Q: Should angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin receptor blockers (ARBs) be hold to prevent Contrast Induced Nephropathy (CIN)? (Select one)

A) Yes
B) No
C) Not Clear


Answer: C

There is no convincing evidence present in literature to support the idea of withholding ACE inhibitors and/or ARBs to prevent CIN. Most of the time, it is done reflexly. Actually, they have been suggested as rather helpful,  by blocking renin-angio II vasoconstriction. 

It should be done only on case to case basis - and should not be held in mild renal insufficiency.


References:

1. Rim MY, Ro H, Kang WC, et al. The effect of renin-angiotensin-aldosterone system blockade on contrast-induced acute kidney injury: a propensity-matched study. Am J Kidney Dis 2012; 60:576. 

2. Rosenstock JL, Bruno R, Kim JK, et al. The effect of withdrawal of ACE inhibitors or angiotensin receptor blockers prior to coronary angiography on the incidence of contrast-induced nephropathy. Int Urol Nephrol 2008; 40:749.