Saline And Gas Contrast
This is a type of gas contrast dye that contains microbubbles with active saline solution. It is placed on a shell-like capsule and, once injected, will only reach the left and right sides of your heart for better imaging results on the area.
Although contrast dye has a risk of putting you on an allergic reaction, it still does you more good than harm.
Without it, it will be less likely feasible for doctors to know the abnormalities inside your body. That would put you at more risk of misdiagnosis and wrong treatments.
What Is A Ct Scan Of The Kidney
Computed tomography is a noninvasive diagnosticimaging procedure that uses a combination ofX-raysand computer technology to produce horizontal, or axial, images of the body. A CT scan shows detailed images of any part ofthe body, including the bones, muscles, fat, and organs. CT scans are moredetailed than standard X-rays.
In standard X-rays, a beam of energy is aimed at the body part beingstudied. A plate behind the body part captures the variations of the energybeam after it passes through skin, bone, muscle, and other tissue. Whilemuch information can be obtained from a standard X-ray, a lot of detailabout internal organs and other structures is not available.
In computed tomography, the X-ray beam moves in a circle around the body.This allows many different views of the same organ or structure. The X-rayinformation is sent to a computer that interprets the X-ray data anddisplays it in a two-dimensional form on a monitor.
CT scans may be done with or without “contrast.” Contrast refers to asubstance taken by mouth or injected into an intravenous line thatcauses the particular organ or tissue under study to be seen more clearly.Contrast examinations may require you to fast for a certain period of timebefore the procedure. Your doctor will notify you of this prior to theprocedure.
How Can I Reduce My Risk For Cin And Nsf
- Know your GFR and if you have CKD. If you do not know your GFR, you can ask your doctor or healthcare professional. Your kidney function is estimated by the glomerular filtration rate, or eGFR.
- Tell all of your healthcare professionals about your GFR and CKD, especially if a diagnostic test such as a CT scan, MRI or angiogram has been ordered. Talk to the doctor ordering the diagnostic test. You can also ask to talk to the radiologist, radiology technician and nurse.
- If you need to have a CT scan, angiogram or MRI:
- Ask about your risk for NSF and CIN, based any risk factors you might have:
CIN Risk Factors
NSF Risk Factors
Use of CT scan or angiography with contrast dye, and one or more of the following:
- Heart and blood vessel problems
- Older age
Use of MRI with gadolinium -based contrast dye, and one of the following:
- Advanced kidney disease
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Why Do I Need Contrast Medium
X-ray or radiography is the imaging of body structures using X-ray beams that are absorbed by different parts of the body in different ways to create an image or picture. This includes CT scans and plain radiography/X-rays. Different structures or parts of the body look lighter or darker on the images, depending on what these structures are made of for example, soft tissue shows as dark grey and bone as light grey. This difference in how various structures of the body absorb the X-ray beam and produce an image is called contrast.
MRI and ultrasound do not use radiation, but still produce images showing the different parts of the body. MRI uses a magnetic field, and ultrasound scans use high-frequency sound waves.
The use of contrast media highlights the differences between various parts of the body, including those parts that have a similar composition. This provides a clearer image of how the body is working, or if there is any disease or abnormality present.
With clearer images, the radiologist can provide your doctor with a more accurate diagnosis of the symptom or condition, to assist in deciding what treatment will be most appropriate.
Tests For Kidney Cancer
Kidney cancer might be found because of signs or symptoms a person is having, or it might be found because of lab tests or imaging tests a person is getting for another reason. The actual diagnosis of kidney cancer is made by looking at a sample of kidney cells in the lab or sometimes by how the kidney looks on an imaging test. If you think you have possible signs or symptoms of kidney cancer, see your doctor.
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Am I At High Risk For Kidney Problems Associated With Contrast Dyes
Most patients with normal kidney function have no problems with the contrast dyes and therefore do not need any special preparations for undergoing an MRI or CT with contrast, but not everyone with impaired kidney function is aware that they have a kidney problem. The risk of kidney disease is higher in some people, such as those over the age of 60 or who have diabetes or other certain other illnesses. Questionnaires help doctors and radiologists identify patients who need additional laboratory testing, such as serum creatinine or eGFR, to determine their kidney function and ensure that the use of contrast dyes is safe.
