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Practice Lesson of the week

Acute renal failure induced by contrast medium: steps towards prevention

BMJ 2006; 333 doi: (Published 07 September 2006) Cite this as: BMJ 2006;333:539
  1. R Mathew, medical student (,
  2. K Haque, specialist registrar in care of the elderly medicine2,
  3. W Woothipoom, consultant physician3
  1. 1 University College London, London WC1E 6BT
  2. 2 North Middlesex University Hospital, London N18 1QX
  3. 3 Care of the Elderly Medicine, North Middlesex University Hospital
  1. Correspondence to: R Mathew
  • Accepted 21 July 2006

Acute renal failure is a well known complication of procedures that involve iodinated contrast media.1 Despite this, contrast medium induced nephropathy accounts for about 12% of all cases of hospital acquired renal failure.2 Prevention of this type of nephropathy is crucial as it is associated with prolonged hospital stay, risk of permanent renal impairment, and a more than fivefold increase in mortality.34 We report a case of acute renal failure in a woman with chronic renal disease who was investigated for metastatic breast cancer with contrast enhanced computed tomography. This case shows the importance of carrying out a risk assessment for contrast medium induced nephropathy before using procedures that involve iodinated contrast media.

Case report

An 81 year old woman with type II diabetes was admitted after a hypoglycaemic episode. She had a four week history of non-productive cough, which failed to resolve with antibiotics. She had been treated with surgery and radiotherapy for breast cancer 13 years previously. She also had stage 3 kidney disease and hypertension.

Breast examination was normal but there were signs of a left sided pleural effusion. Chest x ray showed a possible left sided coin lesion and pleural effusion. Her white blood cell count was 5.6x109/litre, C reactive protein was 15 mg/litre, …

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