Development of acute nephropathy is a safety concern when using contrastenhanced computed tomography (CT) (1,2). Renal function is often still unknown when patients with acute ischemic stroke undergo CT perfusion (CTP) and CT angiography (CTA). Therefore, we assessed the occurrence of acute nephropathy after CTP and CTA in patients with acute ischemic stroke. Patients with a suspected ischemic stroke and without a known history of renal disease were recruited from the Dutch acute Stroke Study (DUST) (3). All 731 patients underwent CTP and CTA within nine-hours after stroke onset. Creatinine levels were measured at admission and again within three-days. Renal dysfunction on admission was defined as an estimated glomerular filtration rate of <60 ml/min/1·73 m. Acute nephropathy was defined as an increase in creatinine level of either >25% or >44 μmol/L within three-days after admission (4). Renal dysfunction on admission was found in 155 (21·2%) patients. Acute nephropathy occurred in 27 (3·7%) patients. The occurrence of acute nephropathy was not increased in patients with renal dysfunction on admission (1·3%) compared with those without (4·3%). In 11 of the 27 patients with acute nephropathy the creatinine rise reached the threshold of renal dysfunction (Fig. 1). However, treatment was considered to be required in only three patients (0·4%). One of these patients had a history of renal disease that was missed on admission. We demonstrated that acute nephropathy occurs in only a minority of patients with acute ischemic stroke without a known history of renal disease, even if renal dysfunction is present on admission. Therefore, it is safe to perform CTP and CTA in these patients before renal function is known. However, high vigilance for obtaining a history of renal disease is important and we recommend follow-up of renal function in the first days after admission.
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