Intracellular Signaling Pathways Involved In Cell Survival And Death
Important results have been obtained by in vitro studies on primary human tubular cells and on HK2 cells exposed to contrast drugs.61 Andreucci et al62 demonstrated reduced cell survival due to decreased activation of Akt and ERK1/2, which are kinases that are known to be involved in cell survival/proliferation this was alleviated by transfecting the HK2 cells with a constitutively active form of Akt. Even a white grape juice extract may alleviate toxicity on human renal proximal tubular cells treated with a contrast drug, through modulation of signaling molecules.63 The same authors have given evidence that in human renal tubular cells, contrast drugs affect the activation/deactivation of: transcription factors like FoxO3a and STAT3, which control the genes that are involved in apoptosis and cell proliferation and other molecules known to be modulated by oxidative stresses, with some differences having been noted between low-osmolar and iso-osmolar contrast drugs.6469 Experimental animal studies performed in vivo and in vitro have suggested that iodinated contrast drugs can induce caspase-mediated apoptosis of tubular epithelial cells.57 Activation of shock proteins and concurrent inhibition of cytoprotective enzymes and prostaglandins may also cause contrast drug-induced apoptosis.70,71
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Where Can I Find Information About Iodine And Gadolinium Contrast Media
This information sheet deals with the use of iodine and gadolinium in patients whose kidney function is much less than normal. If you have kidney disease or diabetes, you will need to have a recent kidney function test result before contrast is given, unless the test or procedure is an emergency. If you are unsure whether your kidneys are working normally or you have other medical conditions, then you should contact your referring doctor to see if a kidney blood test is required before the imaging examination.
The radiologist needs to know how your kidneys are functioning before giving contrast. Both gadolinium contrast and iodinated contrast leave the body in the urine, which is made by your kidneys.
The InsideRadiology website contains further separate information on both iodine and gadolinium . These information items include details of the risks and benefits involved for those with reduced kidney function and normal kidney function. The items also include information about other side effects when using contrast media.
Contrast media are regarded as generally very safe for patients who do not have severe kidney disease. If you do have severe kidney disease, the radiologist in discussion with your doctor might still decide that you should have contrast, because the benefit of the test or procedure outweighs the risk.
What Are The Risks Of A Ct Scan
You may want to ask your doctor about the amount of radiation usedduring the CT procedure and the risks related to your particularsituation. It is a good idea to keep a record of your past history ofradiation exposure, such as previous CT scans and other types ofX-rays, so that you can inform your doctor. Risks associated withradiation exposure may be related to the cumulative number of X-rayexaminations and/or treatments over a long period of time.
If you are pregnant or suspect that you may be pregnant, you shouldnotify your doctor. Radiation exposure during pregnancy may lead tobirth defects.
If contrast media is used, there is a risk for allergic reaction to themedia. Patients who are allergic to or sensitive to medications shouldnotify their doctor. You will need to let your doctor know if you haveever had a reaction to any contrast media, and/or any kidney problems.A reported seafood allergy is not considered to be a contraindicationfor iodinated contrast.
Patients with kidney failure or other kidney problems should notifytheir doctor. In some cases, the contrast media can cause kidneyfailure, especially in patients with underlying kidney problems ordehydration. Patients taking the diabetes medication metformin, or its derivatives, who receive contrast are at increasedrisk of developing a condition called metabolic acidosis, or an unsafechange in blood pH, and the drug may be halted for 48 hours after theprocedure.
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Choice Of Contrast Drug
The first measure for prevention is the correct choice of contrast drug: a preference for IOCM has been suggested, since clinical studies have proven that the nephrotoxicity of iodixanol is lower than that of LOCM 83 the lowest possible dose has to be used, and repetitive injection of the drug within the same procedure needs to be avoided. We should mention, however, that multiple meta-analyses of randomized clinical trials have failed to demonstrate differences between IOCM and LOCM.60,84 However, it has been pointed out that the relative renal safety of the low-osmolar iodixanol may vary with the different type of low-osmolar contrast agent, with a reduction in CI-AKI observed compared with iohexol/ioxaglate, but no difference noted when compared with iopromide/iopamidol/ioversol.84
How Long Does A Contrast Dye Leave Your Body
If you received a contrast dye for a diagnostic test, your body naturally eliminates these substances within 24 hours.
Sometimes, it may take you a few days or weeks before the contrast dye flushes out from your body together with your urine or in your stool. As a result, you may find yourself visiting the restroom more often.
However, research hints that people who have undergone multiple imaging tests are at risk of retaining contrast dye, especially if they received gadolinium-based substances during those tests.
A small amount of the chemical substance stayed in some parts of their brain, tissues, and blood vessels. But, theres no significant study that has proved its adverse effect on the patient.
Assuming that you have a normal renal function or your kidneys are functioning well, they will filter your blood from these chemical substances along with other toxins in your body and eliminate them as wastes.
Doctors may recommend you stay hydrated to help yourself flush these toxins out. They may also prescribe you a detoxifying solution or drugs to help your body remove the contrast dye.
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What Is Nephrogenic Systemic Fibrosis
NSF is a rare but serious disease affecting skin and other organs that has been found in some patients with advanced CKD after exposure to gadolinium-containing contrast dyes that are used in magnetic resonance imaging . NSF appears to affect about 4 percent of patients with advanced CKD. People with acute kidney injury are also at higher risk. NSF has not been reported in people with mild kidney damage or normal kidney function.
NSF can be painful, debilitating, or even fatal. Symptoms and signs of NSF can include burning and itching of the skin, red or dark patches on the skin, joint stiffness, or muscle weakness. The disease can develop within 24 hours up to around 3 months.
