Table of Contents
Conference Papers in Medicine
Volume 2013 (2013), Article ID 801412, 6 pages
http://dx.doi.org/10.1155/2013/801412
Conference Paper

Use and Misuse of a Biomarker: Contrast-Medium-Induced Nephropathy and Serum Creatinine

Institute of Vegetative Physiology, Charité University Medicine Berlin, Campus Charité Mitte, Berlin 10117, Germany

Received 18 January 2013; Accepted 2 April 2013

Academic Editors: A. Bellou, E. Giannitsis, C. Hamm, M. Möckel, and J. Searle

This Conference Paper is based on a presentation given by Pontus B. Persson at “Clinical Decisions in Acute Patients: ACS–POCT–Hypertension and Biomarkers” held from 19 October 2012 to 20 October 2012 in Berlin, Germany.

Copyright © 2013 Pontus B. Persson. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Two different types of contrast media are being used: low-osmolar and isoosmolar contrast media (LOCM, IOCM). Both types induce renal failure. Serum creatinine is routinely used as a marker of renal impairment in many clinical settings. A variety of studies and meta-analyses addressed the differential safety of contrast media with divergent osmolarity. Unfortunately, research in this field is lacking standardized endpoints, as different levels of creatinine increase are used as a surrogate for renal failure, and additionally, serum creatinine levels are influenced by a variety of pathophysiological conditions and thus susceptible for marker artifacts. This is one explanation why conflicting results have been published regarding the different safety of contrast media favoring either LOCM or IOCM. Viscosity which is higher in IOCM rather than osmolarity determines the potential of a CM to induce renal failure. High viscosity reduces flow in renal tubules and vessels and thus impairs renal filtration. Thus, the most effective prevention measure for renal failure is reducing the concentration of contrast media and adequate hydration. In emergency situations, hydration as well as kidney status is commonly unknown, and LOCM are indicated due to their lower viscosity and to their greater water-binding capacity to reduce the risk of renal failure.