Contrast nephropathy following computed tomography angiography of the chest for pulmonary embolism in the emergency department
Contrast nephropathy following computed tomography angiography of the chest for pulmonary embolism in the emergency department
复制标题
DOI：
10.1111/j.1538-7836.2006.02251.x
复制
发表时间：
2007-01-01
影响因子：
10.4
通讯作者：
Kline, J. A.
中科院分区：
文献类型：
--
作者：
Mitchell, A. M.;Kline, J. A.
目的：估计急诊科（艾德）计算机断层扫描血管造影（CTA）后造影剂肾病的频率，以排除肺栓塞（PE）。方法：我们前瞻性随访了在艾德接受CTA治疗PE的患者，持续45天。拒绝随访或正在接受血液透析的患者被排除。严重肾衰竭定义为肌酐升高≥ 3.0 mg dL（-1）或在随访期间需要血液透析。患者还被随访了实验室定义的造影剂肾病，定义为CTA后7天内肌酐升高> 0.5 mg dL（-1）或> 25%。结果如下：共对1224例患者进行了随访，354例[29%，95%置信区间（CI）：26-32%]患者进行了配对（CTA前和CTA后）肌酐测量。无患者发生肾衰竭（0/1224; 0%，CI：0-0.3%）。44例患者发生了实验室定义的造影剂肾病，对应于具有成对肌酐测量值的患者中的总频率为4%（44/1224; CI：3-5%）和12%（44/354; 95% CI：9-16%）。结论：CTA治疗PE后，重度肾衰竭的发生率非常低，但实验室定义的造影剂肾病的发生率（总体为4%，配对测量值为12%）高于预期。
Objective: To estimate the frequency of contrast nephropathy after computed tomography angiography (CTA) to rule out pulmonary embolism (PE) in the emergency department (ED) setting. Methods: We prospectively followed patients undergoing CTA for PE, while in the ED, for 45 days. Patients who refused follow-up or were receiving hemodialysis were excluded. Severe renal failure was defined as an increase in creatinine >= 3.0 mg dL(-1) or a need for hemodialysis within the follow-up period. Patients were also followed for laboratory-defined contrast nephropathy, defined as an increase in creatinine of > 0.5 mg dL(-1) or > 25%, within seven days following CTA. Results: A total of 1224 patients were followed, and 354 [29%, 95% confidence interval (CI): 26-32%] patients had paired (preCTA and post-CTA) creatinine measurements. None developed renal failure (0/1224; 0%, CI: 0-0.3%). 44 patients developed laboratory-defined contrast nephropathy, corresponding to an overall frequency of 4% (44/1224; CI: 3-5%) and 12% (44/354; 95% CI: 9-16%) among those with paired creatinine measurements. Conclusions: Following CTA for PE, the incidence of severe renal failure was very low, but the incidence of laboratory-defined contrast nephropathy (4% overall and 12% of those with paired measurements) was higher than expected.