Table Of ContentPrelims.qxd 9/30/2005 5:43 PM Page i
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1a 1b 2a 2b 3a
8a 9 3b
8b 4a
7a 4b
7b 6a 6b 5a 5b
1. Left subclavian artery stenosis before (a) and after (b) implantation of a peripheral CarbofilmTM-coated
stent
2. Severe stenosis of the right internal carotid artery (a) treated with implantation of a nitinol self-
expandable stent (b)
3. Aortogram of the abdominal aorta showing a large aneurysm before (a) and after (b) endovascualr
repair with implantation of an Excluder™ endograft
4. Eccentric lesion of the right common iliac artery before (a) and after (b) stent implantation
5. Selective right renal artery angiography showing ostial stenosis before (a) and after (b) CarbofilmTM-coated
stent implantation
6. Right coronary artery angiography in an acute myocardial infarction patient showing a disrupted
plaque and superimposed massive thrombosis (a) treated with direct CarbofilmTM-coated stent
implantation (b)
7. Left coronary artery angiography showing severe stenosis of the proximal left anterior descending
coronary artery before (a) and after (b) drug-eluting stent implantation
8. Chronic total occlusion of the right superficial femoral artery before (a) and after (b) implantation of a
nitinol self-expandable stent
9. Histological cross section of the collecting tubules and Henle’s loops of the renal medulla.These are
the kidney microstructures involved in the pathogenetic mechanisms of contrast-induced nephropathy
The angiographic images are from the Catheterization Laboratories of the Centro Cardiologico Monzino,
Milan,Italy.
Cover image by Margherita Bartorelli.
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Edited by
Antonio L Bartorelli MD FACC FESC
Director,Interventional Cardiology
Centro Cardiologico Monzino,IRCCS
Institute of Cardiology of the University of Milan
Milan
Italy
Giancarlo Marenzi MD FESC
Director,Coronary Care Unit
Centro Cardiologico Monzino,IRCCS
Institute of Cardiology of the University of Milan
Milan
Italy
Foreword by
Martin B Leon MD
CRC Press
Taylor & Francis Group
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Boca Raton, FL 33487-2742
© 2008 by Taylor & Francis Group, LLC
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Version Date: 20130325
International Standard Book Number-13: 978-0-203-01847-7 (eBook - PDF)
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Dedication
To the memory of my father,Cesare Bartorelli,who,more with his life than with his words
taught me humanity and the art of medicine.
Antonio L Bartorelli
To my wife,Daniela,and to our children,Elena and Valeria
Giancarlo Marenzi
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C
ONTENTS
List of contributors vii
Foreword xi
Preface xii
Section I 1
1 Pathophysiology of contrast-induced nephropathy 3
Pontus B Persson
2 Epidemiology and predictors of contrast-induced nephropathy 19
Peter A McCullough and Sandeep S Soman
3 Clinical features and prognostic implications of contrast-induced nephropathy 35
Luis Gruberg
4 Coronary risk and chronic kidney disease 47
Rajiv Gupta,Yochai Birnbaum,and Barry F Uretsky
5 Effects of renal chronic kidney disease and contrast-induced nephropathy
on prognosis and treatment outcomes of acute coronary syndromes 57
Giancarlo Marenzi and Antonio L Bartorelli
6 Renovascular disease in patients with coronary artery disease 77
Michael H Duong,Craig A Thompson,and Aaron V Kaplan
Section II 95
7 Prevention of contrast-induced nephropathy with hydration 97
Christian Müeller
8 Contrast media:physiocochemic properties,physiologic effects,and selection 105
Roxana Mehran,Robert Siegel,and Eugenia Nikolsky
9 Pharmacologic prophylaxis 121
Carlo Briguori,Flavio Airoldi,and Antonio Colombo
10 Renal replacement therapies 133
Giancarlo Marenzi and Antonio L Bartorelli
vii
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CONTRAST-INDUCEDNEPHROPATHY
11 Novel preventive strategies for contrast-induced nephropathy 149
Vandana S Mathur
12 Magnetic resonance and carbon dioxide angiography in imaging and interventions 163
Günther Schneider and Roland Seidel
Index 181
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L
IST OF CONTRIBUTORS
Flavio Airoldi MD Luis Gruberg MD FACC
Laboratory of Interventional Cardiology Division of Invasive Cardiology
‘Vita e Salute’University School of Medicine Department of Cardiology
Milan Rambam Medical Center
Italy Haifa
Israel
Antonio L Bartorelli MD FACC FESC
Centro Cardiologico Monzino,IRCCS
Rajiv Gupta MD
Institute of Cardiology of the University of Milan
University of Texas Medical Branch
Milan
301 University Boulevard
Italy
Galveston,
TX,USA
Yochai Birnbaum MD
University of Texas Medical Branch
Aaron V Kaplan MD
301 University Boulevard
Section of Cardiology
Galveston,
Dartmouth-Hitchcock Medical
TX,USA
Center
One Medical Center Drive
Carlo Briguori MDPhD
Lebanon,
Laboratory of Interventional Cardiology
NH,USA
Clinica Mediterranea
Naples
Peter A McCullough MD MPH FACC
Italy
FACP FCCP FAHA
