Is there an alternative to doing an angiogram with contrast?

Glad you asked because I had forgotten all about the dye problem and I had an angiogram 4 months ago. I have only one kidney. Looking at my test results from 2 days ago, it looks like my kidney function is OK and better than 4 years ago in the months after I donated the other kidney. Phew.

This page from the National Kidney Foundation says:

“In [sic] you are at higher risk for CIN, different dyes might be used. These dyes are less dense then others. Dyes might also be used in the smallest possible amounts. This makes them less likely to interfere with blood flow to the kidneys.”

^^I saw that Information also when I googled, but I didn’t see what the alternative is.

The test is already done. His kidneys are already damaged. It’s just a curiosity question.

That’s a scary story. Going in to get help and BAM! whoops, irreparable damage.

@Call_Me_Jay Yes, it sucks. I think it’s pretty rare. I’ve had that dye administered when I was in an accident. Luckily, no problems. A friend of mine was allergic. Thankfully, they were able to treat her. It was years ago.

I had a PT scan of my heart in June; they used a radioactive dye. And when I had an echo cardiogram last month, they used something else.

One issue is what mechanism is being used for the imaging. That dictates what kind of dye is used.

@zenvelo I was wondering that. Maybe there is a more expensive machine that can be used. Meaning Pet instead of CT, or whatever. I really have no idea. I just know CT is usually the least expensive. MRI seems like it would take too long? I don’t know.

@zenvelo

That seems unusual. I’ve never heard of dyes or anything of the sort being used for an echocardiogram. And I’ve had more than I can count.

@Darth_Algar I think it’s the same as a bubble echo. I’m not sure. It’s called an echo with contrast also.

One of our jellies works in the field of these diagnostics, I don’t remember if he is an MD or a tech for imaging. I wish I remembered who it is.

@Darth_Algar I was diagnosed with heart failure in June, so the doctors want extra info on my left ventricle. The tech did the usual thorough echo and then had the nurse come in and give me some contrast dye via an IV.

Greetings, fellow invalid, @zenvelo. I had a heart attack in June. Best thing that happened to me all year. I got two stents to help the problem I did not know I was carrying around. And I had 12 weeks of rehab, which was basically a gym membership with expert supervision and dietary education. I’m in my best shape in many, many years.

@Call_Me_Jay I am in cardiac rehab now, too. Doctors are still trying to figure out what their long term plan is.

There is a dye for people with kidney issues. Angiogram is really the best quality test, but it depends on why the test is indicated, whether a heart attack is suspected, what other workups have been done, whether requiring a stent or surgery is suspected, etc. The interventional cardiologist should be able to speak to all of this before the procedure.

I worked in a cardiac catheterization lab and cardiac operating room, although it was about fifteen years ago now.

@Cupcake Do you know the name of the dye? I have no idea if this guy had a heart attack or if he was just having symptoms and a bad stress test maybe.

@JLeslie I found this: https://advancingthescience.mayo.edu/2017/01/31/contrast-dye-in-kidney-disease-patients-can-we-reduce-the-risk/

According to it, iohexol is easier on kidneys than iodixonal.

@JLeslie I just downloaded and reviewed a list of FDA approved contrasts. The ones we used when I worked there are discontinued, so I don’t have up-to-date names. It’s a good question and anyone in the cath lab should be able to answer or find someone with the answer. You can even call the lab and ask.

@Cupcake Thanks. I think that is a good idea about calling the cath lab, not that I would do that now for this Q, I just mean if someone was concerned. In 20 years I might have a similar situation, I hope it is not before that. By then there might be totally different diagnostic tools.

As I said above I have had contrast before and no affect on my kidneys, but I do seem to have kidney damage from a BP drug I took. My doctors don’t seem to care. I hover right at the normal line now, sometimes just slightly below normal sometimes slightly above normal. I used to always have much better numbers, and I am tested twice a year for 15 years, just because it is on the panel that is ordered.

I don’t trust doctors to follow up on concerns. It’s a horrible position. Like when my dad had his last colonoscopy he told the doctor not to give him a specific drug for the procedure because last time he had a very bad experience. The doctor either didn’t pay close enough attention, or dismissed my father’s concerns as patients worrying about coincidences and gave him the drug and my dad wind up having his heart go down to 35 beats a minute, his blood pressure was bad also, I don’t remember the numbers, and they had to take him straight from the diagnostic area to the ER. It’s at Walter Reed so it is all there together. This is not my only example of doctors not taking allergy and side effect concerns seriously.

@JLeslie It really is a great question and, in my experience, is taken very seriously in the cath lab. Everyone gets creatinine labs before the procedure and techs/nurses/doctors all check beforehand to know which contrast to use. Providers will also be more judicious in their use of contrast. Unfortunately, at least in my time, the better contrast for low kidney function has less clarity on screen, so sometimes a greater volume has to be used. But, in most every case, a specialized contrast and judicious use is perfectly fine.

You raise another great point, that patients should request follow-up post-cath labs with kidney function concerns. I don’t know how that usually works.

Gee thanks @JLeslie now you have me freaked out.

I got put on much stronger blood pressure medicine in July and on an increased dose last month. The nurse didn’t like my increased creatinine on last Thursday’s blood test, so I have to go for another blood draw today ahead for doctor’s appt on Wednesday.

@zenvelo Well, at least your doctor’s office is competent and tested you and called you. I had to ask for the test (I’m seen as an annoying patient I’m sure) and when it came back low no one called me. If I hadn’t checked my own labs I would not have known.

When I called my doctor they said they had no record of the results, they would not give me an email address to send the result. I said fine please request the result from
Quest Labs. I waited three days no call back. I followed up again and a different person said no record of the test result. They had done nothing. Inexcusable! I already told them I did the test and it shows low kidney function. They ordered the test. All they had to do was call the lab.

I walked myself into the office gave them the labwork and asked for a doctor to order a repeat test.

Another day goes by and nothing.

I went back to the office in person again asking for a repeat test. They wanted me to pay for an appointment with the doctor. I told them to shut the fuck up and give me the lab order in the nicest way I could and finally when the office manager heard the whole story she got me the order. The nerve to ask me to pay for an appointment when they are lucky I’m not calling the AMA.

Result was a low number again. Ugh, I won’t even tell you the whole story. Let’s just say it continued on like this.

I stopped taking the medication on my own. I did another repeat test and my numbers were slightly better, but still below normal. About three weeks after I had stopped the office called me saying I should stop taking the medication. As far as I’m concerned it was straight up negligence.

My kidney function did go back up to the borderline numbers I described above, but never back to where I had consistently been before the medication.

The drug was Losartin, but many people take that drug with no problems.