A Patient with Renal Cell Carcinoma - Case Study Example

Renal Cell Carcinoma Name Course name and Code Instructor’s Name Date Table of Contents Table of Contents 2 Introduction 3 IV Contrast Media Reactions 4 Categorization according to severity 4 Specific contrast media reaction in Kidney failure 5 Anaphylactoid 6 Vasovagal Reactions 6 Combined Reactions 6 Preventions 7 Dose Concentration 7 Patient selection and preparation strategies 8 Injection of contrast media 8 Risk Factors of Contrast Media 9 After Care Management 10 Conclusion 10 References 11 Introduction Renal Cell Carcinoma is a kidney cancer that is found in the proximal convoluted tubule lining; small tubes within the kidney that are tasked with transporting the glomerular filtrate (GF) from the glomerulus to the descending limb of the loop of Henley of the nephrone. It is also called hypernephroma. According to studies, it is the most common kidney cancer in adults that account for approximately 3% of adult malignance and 90 -95 % of neoplasms that arise from the kidney (Stucker, Souza and Kenyon 2009, p. 55). IV contrast agent is a type of radio contrast agents that is used in enhancing the visibility of the internal body structure based on the X-Ray imaging techniques including Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). Radio contrast agents can be either ionic or non-ionic. IV contrast is very useful in the radiology practice particularly for visualizing vessels and changes in tissues on radiography and CT. Contrast agents are very useful in investigating tumours in the urinary tract, fallopian tubes, and the uterus (Lindor and Talwaker 2010, p. 193). Despite of the benefits that contrast agents offer, the risks associated with them are immense and hence cannot be neglected; there are adverse body reactions of varying magnitudes that have been associated with these agents (Ellis, Calne and Christopher 2011, p. 35). Following this observation, it is extremely important for physicians administering the contrast media to be familiar with the adverse body reactions that the agents can cause (Tobias and Hochhauser 2010, p.61). Similarly, the physician must be keen and cautious to recognize the potential side effects of these agents and promptly put in place relevant treatment measures. This essay discusses the various adverse reactions a patient suffering from Renal Cell Carcinoma is likely to exhibit when he/she is injected with IV contrast agent, the prevention measures for these reactions and the after care management will also be extensively explained. IV Contrast Media Reactions The patient suffering from RCC is highly exposed to adverse reactions when he/she is injected with IV contrast media. These reactions are usually categorized according to severity and adverse reactions (Stucker, Souza and Kenyon 2009, p. 58). When these reactions are categorized according to severity, they provide immediate clinical relevance. For instance, when the reactions occur they give a framework within which an appropriate course of treatment can be determined (Collins and Collins 2012, p. 421). The adverse reaction categorization on the other hand helps in comprehending the mechanisms of reactions. Categorization according to severity This method of categorization was developed by the American College of Radiology where severity is categorized into mild, moderate and severe (Stucker, Souza and Kenyon 2009, p. 59). When a patient suffering from RCC is administered with IV contrast media will display the following mild reactions symptoms: nausea, dizziness, shaking, vomiting, anxiety, fever, pallor, chills, sweats, rash, and hives. These reactions although not life threatening they can progress into more severe reactions and hence the patient must be monitored and reassured all the time (Stucker, Souza and Kenyon 2009, p. 59; CIBA Foundation Symposium 2009, p. 14). Similarly, a patient suffering from RCC will exhibit the following moderate reactions when injected with IV contrast media: hypertension coetaneous reaction, tachycardia, hypotension, and dypnea (Collins and Collins 2012, p. 421). When an RCC patient shows the mentioned symptoms, he should be treated promptly and closely observed. Accordingly, when a Renal Cell Carcinoma patient is injected with IV contrast media can react severely to this agent. The symptoms under severe reactions include profound hypotension, convulsion, unresponsiveness, chemically arrhythmias, and cardiopulmonary arrest (Collins and Collins 2012, p. 422). When the patient exhibits these reactions, he/she must be promptly admitted in a hospital and treated accordingly. Specific contrast media reaction in Kidney failure Studies have established that most of the adverse side effects