Bachli, Esther B.

Koneth, Irene

Weishaupt, Dominik

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Nephrol Dial Transplant (2004) 19: 1654–1655DOI: 10.1093/ndt/gfh157Images in Nephrology(Section Editor: G. H. Neild)Persistent nephrogram after administration of anisoosmolar contrast mediumIrene Koneth1, Dominik Weishaupt2 and Esther B. Bachli31Division of Renal Medicine, 2Department of Radiology and 3Department of Internal Medicine,University Hospital, Zurich, SwitzerlandKeywords: contrast media; contrast media-inducednephropathy; nephrogram; nephrotoxicity; renalcortical retentionIn February 2003, a study by Aspelin et al. [1]was published in the NEJM concerning reducednephrotoxicity using the isoosmolar contrast mediumiodixanol in high risk patients.CaseRecently, we performed a contrast-enhanced thoracic16-channel multi-slice computed tomography (CT)with intravenous (i.v.) administration of iodixanol[Visipaque, dose 0.5 g I/kg body weight (bw)] in a73-year old patient, suffering from multiple myelomaand chronic renal failure (calculated creatinine clear-ance of 23ml/min). Three days later, an unenhancedCT of the upper abdomen was performed, showing astriking enhancement of the renal parenchyma of bothkidneys [mean, 142 hounsﬁeld units (HU)] (Figure 1).No contrast excretion within the collection systemwas noted. Eight days later there was still residualrenal cortical attenuation of both kidneys (67HU).Unenhanced CT 17 days after the ﬁrst examinationrevealed normal ﬁndings of both kidneys with com-plete vanishing of the parenchymal abnormality. Thebaseline serum creatinine was 2.3mg/dl (202 mmol/l)and rose to 2.6mg/dl (235 mmol/l) 4 days after theadministration of the contrast media.CommentProlonged renal cortical retention of contrast media isdescribed in the literature as persistent nephrogramand was demonstrated for iodixanol and for othercontrast media [2]. Although the exact mechanism ofthe persistent nephrogram following i.v. administra-tion of iodinated contrast agents is not known, basedon animal studies, it has been hypothesized that thecontrast medium is retained in the proximal tubularcells by vacuolization. Nevertheless, the major propor-tion of the contrast agent is excreted by glomerularﬁltration during the early phase after injection,explaining attenuation of the renal cortical site withoutdetection of the contrast medium in the aorta and theurinary collecting system (Figure 1). The impact of thecortical retention of contrast media on renal function isdebatable. While studies using iodixanol in healthyvolunteers and in non-diabetic patients with chronicrenal failure did not demonstrate any associationbetween persistent cortical attenuation and contrastmedia-induced nephrotoxicity, authors using contrastmedia other than iodixanol showed a higher rateof nephrotoxicity in patients with stronger renalcortical retention (CT value >108HU and >100HU,respectively).In our high-risk patient, the administration ofiodixanol did not result in signiﬁcant nephrotoxicity,but in a striking renal cortical retention, a phenom-enon that clinicians using iodixanol should be aware ofand whose relation to nephrotoxicity will be studied.Conﬂict of interest statement. None declared.Correspondence and offprint requests to: Irene Koneth, Division ofRenal Medicine, University Hospital, Zurich, Switzerland. Email:irene.koneth@usz.chNephrol Dial Transplant Vol. 19 No. 6  ERA–EDTA 2004; all rights reservedReferences1. Aspelin P, Aubry P, Fransson SG, Strasser R, Willenbrock R,Berg KJ. Nephrotoxic effects in high-risk patients undergoingangiography. New Engl J Med 2003; 348: 491–4992. Yamazaki H, Oi H, Matsuhshita M et al. Renal corticalretention on delayed CT after angiography and contrastassociated nephropathy. Br J Radiol 1997; 70: 897–902Fig. 1. Axial CT scan of the patient with i.v. administration 0.5 g I/kg bw of iodixanol (A) and serial unenhanced CT scans (B–D) following 3(B), 8 (C), and 17 days (D) after administration of iodixanol. Dense and regular attenuation of both renal cortices as a sign of persistent renalretention of contrast medium is noted at day 3, with subsequent vanishing of the cortical abnormalities over time.Persistent nephrogram after administration of an isoosmolar contrast medium 1655

Persistent nephrogram after administration of an isoosmolar contrast medium

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