CIN - Further References and Resources

1. Department of Health, Western Australia, Imaging Pathways (Contrast Induced Nephropathy), May 2011. Available from

Western Australia Department of Health contrast induced nephropathy (CIN) information and pathway including a risk assessment and management protocol.

2. Royal Australian and New Zealand College of Radiologists (RANZCR), Guidelines for Iodinated Contrast Administration, March 2018

General guidelines for radiologists using iodinated contrast media developed by the Standards of Practice and Accreditation Committee of The Royal Australian and New Zealand College of Radiologists (RANZCR).

The Canadian Association of Radiologists Consensus Guidelines are intended as a practical approach to risk stratification and prevention of CIN.

University of Kentucky Guidelines for CIN Prevention in Adults for use at University of Kentucky Chandler Medical Center.

5. Stein, J. Renal and Urology News, Drug offers no CIN protection, January 2012.

For the trial, the researchers randomized patients to receive 1,200 mg of oral acetylcysteine twice daily taken as two doses before and two doses after the procedure, or placebo. About 75% of patients in both groups received a low-osmolar dye.
“Our trial is the largest ever to examine the efficacy of the antioxidant agent acetylcysteine for the prevention of contrast-induced nephropathy with a randomized design, and we believe that the results convincingly demonstrate that acetylcysteine does not protect against contrast-induced nephropathy in patients undergoing angiography,” said principal investigator Otavio Berwanger, MD, Director of the Hospital do Coracao's Research Center in São Paolo.

Brazilian researchers report that N-acetylcysteine should no longer be routinely used to prevent contrast-induced nephropathy (CIN) in patients undergoing coronary and vascular angiography.
At the American Heart Association Scientific Sessions 2010, the investigators presented data from the 2,308-patient Acetylcysteine for the Prevention of Contrast-Induced Nephropathy (ACT) trial.

The results of this study do not suggest that hydration with sodium bicarbonate is superior to hydration with sodium chloride for the prevention of contrast medium–induced nephropathy in patients with moderate to severe chronic kidney disease who are undergoing coronary angiography.

8. Alice Goodman, Renal and Urology News, CIN Rare After Chest Imaging Procedures, July 2008.

CHICAGO—Routine use of contrast agents for evaluating chest pain carries a risk of contrast- induced nephropathy (CIN).
In a retrospective study, CIN occurred in 3% of patients who received diagnostic testing that required contrast, JoEllen Kohlman, MD, of Saint Louis University in St. Louis, Mo., reported at the American College of Cardiology annual meeting. “This suggests the need for caution prior to subjecting all patients to ‘routine' contrast imaging studies during chest pain.”

“Our meta-analysis demonstrates that N-acetylcysteine is the most effective agent for preventing contrast-induced nephropathy in patients with chronic renal insufficiency,” the researchers wrote. “Whether this risk reduction translates into a benefit in clinical outcomes remains to be proven.”
“Our findings indicate that the use of such oral agents as N-acetylcysteine is reasonable in high-risk patients who are to receive large or repeated volumes of contrast agents. We believe that the lack of significant side effects and the low cost justifies use of these agents while empirical data on clinical outcomes mature.”
Hydration and iso-osmolar or low-osmolar contrast agents such as iodixanol are all associated with a decreased incidence of contrast-induced nephropathy in patients with renal impairment, Dr. Kelly's group observed.

10. Wikipedia - Contrast-induced nephropathy, 13 April 2012.

11. Stacul, F. (2006) Strategies to reduce the risk of contrast induced nephropathy, The American Journal of Cardiology, vol. 98, no. 6, supplement 1, pp. 59-77.

12. Rebel EM, Contrast Induced Nephropathy - Fact or Myth? 20 March 2017

13. Ahmad, F.S. (2013) The Myth and Reality of Contrast Induced Nephropathy, Applied Radiology, vol. 12, pp. 16-18.

14. PulmCrit, Do CT scans cause contrast nephropathy, 29 March 2015

15. Edwards, J. (2017) Contrast Induced Nephropathy - Myth or Reality? Evidence in Review in Emergency Medicine Conference, 2 March 2017.