associated with contrast media reactions are mild and moderate which are regarded as not life threatening and only require observation, reassurance and support (Stucker, Souza and Kenyon 2009, p. 60). Furthermore, in general, all patients administered with contrast agents including those suffering from RCC, their severe adverse effects start as mild or moderate reactions, which then progress drastically within 20 minutes of admission. In the same line of argument, for RCC patients who exhibit severe contrast media reaction, it has been established that the procedure for administering the latter was not right or compromised (Collins and Collins 2012, p. 422). In this regard, either the dose, the route for administering, and/or the rate of delivery was not up to standard and according to the regulated specifications (Stucker, Souza and Kenyon 2009, p. 61). The types of reactions exhibited that patients injected with IV contrast agent here are anaphylactoid, nonanaphyctoid including chemotoxic, nasovagal, idiopathic or a combination of these reactions (CIBA Foundation Symposium 2009, p.15). Anaphylactoid When a patient with RCC like any other patient administered with IV contrast media; anaphylactoid reactions occur unexpectedly and the specific causes of these reactions is yet to be established since there causes are uncertain (Stucker, Souza and Kenyon 2009, p.62). Anaphylactoid reactions are also referred to as idiosyncratic reactions. Other reactions associated to osmotic, chemotoxic, direct organ toxicity or vasomotor effects are predictable and hence they are well understood (Stucker, Souza and Kenyon 2009, p. 62). These reactions have characteristics not related to anaphylactoid reactions and thus they are regarded as nonanaphylactoid (CIBA Foundation Symposium 2009, p. 45). In some patients including RCC patients may have both anaphylactoid and nonanaphylactoid reactions thus the combine reactions (CIBA Foundation Symposium, 2009). Vasovagal Reactions These effects occur due to the increased vagal tone on the heart and blood vessels (Stucker, Souza and Kenyon 2009, p. 32). The outcomes here are mainly bradycardia and decreased blood pressure, which might be accompanied with apprehension, confusion, unresponsiveness, and loss of bowel or bladder control signals (Collins and Collins 2012, p. 103). Similarly, other vagal reactions may not be because of the contrast media administration but because of coincident events related to the examination like needle puncture a common procedure associated with administering contrast media to RCC patients (CIBA Foundation Symposium 2009, p. 54) Combined Reactions RCC patients can show both anaphylactoid and nonanaphylactoid reactions occurring simultaneously. The outcomes are complex, life threatening and the patient is always in shock (Abdel-Halim 200, p.73). When the patient presents these symptoms, careful attention to the specific signs and symptoms will automatically help in identifying the real cause of the reaction (Stucker, Souza and Kenyon 2009 p. 61). Accordingly, the history of the patient with regard to previous medications is very vital in establishing the possible effects of the medication. Preventions Dose Concentration The use IV contrast media to patients with RCC should be avoided particularly if the patient allergic to contrast media including laryngeal edema, cardiac arrhythmias, severe bronchospasm, pulmonary edema, and hypotension (Stucker, Souza and Kenyon 2009, p. 63). However, if contrast treatment is desired, then premedication is recommended. The patient should be treated with Prednisone 50mg PO, which must be administered in 13 hours, 7 hours and/or 1 hour prior to administration of contrast media. Similarly, the patient can be treated with Methylprednisolone 125mg IV that is administered in 7 hours and 1 hour prior to IV contrast media administration (Collins and Collins 2012, p. 422). Accordingly, the patient can be treated with Benadryl 150mg PO or IM 30 minutes prior to the contrast media injection. Accordingly, the patient can also be treated with Axid 150mg PO or Zantac 50mg IV 30 minutes before the study. Renal Carcinoma patients with a history of severe allergy including severe asthma, atopic, and prior anaphylactic reaction to other things not related to contrast media but do not have initial known exposure to contrast media, the use of the above described protocol should be followed and/or Benadryl or Methylprednisolone should be considered. However, if the patient is anxious and requests for treatment prior to the examination, Benadryl can be used if it is ordered by the patient’s physician or the radiologist covering the service. Patient selection and preparation strategies This has two general