The demise of contrast nephropathy; can this be true? A contrarian view; a representative case report of contrast nephropathy from Mayo Clinic Health System in Northwestern Wisconsin

Abstract

In the cognate nephrology literature, a few recent publications from major academic centers in the United States have suggested that the incidence of contrast nephropathy was exaggerated and overstated. These investigators have concluded that intravenous contrast material administration was not associated with an increased risk of acute kidney injury (AKI), emergent dialysis, and short-term mortality in a cohort of patients with diminished renal function. As a contrarian opinion, we first describe a clear cut case of contrast-nephropathy resulting in AKI requiring hemodialysis treatment managed in the Renal Unit of the Mayo Clinic Health System, Northwestern Wisconsin, in the Spring of 2017. We subsequently revisit the overwhelming evidence-base in the English literature that supports the enormous impact of contrast-nephropathy as a clinical syndrome. We finally posit that these recent repudiations of the existence and significance of contrast-nephropathy as a significant clinical entity represent an overreach in statistical expertise. There is no basis for a requiem song over contrast-nephropathy.

Keywords

• Acute kidney injury
• Chronic kidney disease
• Contrast nephropathy
• Hemodialysis
• Hospital-acquired acute kidney injury
• Nephrotoxic medications
• Preventative nephrology
• Renal replacement therapy