Richard W. Katzberg, MD Jeffrey H. Newhouse, MD
That acute renal dysfunction may be caused by intravenously administered radiologic contrast media (CM) has become/axiomatic in the practice and liter¬ature of modern medicine (1). Thus, these CM are often withheld when computed tomography (CT) is performed (2). This may reduce the diagnostic accuracy of the examination and can lead to less-than-ideal disease management. Contrast medium-induced nephropathy (CIN) is not com¬mon in patients with normal preexisting renal function; rather, it occurs more fre¬quently in patients with renal impairment and is possibly exacerbated when the impairment is due to diabetic nephropa¬thy. In most studies, controls for concur¬rent disease have been almost completely lacking (3), variation in serum creatinine (SCr) levels has been interpreted as in¬dicating nephrotoxicity even though such variation occurs without CM adminis¬tration (4), and the risks of intravenous CM injection and intraarterial CM injec¬tion during angiocardiography have been unjustifiably equated (5). In this editorial, we will (a) analyze clinical experiences in which researchers compared variations in renal function between patients who underwent contrast medium-enhanced (CE) CT and control subjects who under¬went CT without CM administration, (b) analyze random variations in the SCr level of hospitalized patients, and (c) discuss the comparison of rates and adverse out¬comes of CIN in prospective clinical trials between outpatient and inpatient cohorts that underwent CE CT and cardiac cath¬eterization procedures. We believe that the risk of CIN with CE CT is overstated and that a more accurate assessment of the risk of CIN could lead to wider CM use, more accurate diagnoses, and bet¬ter clinical treatment.