objectives: to prevent contrast reaction from occurring and to be well and fully prepared to treat the reaction should one occur. The following procedure should be duly followed in order to avoid contrast reaction, which includes patient history (Stucker, Souza and Kenyon 2009, p. 63). When reviewing the patient’s history, the focus should concentrate on factors that may indicate reaction to contrast media or if there is an increased probability of a contrast media reaction if the patient if injected with contrast media. Similarly, the hemodynamic, neurologic and the general nutrition status of the Renal Carcinoma patient should be determined or assessed in relation to risk factors. For this matter, strong emphasis should focus on patients with significant allergies such as asthma since it an indicator of high likelihood of a contrast reaction (Stucker, Souza and Kenyon 2009, p.63). Studies have concluded that all patients with known allergies have higher probabilities of contrast reaction. Furthermore, anxious patients are susceptible to contrast media reaction (CIBA Foundation Symposium, 2009 p. 91) Injection of contrast media The injection methods vary with regard to vascular access, clinical problems, together with types of examination (Stucker, Souza and Kenyon 2009, p. 96). Either delivery of contrast media is by hand or power injector or also it varies according to the procedure. The following procedure is recommended when administering an injection IV contrast media (Collins and Collins 2012, p. 121). In order to avoid potential complications, patient’s full cooperation must be obtained and communicate with the patient prior to and after the contrast medium injection (Stucker, Souza and Kenyon 2009, p. 67). This is very essential if the patient reports pain or sensation of swelling at the injection site, injection should be discontinued (Stucker, Souza and Kenyon 2009, p. 52). A critical step in preventing extravasations in RCC patients is by directly monitoring of the venipuncture site by palpation during the initial portions of contrast media injection (CIBA Foundation Symposium 2009) Risk Factors of Contrast Media The risk factor of contrast media in renal carcinoma patients include previous reaction to contrast, asthma, allergies, renal diseases and history of renal dysfunction or diabetes mellitus (Collins and Collins 2012, p. 78). Other risk factors include suspected renal dysfunction, baseline blood urea nitrogen and creatinine (Stucker, Souza and Kenyon 2009, p. 63). For RCC patients with impaired renal dysfunction, the volume of contrast media used should be limited and in accordance with the physician specifications. It is also important to consider the patient’s cardiac status. ). Patients with cardiac infections have higher risks of contrast reaction and the emotional state of the patient must be determined (CIBA Foundation Symposium 2009, p. 42). Severe contrast media effects to some extent can be mitigated by reducing the patient’s anxiety levels. Other contrast media risk factors are paraproteinemia such as multiple myeloma, which are associated with predisposition of irreversible renal failure after administration of contrast media as it causes precipitation in the renal tubules (Collins and Collins 2012, p. 113). Similarly, ongoing quality assurance and quality control programs should be in place together with in-service training and review sessions are recommended. After Care Management Optimal treatment of contrast media reactions include a well-designed plan action, properly staffed and equipped imaging facility, training of on-site personnel attending to patients receiving contrast media (Collins and Collins 2012, p. 43). Ongoing quality assurance and quality control programs should be in place, and in-service training and review sessions are recommended Conclusion Renal Cell Carcinoma is a kidney cancer that originates from within the proximal convoluted tubule lining. Contrast media are used by radiologists to enhance the visibility of internal body organs when using imaging technology like CT scan and MRI. Although these contrast agents are significantly important in these investigations, they are associated with adverse contrast reactions. These reactions include mild, moderate, and severe; they can also result into renal failure. In this regard, specialists administering contrast media should and must be equipped with countermeasure mechanisms to counter these reactions. Similarly, when administering the contrast media, the physician or the radiologist attending to the patient must ensure that all preventive measures are adhered to in order to prevent the occurrence of contrast reactions. 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