MRIs are routinely used in patients to visualize internal organs and limbs to help detect and monitor many different diseases or injuries. Contrast dyes are often used during MRI to enhance the images obtained, and these dyes contain an element called gadolinium. In people with CKD, the kidneys are not able to filter out wastes, drugs and toxins the way they normally should. In advanced CKD, the excretion of gadolinium-containing contrast dyes used in MRIs is slower than in people with normal kidney function. This delay in excretion is thought to be one the main reasons why NSF may happen.
Contrast Dye And The Kidneys
Diagnostic tests such as MRIs, CT scans and angiograms are routinely used because they provide important information about many diseases or injuries and can help in diagnosis and treatment. In many cases, the use of a contrast dye is necessary to enhance these tests, but sometimes these dyes can either lead to kidney problems, or cause problems in patients with kidney disease. There are two rare but serious disorders associated with contrast dyes and the kidneys: contrast induced nephropathy and nephrogenic systemic fibrosis .
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Can Contrast Hurt My Kidneys
Your doctor may order an MRI, CT scan or other diagnostic tests to learn important information about a disease or injury, and to help in the diagnosis and treatment of the problem. Depending on your exact case, your doctor may request the use of a contrast dye to enhance the results of the test. While the tests and contrast dyes used are generally safe, the contrast eyes may lead to the development of kidney problems or cause problems in patients with kidney disease.
During an MRI or CT with contrast, the radiology team injects contrast dye into an intravenous needle. Contrast dyes typically contain iodine or gadolinium, which helps enhance the MRI or CT images. These dyes circulate through the bloodstream and eventually reach the kidneys. Tiny filters in the kidneys, known as glomeruli, work to filter wastes, drugs and toxins from the bloodstream.
Healthy kidneys are able to easily and quickly clear contrast dye from the system. Unhealthy kidneys, though, may be slower and less efficient when it comes to clearing the contrast from the blood. While the medical community has not yet determined exactly how contrast dye causes kidney problems, they think it has to do with this slow clearance of the dyes from the body.
Imaging Tests To Look For Kidney Cancer
Imaging tests use x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body. Imaging tests are done for a number of reasons, such as:
- To look at suspicious areas that might be cancer
- To learn how far cancer might have spread
- To help determine if treatment is working
- To look for possible signs of cancer coming back after treatment
Unlike most other cancers, doctors can often diagnose kidney cancer with fair certainty based on imaging tests without doing a biopsy . Some patients, however, may need a biopsy.
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What Do I Need To Know About Having Gadolinium Contrast Medium Or Iodine Contrast Medium If I Do Not Have Normal Kidney Function
If you have severely reduced kidney function for any reason , you need to be aware of possible increased risks that might be associated with contrast medium injections .
Each contrast medium has a specific, and important risk associated:
- Gadolinium-based contrast medium can cause a condition known as nephrogenic systemic fibrosis in patients with severely reduced kidney function. Severely reduced function is usually determined by a blood test called an estimated glomerular filtration rate . If your eGFR is 30 mL/min or below, or you are seriously unwell and your kidney function is actively deteriorating, you have a small increased risk of NSF if certain gadolinium contrast agents are used .
- Iodine-containing contrast medium has the potential to cause a condition known as contrast-induced nephropathy. This condition can result in temporary and sometimes permanent reduction in kidney function to those with an already existing kidney problem . Contrast-induced nephropathy has been shown to affect only people with very poor or deteriorating kidney function.
If you are on permanent dialysis, your kidney function will not be made worse by iodinated contrast. Some kinds of gadolinium contrast agents are associated with an increased risk of NSF in people on dialysis.
Potentiation Of Angiotensin Ii Effects Reduction Of No Bioavailability And Direct Constriction Of Medullary Descending Vasa Recta: Formation Of Reactive Oxygen Species
Sendeski et al47 demonstrated in vitro in isolated outer medullary descending vasa recta of rats microperfused with a solution of iodixanol that this contrast drug directly constricted these vessels by 52%, reduced NO, and increased the vasoconstrictor response to angiotensin II. The consequence of this constriction in vivo will be severe local hypoxia36 . The same authors demonstrated an important role for reactive oxygen species in constricting medullary vasa recta following contrast-drug administration in fact, the superoxide dismutase mimetic Tempol reduced the vasoconstriction by iodixanol.36,47
It is also known that in normal kidneys, epithelial tubular transport leads to ROS formation, particularly in the medullary thick ascending limb of Henles loop, where the dense mitochondrial population is the main source for the generation of superoxide anions , and hydroxyl radicals by NADH-oxidase.48,49 The injection of a contrast drug causes an increase in ROS formation and oxidative stress that exerts direct injury to endothelial and epithelial cell membranes in vascular and tubular structures, respectively, which leads to cellular apoptosis and necrosis and increased medullary hypoxia49 .
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