et al. NGAL is an early predictive biomarker of contrast-induced nephropathy in children. Pediatr Nephrol 2007;22:2089-95. https://doi.org/10.1007/s00467-007-0601-4
  12. Tkaczyk M, Tomczyk D, Jander A, Goreczny S, Moszura T, Dryzek P, et al. Glomerular filtration decrease after diagnostic cardiac catheterisation in children with congenital cardiac malformation - the role of serum creatinine, cystatin C, neutrophil gelatinase and urine output monitoring. Postepy Kardiol Interwencyjnej 2018;14:67-74.
  13. Spasojevic-Dimitrijeva B, Kotur-Stevuljevic J, Dukic M, Paripovic D, Milosevski-Lomic G, Spasojevic-Kalimanovska V, et al. Serum Neutrophil Gelatinase-Associated Lipocalin and Urinary Kidney Injury Molecule-1 as Potential Biomarkers of Subclinical Nephrotoxicity After Gadolinium-Based and Iodinated-Based Contrast Media Exposure in Pediatric Patients with Normal Kidney Function. Med Sci Monit 2017;23:4299-305. https://doi.org/10.12659/MSM.903255
  14. Bennett MR, Ravipati N, Ross G, Nguyen MT, Hirsch R, Beekman RH, et al. Using proteomics to identify preprocedural risk factors for contrast induced nephropathy. Proteomics Clin Appl 2008;2:1058-64. https://doi.org/10.1002/prca.200780141
  15. Zappitelli M, Greenberg JH, Coca SG, Krawczeski CD, Li S, Thiessen-Philbrook HR, et al. Association of definition of acute kidney injury by cystatin C rise with biomarkers and clinical outcomes in children undergoing cardiac surgery. JAMA Pediatr 2015;169:583-91. https://doi.org/10.1001/jamapediatrics.2015.54
  16. Uber AM, Montez-Rath ME, Kwiatkowski DM, Krawczeski CD, Sutherland SM. Nephrotoxin exposure and acute kidney injury in critically ill children undergoing congenital cardiac surgery. Pediatr Nephrol 2018;33:2193-9. https://doi.org/10.1007/s00467-018-4010-7
  17. Goldstein SL, Mottes T, Simpson K, Barclay C, Muething S, Haslam DB, et al. A sustained quality improvement program reduces nephrotoxic medication-associated acute kidney injury. Kidney Int 2016;90:212-21. https://doi.org/10.1016/j.kint.2016.03.031
  18. Uber AM, Sutherland SM. Acute kidney injury in hospitalized children: consequences and outcomes. Pediatr Nephrol 2018.
  19. Cleper R, Shavit I, Blumenthal D, Reisman L, Pomeranz G, Haham A, et al. Neonatal acute kidney injury: recording rate, course, and outcome: one center experience. J Matern Fetal Neonatal Med 2019;32:3379-85. https://doi.org/10.1080/14767058.2018.1463985
  20. Starr MC, Hingorani SR. Prematurity and future kidney health: the growing risk of chronic kidney disease. Curr Opin Pediatr 2018;30:228-35. https://doi.org/10.1097/MOP.0000000000000607
  21. Oster ME, Lee KA, Honein MA, Riehle-Colarusso T, Shin M, Correa A. Temporal trends in survival among infants with critical congenital heart defects. Pediatrics 2013;131:e1502-8. https://doi.org/10.1542/peds.2012-3435
  22. Seikaly MG, Ho PL, Emmett L, Fine RN, Tejani A. Chronic renal insufficiency in children: the 2001 Annual Report of the NAPRTCS. Pediatr Nephrol 2003;18:796-804. https://doi.org/10.1007/s00467-003-1158-5
  23. Abbas FM, Julie BM, Sharma A, Halawa A. "Contrast nephropathy" in renal transplantation: Is it real? World J Transplant 2016;6:682-8. https://doi.org/10.5500/wjt.v6.i4.682
  24. Paul KM, 2nd, Johnson J, Garwe T, Sarwar Z, Motghare P, Daly W, et al. Computed Tomography with Intravenous Contrast Is Not Associated with Development of Acute Kidney Injury in Severely Injured Pediatric Patients. Am Surg 2019;85:e1-e5.
