Contrast induced nephropathy differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamed Moubarak, M.D. [2]

Overview

The differential diagnosis includes atheroembolic renal failure, acute renal failure, acute interstitial nephritis, and acute tubular necrosis.

Contrast Induced Nephropathy Differential Diagnosis

Multiple Conditions should be considered in differentiating CIN include the following

Atheroembolic renal failure - More than 1 week after contrast, blue toes, livedo reticularis, transient eosinophilia, prolonged course, and lower recovery

Acute renal failure (includes prerenal and postrenal azotemia) - There may also be associated dehydration from aggressive diuresis, exacerbated by preexisting fluid depletion. Tthe acute renal failure is usually oliguric, and recovery is anticipated in 2-3 weeks

Acute interstitial nephritis (triad of fever, skin rash, and eosinophilia) - Also eosinophiluria may be present. The nephritis is usually from drugs such as penicillin, cephalosporins, and nonsteroidal anti-inflammatory drugs (NSAIDs)

Acute tubular necrosis - Ischemia from prerenal causes, endogenous toxins, such as hemoglobin, myoglobin, and light chains. Exogenous toxins, such as antibiotics, chemotherapeutic agents, organic solvents, and heavy metals