Contrast Dyes and Kidney Damage

When Mom and I interviewed dialysis patients for our KidneySteps book, we were surprised at the number who told us they ended up on dialysis after receiving dye for a CT scan.  As a nurse, I also see patients who believe their kidneys were damaged by contrast dyes given during lab imaging tests.  These people aren’t imagining the damage.  Contrast agents, commonly used for coronary  procedures, are known to be toxic to kidneys.  The  kidney damage they cause is called contrast-induced nephrology (“CIN”).

People who already suffer reduced kidney function are particularly susceptible to CIN.  Those in stage 3 or 4 of kidney disease have the greatest risk.  Other risk factors for developing CIN include being diabetic, dehydrated, over age 70, having congestive heart failure, or using NSAIDs (aspirin and other pain relievers) at the time of the test.

You have CIN from contrast dye if your serum creatinine (kidney patients know what this is) increases by 25% from baseline (e.g. creatinine increases from 2 mg/dL to 2.5 mg/dL) within 2 to 3 days after receiving the dye.

CIN is usually temporary, with kidney function returning to normal within a couple of weeks.  However, just developing CIN is a hazard.  It is associated with a significantly higher risk of death while in the hospital and within a year thereafter.  In those with kidney disease, CIN can be permanent and can propel someone into end stage and dialysis.

Unfortunately, many physicians ordering CT scans with contrast dye are not fully informed about the CIN risk.  If the patient is diabetic and/or has a creatinine level greater than 2 or 3, CIN can result up to 50% of the time, studies indicate, which sharply increases risk of death and permanent kidney damage and dialysis.

What to do:  If your doctor orders a test that includes contrast dye, express your concern about your diabetes or kidney function.  Ask about an alternative (such as an MRI), and see if the test is urgent.  I have told my mother, the recipient of my kidney, to avoid contrast imaging.  Transplantation does not cure kidney disease, and avoiding contrast dyes where at all possible is a reasonable precaution.

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25 Responses to Contrast Dyes and Kidney Damage

  1. norman west says:

    I told the dr my creatine levels were 2.4 and he injected me with dye anyway…..it made me feel warm for a few seconds all the way from my waist to my knees………when in the hospital 5 yrs ago I had a 2.1 creatine and they shot me with dye but I felt no heat
    or warning of heat.

    • Vicki says:

      Certain dyes do cause the feeling of heat radiating through the body. The “heat” sensation is insignificant and passes. It is the contrast dye itself that can harm kidney function in people with already compromised function.

  2. Shannon says:

    How common is it for someone with normal kidney function to get CIN? I had a ab/pelvic ct done about 3 days ago and I know I was dehydrated before the test. The next night after the scan I started getting kidney pain and it hasn’t gone away since then which has been 2 days. Do you think this could have damaged me since I was healthy beforehand?

    • Vicki says:

      Shannon, thank you for visiting us. Your pain could be something other then kidney pain. Many people with very poor kidney function never experience pain. Please call your doctor to see what other reasons might lead to your pain. If you really want assurance that your kidney function remains good, ask for both a blood test to determine your GFR and an albuminuria test for protein in your urine.

  3. Angie Jeffreys says:

    My Mother had about fifteen (15) contrast dye test between
    1994-2008. She had triple bypass surgery in ’94 and several
    cardiac “events” since. For the past several years she has dealt
    with kidney problems and has been told dialysis is in the near
    future. The fistula clogged before she healed from the surgery
    and that was just over 3 years ago. Now, congestive heart
    failure, kidney disease and lingering effects from strokes are
    Taking their toll on her 72 year old body. I don’t understand
    kidney disease. I think she may have some atypical symptoms.
    I live in a different state and can’t make it to many of
    her Dr appt. I’m afraid she’s near death and I’m trying to
    Figure out how much time I have left with her. Is there
    Anything you can tell me? I don’t even know what kinds of
    Questions to ask the Dr. Her creatinine levels fluctuate a lot.
    Any advice or info would be welcome.

    • Vicki says:

      Angie, your mother’s health sounds poor. Dialysis my extend her life but is difficult. Cardiovascular events are the primary and likely cause of death for people with kidney disease and for people on dialysis. Perhaps, you may want to arrange a meeting (appointment) for your mother with her nephrologist (kidney doctor) at a time you can attend. (She should be seeing a nephrologist and not just her family doctor.) The nephrologist can give you a good idea of your mother’s kidney status and likelihood of success on dialysis.

      Good luck to both of you, and thank you for visiting this site. If you search through different topics on the site, you will learn much about dialysis and kidney disease itself.

  4. TERRI ROMERO says:

    On 05/28/2013 I had an MRI with contrast dye done on me because of bad pain in my right shoulder( which I later found out was a Rotary Cuff tear)as soon as the MRI TEST was finished I felt very dizzy and could not walk without help, I was also talking a little slurry in my speech as if I were drunk and felt very doped-up.I was told that this would soon pass, that I should just drink a lot of water to flush out the dye. Well I went home and did exactly that, but 6 days later I was STILL DIZZY! It got WORSE on 6/02/2013 and I got scared and went to the Emergency Room. I had a lot of test done on me and was told that I WAS JUST HAVEING VERTIGO. I was also feeling very weak and was told that I also had a urinary tract infection and the E.R. Doctor gave me a prescription for Cipro and also MECLIZINE TABLETS for the dizziness. Is it possible that I could have gotten KIDNEY damage or even made my kidneys worse because of the contrast dye. I still don’t feel well but the dizziness has subsided.MAY I GET AN OPINION FROM SOMEONE.

  5. Vicki says:

    Terri,

    Thank you for leaving your comment. Your symptoms are not normal post-MRI reactions. If the contrast dye did harm your kidney function, you will want to know immediately. Please have blood and urine tests (very simple process) to determine that current status of your kidney function. Thank you.