  25. Zo'o M, Hoermann M, Balassy C, Brunelle F, Azoulay R, Pariente D, et al. Renal safety in pediatric imaging: randomized, doubleblind phase IV clinical trial of iobitridol 300 versus iodixanol 270 in multidetector CT. Pediatr Radiol 2011;41:1393-400. https://doi.org/10.1007/s00247-011-2164-6
  26. Ciavatta DJ, Yang J, Preston GA, Badhwar AK, Xiao H, Hewins P, et al. Epigenetic basis for aberrant upregulation of autoantigen genes in humans with ANCA vasculitis. J Clin Invest 2010;120:3209-19. https://doi.org/10.1172/JCI40034
  27. McDonald JS, McDonald RJ, Tran CL, Kolbe AB, Williamson EE, Kallmes DF. Postcontrast Acute Kidney Injury in Pediatric Patients: A Cohort Study. Am J Kidney Dis 2018;72:811-8. https://doi.org/10.1053/j.ajkd.2018.05.014
  28. Nijssen EC, Rennenberg RJ, Nelemans PJ, Essers BA, Janssen MM, Vermeeren MA, et al. Prophylactic hydration to protect renal function from intravascular iodinated contrast material in patients at high risk of contrast-induced nephropathy (AMACING): a prospective, randomised, phase 3, controlled, open-label, noninferiority trial. Lancet 2017;389:1312-22. https://doi.org/10.1016/S0140-6736(17)30057-0
  29. Weisbord SD, Gallagher M, Jneid H, Garcia S, Cass A, Thwin SS, et al. Outcomes after Angiography with Sodium Bicarbonate and Acetylcysteine. N Engl J Med 2018;378:603-14. https://doi.org/10.1056/NEJMoa1710933
  30. Barrett BJ, Carlisle EJ. Metaanalysis of the relative nephrotoxicity of high- and low-osmolality iodinated contrast media. Radiology 1993;188:171-8. https://doi.org/10.1148/radiology.188.1.8511292
  31. Azzalini L, Vilca LM, Lombardo F, Poletti E, Laricchia A, Beneduce A, et al. Incidence of contrast-induced acute kidney injury in a large cohort of all-comers undergoing percutaneous coronary intervention: Comparison of five contrast media. Int J Cardiol 2018;273:69-73. https://doi.org/10.1016/j.ijcard.2018.08.097
  32. Kronbichler A, Shin JI, Windpessl M. What is left to prevent contrast-induced acute kidney injury? No difference between low and iso-osmolar contrast media. Int J Cardiol 2018;273:94-5. https://doi.org/10.1016/j.ijcard.2018.09.050
  33. Media ACoDaC. ACR Manual On Contrast Media. 2018.
  34. Trout AT, Dillman JR, Ellis JH, Cohan RH, Strouse PJ. Patterns of intravenous contrast material use and corticosteroid premedication in children--a survey of Society of Chairs of Radiology in Children's Hospitals (SCORCH) member institutions. Pediatr Radiol 2011;41:1272-83. https://doi.org/10.1007/s00247-011-2112-5
  35. Verghese PS. Contrast nephropathy in children. J Pediatr Intensive Care 2014;3:45-52.
  36. McDonald JS, Leake CB, McDonald RJ, Gulati R, Katzberg RW, Williamson EE, et al. Acute Kidney Injury After Intravenous Versus Intra-Arterial Contrast Material Administration in a Paired Cohort. Invest Radiol 2016;51:804-9. https://doi.org/10.1097/RLI.0000000000000298
  37. Liu Y, Li H, Chen S, Chen J, Tan N, Zhou Y, et al. Excessively High Hydration Volume May Not Be Associated With Decreased Risk of Contrast-Induced Acute Kidney Injury After Percutaneous Coronary Intervention in Patients With Renal Insufficiency. J Am Heart Assoc 2016;5.
