NSAIDs and CIN

Q: Out of the following which one drug should be hold to prevent contrast induced nephropathy (CIN)?

A) Angiotensin-converting enzyme (ACE-I)
B) Angiotensin II receptor blockers (ARBs)
C) Nonsteroidal anti-inflammatory agents (NSAIDs)
D) Vitamin C
E) Hydralazine


Answer: C

Reflexively, ACE-I comes to the mind as an answer, but there is no evidence that ACE-Is or ARBs (or Hydralazine) increase the risk of CIN.

Actually NSAIDs increased the risk of CIN more than any other drugs, and should be stopped 24 to 48 hours prior to the study/procedure. 

Vitamin C has shown some benefit in CIN.


References: 

1. 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.

2. Weisbord SD, Bruns FJ, Saul MI, Palevsky PM. Provider use of preventive strategies for radiocontrast nephropathy in high-risk patients. Nephron Clin Pract 2004; 96:c56. 

3. Dvoršak B, Kanič V, Ekart R, Bevc S, Hojs R. Ascorbic Acid for the prevention of contrast-induced nephropathy after coronary angiography in patients with chronic renal impairment: a randomized controlled trial. Ther Apher Dial. 2013 Aug;17(4):384-90.