Case 24 - Angiographyin the patient with kidney failure

Summary

Contrast-induced nephropathy (CIN) from iodine contrast media during radiologic procedures is one of the most common causes of acute kidney injury. This chapter presents a case study of a 65-year-old, 88-kg female presented for cerebral angiography and planned coiling of a large middle cerebral artery aneurysm. It presents a case that necessitated continued perioperative assessment of renal function during cerebral aneurysm coiling in a patient with chronic renal insufficiency. Initial management included a noncontrast computed tomography (CT) scan, which diagnosed extensive subarachnoid hemorrhage suggestive of aneurismal rupture. General anesthesia with endotracheal intubation, central venous pressure monitoring, and careful blood pressure control was planned for the aneurysm coiling procedure. The best plan for preventing acute renal failure secondary to CIN includes hydration with normal saline, intravenous sodium bicarbonate infusion prior to the procedure, minimization of dye exposure, and consideration of postprocedure hemodialysis.