  6. TERRI ROMERO says:

    Thankyou Vicki. From TERRI 06/06/2013.

  7. Annette says:

    I was so happy to find your site. My 74-year old mother is currently in the hospital. She is a diabetic (due to a Whipple procedure from caner in ’90). She struggles with high BP, terrible shortness of breath, and lately weight loss due to la k of appetite). She has been hospitalized three times this year due to fluid in lungs. Her creatine level is 2.7, which I understand from the nephrologist means about 75% of her kidney function is gone.

    We just received the results of her VQ scan from yesterday which shows a potential clot in the lung. I believe the VQ suggests about a 50% chance of having a clot. I understand that doing a CT scan to confirm or dispel the possibility of a clot would like damage her kidneys more. On the flip side, I also understand that placing her on blood thinners if she doesn’t have a clot could cause potentially dangerous side effects.

    I would be so apprecistive if you have any strong recommendation as to whether to proceed with the CT scan (and risk further kidney damage) or start on blood thinners and assume this is a clot.

    Kindest Regards,
    Annette

    • Vicki says:

      Annette, thank you for contacting us. You and your mother must find all of this difficult and frightening. She is fortunate that she has you to seek information for her.

      Please have a candid conversation with her medical team, which should include a nephrologist. There are options to a CT scan that may provide the information the doctors seek but are safer for your mother’s kidneys. Also, new approaches exist for flushing the system of the contrast dye or diluting it, if the CT scan is the only option. For example, some patients do much better if given an IV diluting solution for several hours before the scan and then following the scan. Also, there are several dyes, some safer for kidneys than others. Perhaps, you can explore all these options with the doctor. Good luck to your mother.

  8. Annette says:

    Many thanks for any advise or info you might be able to share.

  9. Vicki says:

    Annette, see above. Thank you.

  10. Annette says:

    Vicki, I can’t thank you enough for your response. That was so helpful and informative. Thanks again for your kindness and quick response. What a blessing you obviously are to so many people seeking information.

    Thanks again,
    Annette

  11. Vicki says:

    Annette, you are most welcome. Please let me know how your mother is in a few months. Thank you.

  12. Gisele Anderson says:

    Hello,

    I am so thankful I have found this site! My father, age 92, recently had a cystoscopy. He has had them annually for quite some now, as he has had low grade bladder cancer since 1985. It has been kept under control with occasional bladder restricted chemo treatments and burning off the tumors during a cystoscopy. Last year,the urologist noted several small tumors in his left ureter which he burned off. During this last surgery, he investigated further up the ureter and into the kidney. He noted that the uppermost calyces was blocked, and enlarged. Everything else looked normal. He order a CT scan, however, he mentioned that my father’s latest creatinine level was 1.7 prior to the surgery, He ran another blood test last week, and his creatinine level was at 1.4. My father had been on Lisinopril for over a year, and we just took him off it last week in favor of another blood pressure medication called Losarpan. His MD told him that his creatinine levels were elevated because of the Lisinopril and that he was getting a ‘false reading’. I am very concerned about the risks associated with a CT scan at his age, and with the elevated creatinine levels. He is not a candidate for an MRI because he has a pacemaker. Any thoughts on how best to proceed? We are meeting with his urologist again tomorrow at 4 PM. Thank you so much.

  13. Vicki says:

    Thank you, Gisele, for visiting our site and for your questions. A creatinine of 1.4 is rather impressive for a 92-year old. Your concern about contrast dye is merited, though. If no other test option is available, perhaps you can discuss with the doctor whether the test is even necessary, given your father’s age. If there is renal cancer, some studies indicate the tumors can take years to cause serious problems.

    Also, discuss different dye types. Some are less harmful to kidneys. Also ask about IV infusions prior to the test and then after the test to help neutralize the dye. This approach has been used recently.

    Good luck.

  14. Gisele Anderson says:

    Thank you so much. We had a great meeting with my Dad’s urologist, and have decided to wait another 3 weeks to see if his creatinine levels drop now that he is no longer on the Lisinopril. We will also ask them to use the contrast “Isovue, if we do the CT scan which seems to fare better. I really appreciate your feedback. God Bless You!

  15. Vicki says:

    I’m pleased your meeting went well. I look forward to hearing more from you.

  16. Teresa Altman says:

    I have a six year old with Spina Bifida as result she has neurogenic bladder. We adopted her and she has been with us for 8 months. In late December routine blood work showed a creatinine level of .27
    On June 11 she had an IVP done so she received contrast for that. Yesterday we had to go back and have a CT of her abdomen and pelvis with contrast. Before doing the test they tested her blood and her creatinine was 2. They said it was fine, but after getting home it just didn’t sound right to me. Should these levels come down on their own? Other facts about her she is on an antibiotic for a UTI. Didn’t know if just having a UTI could increase creatinine levels.

    • Vicki says:

      Teresa,
      Thank you for visiting our web site. We agree with you that a creatinine of 2 is too high. Please talk to your doctor about this, and have it checked again.

  17. Ram says:

    Hi Vicki,

    My mom had an angiogram done 2 months back. Her Creatinine was 2.5mg/dl before the procedure and was 2.8mg/dl after 72 hours and in a week came down to 2.6mg/dl. 2 weeks later, it dropped to 2.0mg/dl.

    But after 2 months now, it is rising and is at 5.4mg/dl
    She has a UTI and takes antibiotic for that. She was recently put on insulin for her diabetes
    Would CIN show its impact after 2 or 3 months and raise Cr levels? or could it be the UTI? She is 10 days into the antibiotic course.

    Please advice

    Thanks,
    Ram

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