Radiology: Volume 267: Number 1- April 2013
Jeffrey H. Newhouse, MD and Arindam RoyChoudhury , PhD
The nephrotoxic potential of contrast agents was first suggested at least a half a century ago (1), just a few years after the invention of the first modern ionic contrast agent (2). That a contrast agent posed a serious risk became embedded in most physicians’ minds and practices, and the concept remains an article of clinical faith. The effect of this idea has been great: contrast medium is universally held to be one of the most common causes of acute renal failure among hospitalized patients, and the consequences of nephropathy may be severe, including higher death rates, longer hospitalization stays, increased risk of persistent renal failure and higher rates of cardiovascular and neurovascular events (3). Fear of incurring these conditions has led clinical physicians to avoid requesting contrast medium–requiring examinations for many patients and has caused radiologists to omit contrast medium from a substantial number of examinations. The risk of contrast medium–induced nephropathy has long been assumed to be proportional to the degree of preexisting renal failure (4,5), which is by far the most frequent reason for avoiding contrast medium use.