Risk Factors and Pathophysiology of Contrast- Induced Nephropathy after Contrast Enhanced Multidetector Computed Tomography

. The number of contrast enhanced MDCT is growing everywhere. The risk adverse events after intravascular injection of contrast media increased also. One of these adverse events is an acute renal injury (known in the literature as a “contrast-induced nephropathy, CIN”). Literature data are often contradictory. We need an objective analysis of information on the incidence of CIN and evaluation of risk groups for MDCT-CIN. The aim of the study: the evaluation of factors affecting the development of CIN, understanding of its pathophysiology, including patients with diabetes mellitus, at contrast-enhanced MDCT. Material and methods . 62 English-language scientific publications, the full text of which and bibliography is available for search in PubMed (2013–2016 years), were analyzed. Factors of pathophysiology of CIN were divided into groups and subgroups for critical analysis and understanding the contraindications to the use of contrast-enhanced MDCT in the diagnostic process. Results. Age older than 65 years, low baseline estimated glomerular filtration rate (eGFR), diabetes, low levels of serum albumin, hypertension predispose patients to CIN more often than the modified baseline serum creatinine. Intravenous injection of low osmolar CM is not a risk factor in patients with eGFR ≥45 ml /kg /1.73 m2. SCr levels may vary to levels greater than or less than 25% of baseline even without administration of iodinated CM and may not be a reliable diagnostic test. Conclusion. The introduction into the everyday practice of screening CIN such test as the eGFR, considering the risk of CIN threshold level lower than 45 mL/ min / 1.73 m2, will reduce the risk of misidentification of CIN in a large number of adult inpatients with a threshold level of serum creatinine (SCr) > 1,5 mg /dl.