  38. 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;33:403-11. https://doi.org/10.1016/S0735-1097(98)00574-9
  39. Mattathil S, Ghumman S, Weinerman J, Prasad A. Use of the RenalGuard system to prevent contrast-induced AKI: A metaanalysis. J Interv Cardiol 2017;30:480-7. https://doi.org/10.1111/joic.12417
  40. Tepel M, van der Giet M, 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;343:180-4. https://doi.org/10.1056/NEJM200007203430304
  41. Investigators ACT. Acetylcysteine for prevention of renal outcomes in patients undergoing coronary and peripheral vascular angiography: main results from the randomized Acetylcysteine for Contrast-induced nephropathy Trial (ACT). Circulation 2011;124:1250-9. https://doi.org/10.1161/CIRCULATIONAHA.111.038943
  42. Assadi F. Acetazolamide for prevention of contrast-induced nephropathy: a new use for an old drug. Pediatr Cardiol 2006;27:238-42. https://doi.org/10.1007/s00246-005-1132-z
  43. Phan H, Nahata MC. Clinical uses of dexmedetomidine in pediatric patients. Paediatr Drugs 2008;10:49-69. https://doi.org/10.2165/00148581-200810010-00006
  44. Billings FTt, Chen SW, Kim M, Park SW, Song JH, Wang S, et al. alpha2-Adrenergic agonists protect against radiocontrastinduced nephropathy in mice. Am J Physiol Renal Physiol 2008;295:F741-8. https://doi.org/10.1152/ajprenal.90244.2008
  45. Bayram A, Ulgey A, Baykan A, Narin N, Narin F, Esmaoglu A, et al. The effects of dexmedetomidine on early stage renal functions in pediatric patients undergoing cardiac angiography using nonionic contrast media: a double-blind, randomized clinical trial. Paediatr Anaesth 2014;24:426-32. https://doi.org/10.1111/pan.12348
  46. Liu Y, Sheng B, Wang S, Lu F, Zhen J, Chen W. Dexmedetomidine prevents acute kidney injury after adult cardiac surgery: a metaanalysis of randomized controlled trials. BMC Anesthesiol 2018;18:7. https://doi.org/10.1186/s12871-018-0472-1
  47. McCullough PA. Multimodality prevention of contrast-induced acute kidney injury. Am J Kidney Dis 2008;51:169-72. https://doi.org/10.1053/j.ajkd.2007.12.004
  48. Lakhal K, Ehrmann S, Robert-Edan V. Iodinated Contrast Medium Renal Toxicity: The Phantom Menace or Much Ado About Nothing? Crit Care Med 2017;45:e745-e6.
  49. Newhouse JH, Kho D, Rao QA, Starren J. Frequency of serum creatinine changes in the absence of iodinated contrast material: implications for studies of contrast nephrotoxicity. AJR Am J Roentgenol 2008;191:376-82. https://doi.org/10.2214/AJR.07.3280
  50. McDonald JS, McDonald RJ, Williamson EE, Kallmes DF, Kashani K. Post-contrast acute kidney injury in intensive care unit patients: a propensity score-adjusted study. Intensive Care Med 2017;43:774-84. https://doi.org/10.1007/s00134-017-4699-y
  51. McDonald JS, McDonald RJ, Williamson EE, Kallmes DF. Is Intravenous Administration of Iodixanol Associated with Increased Risk of Acute Kidney Injury, Dialysis, or Mortality? A Propensity Score-adjusted Study. Radiology 2017;285:414-24. https://doi.org/10.1148/radiol.2017161573
  52. Ehrmann S, Aronson D, Hinson JS. Contrast-associated acute kidney injury is a myth: Yes. Intensive Care Med 2018;44:104-6. https://doi.org/10.1007/s00134-017-4950-6

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