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(Stroke. 2009;40:2393.)
© 2009 American Heart Association, Inc.

Original Contributions

CT Angiography for Intracerebral Hemorrhage Does Not Increase Risk of Acute Nephropathy

Alexandra Oleinik, BA; Javier M. Romero, MD; Kristin Schwab, BA; Michael H. Lev, MD; Nupur Jhawar, BA; Josser E. Delgado Almandoz, MD; Eric E. Smith, MD, MPH, FRCPC; Steven M. Greenberg, MD, PhD; Jonathan Rosand, MD, MS Joshua N. Goldstein, MD, PhD

From the Departments of Neurology (A.O., K.S., S.M.G., J.R.), Emergency Medicine (J.N.G., N.J.), and Radiology (J.M.R., M.H.L., J.E.D.A.), the Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Boston; and the Calgary Stroke Program (E.E.S.), Department of Clinical Neurosciences, University of Calgary, Alberta, Canada.

Correspondence to Joshua N. Goldstein, MD, PhD, Department of Emergency Medicine, Massachusetts General Hospital, Zero Emerson Place, Suite 3B, Boston, MA 02114. E-mail jgoldstein{at}partners.org

Background and Purpose— CT angiography (CTA) is receiving increased attention in intracerebral hemorrhage (ICH) for its role in ruling out vascular abnormalities and potentially predicting ongoing bleeding. Its use is limited by the concern for contrast induced nephropathy (CIN); however, the magnitude of this risk is not known.

Methods— We performed a retrospective analysis of a prospectively collected cohort of consecutive patients with ICH presenting to a single tertiary care hospital from 2002 to 2007. Demographic, clinical, and radiographic data were prospectively collected for all patients. Laboratory data and clinical course over the first 48 hours were retrospectively reviewed. Acute nephropathy was defined as any rise in creatinine of >25% or >0.5 mg/dL, such that the highest creatinine value was above 1.5 mg/dL.

Results— 539 patients presented during the study period and had at least 2 creatinine measurements. 348 (65%) received a CTA. Acute nephropathy developed in 6% of patients who received a CTA and in 10% of those who did not (P=0.1). Risk of nephropathy was 14% in those receiving no contrast (130 patients), 5% in those receiving 1 contrast study (124 patients), and 6% in those receiving >1 contrast study (244 patients). Neither CTA nor any use of contrast predicted nephropathy in univariate or multivariate analysis.

Conclusion— The risk of acute nephropathy after ICH was not increased by use of CTA. Studies of CIN that do not include a control group may overestimate the influence of contrast. Patients with ICH appear to have an 8% risk of developing "Hospital-Acquired Nephropathy."

Key Words: cerebral hemorrhage • tomography • X-ray computed • contrast media