Divisons of Cardiology,Nutrition,
Antonio Colombo MD
and Preventive Medicine
Laboratory of Interventional Cardiology
William Beaumont Hospital
‘Vita e Salute’University School of Medicine
Royal Oak,
Milan
MI,USA
Italy
Michael H Duong MD Giancarlo Marenzi MD FESC
Section of Cardiology Centro Cardiologico Monzino,
Dartmouth Medical School/Dartmouth-Hitchcock IRCCS
Medical Center Institute of Cardiology of the
One Medical Center Drive University of Milan
Lebanon, Milan
NH,USA Italy
ix
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CONTRAST-INDUCEDNEPHROPATHY
Vandana S Mathur MDFASN Roland M Seidel MD
Mathur Consulting Department of Diagnostic and
25 Upenuf Road,Suite 100 Interventional Radiology
Woodside, University Hospital
(cid:1)
CA,USA Homburg Saar
Germany
Roxana Mehran MD
Columbia University Medical Center Robert Siegel MD
Cardiovascular Research Foundation Postdoctoral Residency Fellow
New York, Columbia University Medical Center
NY,USA NewYork
NY,USA
Christian Müeller MD
Department of Internal Medicine Sandeep S Soman MD
University Hospital Division of Nephrology and
Basel Hypertension
Switzerland Henry Ford Health System
Detroit,
Eugenia Nikolsky MDPhD MI,USA
Clinical Research and Data Coordinating and
Analysis Center Craig A Thompson MD
Cardiovascular Research Foundation Section of Cardiology
New York Dartmouth Medical School/
NY,USA Dartmouth-Hitchcock
Medical Center
Pontus B Persson MD PhD Lebanon,
Institute für Vegetative Physiologie NH,USA
Humboldt Universität,Berlin
Medizinische Fakultät (Charité) Barry F Uretsky MD FACC
Berlin Division of Cardiology
Germany University of Texas Medical
Branch
Günther Schneider MD Galveston,
Department of Diagnostic and TX,USA
Interventional Radiology
University Hospital
(cid:1)
Homburg Saar
Germany
x
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F
OREWORD
Why should we focus on contrast-induced nephropathy? At an exciting juncture in the evolution
of invasive cardiovascular diagnosis and therapy,why dwell on one of our least well understood
and poorly treated ‘dirty little secrets’of radiology and cardiology? The answer should be obvious
to all thoughtful clinical practitioners and scientists as the optimal management and avoidance of
contrast-induced nephropathy represents one of the most embarrassing unmet clinical needs in
cardiovascular medicine today.Although the syndrome has been recognized for decades, only
recently have we begun to systematically study fundamental aspects of pathophysiology,clinical
epidemiology,socioeconomic healthcare consequences,and treatment alternatives.As our popu-
lation ages,as the prevalence of diabetes reaches epidemic proportions,and as we bask in the glory
of newly introduced contrast-requiring diagnostic techniques and catheter-based interventional
therapies, the syndrome of contrast-induced nephropathy has become the forgotten stepchild,
only now beginning to wreak it’s ugly head as an important ‘dark side’problem which must be
targeted and solved in the future.
Importantly, this book, simply entitled Contrast-Induced Nephropathy, edited by Bartorelli
and Marenzi,addresses another unmet need namely ‘exposure and education’,by presenting an
authoritative text spanning the range from basics,to subtle nuances in this rapidly increasing iatro-
genic disease complex.During an era when several million radiographic procedures for diagnos-
tic and therapeutic purposes requiring radiocontrast agents are performed each year worldwide,
it remains shocking how few practicing physicians understand the dire prognostic consequences
of contrast-induced nephropathy. Similarly, the preparatory management of contrast-induced
nephropathy has been a confusing potpourri of ill-defined treatment strategies,with little to sug-
gest that we can truly claim a ‘standard-of-care’.This book breaks though these barriers of igno-
rance and confusion by attempting to separate fact from medical myth with an overwhelming
presentation of known data and attention to detail. Respected world experts in nephrology,
cardiology,and radiology have joined forces to contribute to this inter-disciplinary compendium.
Every chapter is well organized, carefully written and provides clinically useful insights.
Moreover,the book is both balanced and truly current,providing the reader with a sense of unbi-
ased data interpretation, reflections on contemporary issues, as well as projections for future
management pathways.
Undoubtedly,Contrast-Induced Nephropathyis a ‘must read’text handbook for all health-related
professionals involved in any aspect of the care and treatment of patients who are at risk for
this insidious disease entity. Readers will acquire a new-found understanding and respect for
the importance of contrast-induced nephropathy, an appreciation of the pathophysiology and
prognostic implications,and a working knowledge of present standard-of-care avoidance therapies
and management concepts.In short,readers will become better clinical care-givers and patients
xi
