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Suspected contrast-induced nephropathy in three sequential patients undergoing computed tomography angiography and transarterial embolization for nonresectable neoplasia

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  • 1 From the William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616.
  • | 2 Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616.
  • | 3 Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616.
  • | 4 Department of Food Safety Laboratory, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616.

Abstract

CASE DESCRIPTION

During the same week, 3 sequential patients (a 10-year-old 8.7-kg spayed female poodle cross [dog 1], 13-year-old 2.6-kg spayed female domestic longhair cat, and 13-year-old 9.0-kg castrated male mixed-breed dog [dog 2]) underwent CT-angiography (day 0) and transarterial embolization (day 1) for nonresectable hepatocellular carcinoma (n = 2) or prostatic carcinoma (1).

CLINICAL FINDINGS

Contrast-induced nephropathy (CIN) was suspected in all animals on the basis of higher serum creatinine concentrations after contrast medium administration (exposure), compared with baseline concentrations before exposure, consistent with CIN definitions. The total dose of contrast medium was < 3 mL/kg for each exposure. For all 3 patients, creatinine concentration peaked at a median of 3 days (range, 2 to 3 days) after the first exposure (day 0), and the median absolute and relative increases in creatinine concentration after exposure (vs baseline concentrations before exposure) were 2.9 mg/dL (range, 2.2 to 3.7 mg/dL) and 410% (range, 260 to 720%), respectively.

TREATMENT AND OUTCOME

The patients received individually tailored supportive care for acute kidney injury. Serum creatinine concentrations began to improve at a median of 4 days (range, 3 to 4 days) and returned to within reference limits at a median of 7 days (range, 3 to 13 days) following initial exposure.

CLINICAL RELEVANCE

CIN should be considered as a potential complication following IV administration of contrast medium. Short-term outcome following CIN can be excellent with supportive care.

Abstract

CASE DESCRIPTION

During the same week, 3 sequential patients (a 10-year-old 8.7-kg spayed female poodle cross [dog 1], 13-year-old 2.6-kg spayed female domestic longhair cat, and 13-year-old 9.0-kg castrated male mixed-breed dog [dog 2]) underwent CT-angiography (day 0) and transarterial embolization (day 1) for nonresectable hepatocellular carcinoma (n = 2) or prostatic carcinoma (1).

CLINICAL FINDINGS

Contrast-induced nephropathy (CIN) was suspected in all animals on the basis of higher serum creatinine concentrations after contrast medium administration (exposure), compared with baseline concentrations before exposure, consistent with CIN definitions. The total dose of contrast medium was < 3 mL/kg for each exposure. For all 3 patients, creatinine concentration peaked at a median of 3 days (range, 2 to 3 days) after the first exposure (day 0), and the median absolute and relative increases in creatinine concentration after exposure (vs baseline concentrations before exposure) were 2.9 mg/dL (range, 2.2 to 3.7 mg/dL) and 410% (range, 260 to 720%), respectively.

TREATMENT AND OUTCOME

The patients received individually tailored supportive care for acute kidney injury. Serum creatinine concentrations began to improve at a median of 4 days (range, 3 to 4 days) and returned to within reference limits at a median of 7 days (range, 3 to 13 days) following initial exposure.

CLINICAL RELEVANCE

CIN should be considered as a potential complication following IV administration of contrast medium. Short-term outcome following CIN can be excellent with supportive care.

Contributor Notes

Address correspondence to Dr. Culp (wculp@ucdavis.edu).