creatinine increased up to 4 milligrams in 5 days after IV contrast and starting hydration and antioxidant treatmnet
The time is extremely variable, according several variables. Age of patient, quantity of contrast, measure to prevent CIN, renal function before CIN. Several patients never recovery completely, See the enclosed paper,
Maurizio Salvadori
Congratulations to the statement of @Maurizio Salvadori. If the patient was young, renal function was good before, and CIN was managed promptly with hydration, prognosis is very good.
Recovery time is variable. However in majority of cases renal function recovers within 7to14days of contrast administration. Less than one third of cases might have residual renal dysfunction. 1percent case may need dialysis.. Patient with preexisting renal dysfunction, diabetes and who are undergoing primary PCI are more likely to get dialysis. Dialysis is associated with increased mortality. Older age, diabetes, preexisting renal dysfunction, hypotension, anaemia, multiple myeloma, peripheral vascular disease, IABP use, nature and amount of contrast use ,hypoalbuminia etc are associated with increased risk of CIN. Pre intervention hydration is the most effective in prevention.. Thanks
http://emedicine.medscape.com/article/246751-overview#a1
A lot has been mentioned here, but I would add it is highly dependent on correct diagnosis. Overdiagnosis of CIN as a cause of AKI is common, specially in cath labs (with all the respect to friends cardiologists). Before assuming non resolving CIN reanalyze possible causes of this AKI case.
Contrast-induced AKI is generally reversible and non-oliguric. SCr peaks typically 2 or 3 days after PCI and returning to baseline within 2 weeks in most cases. Although rare, persistent elevation of SCr may develop and last for several months. All that depends on several factor that increase the risk for permanent kidney dysfunction including basal renal function, comorbidities (i.e. diabetes, MM), age, injected volume of radiocontrast, dehydration, medications (NSAIDs, ACE-I/ARBS, SGLT-2 inhibitors) and recent colonoscopy.
All the answers above are appreciated.
We are all using creatinine as the marker of renal functions, which may not be accurate. It has multiple confounding factors - (a) time lag between the actual injury and the rise in creatinine; (b) does not take into account the hyperfiltration that may be transient; (c) variation in its production due to acute illness / hypercatabolic state / nutritional changes
Even if we consider histology - there may be a time difference between injury and complete healing
As prognosis in CIN usually is very good, diuresis and creatinine as marker of renal function are sufficient. Further studies, e.g. renal biopsy, is not necessary in clinical routine, but it may be indicated if there is an atypical course with another treatable cause.
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