Contrast-induced nephropathy: pathogenesis and prevention

被引:43
作者
Cronin, Robert E. [1 ,2 ]
机构
[1] VA N Texas Hlth Care Syst 111, Dallas, TX 75216 USA
[2] Univ Texas SW Med Ctr Dallas, Dallas, TX 75390 USA
关键词
Contrast media; Hemofiltration; Kidney; Pathogenesis; Prevention; HIGH-RISK PATIENTS; PERCUTANEOUS CORONARY INTERVENTION; RADIOCONTRAST-INDUCED NEPHROPATHY; RANDOMIZED CONTROLLED-TRIAL; CHRONIC KIDNEY-DISEASE; ACUTE-RENAL-FAILURE; NEPHROGENIC FIBROSING DERMOPATHY; AGENT-INDUCED NEPHROPATHY; N-ACETYLCYSTEINE; SODIUM-BICARBONATE;
D O I
10.1007/s00467-009-1204-z
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Contrast-induced nephropathy (CIN) is the third most common cause of acute kidney injury in hospitalized patients. Diagnostic and interventional cardiovascular procedures generate nearly half the cases. Elderly patients and those with chronic kidney disease, diabetes, and cardiovascular disease are at greatest risk. Procedure-related risk factors include large volumes of contrast and agents with a high osmolality. Renal medullary ischemia arising from an imbalance of local vasoconstrictive and vasodilatory influences coupled with increased demand for oxygen-driven sodium transport may be the key to its pathogenesis. Contrast agents may also have a direct cytotoxic effect that operates through the generation of reactive oxygen species. Pre- and post-procedure administration of normal saline, isotonic sodium bicarbonate, N-acetylcysteine, and a variety of other pharmacologic agents have been used to prevent or mitigate CIN. While normal saline is generally accepted as protective against CIN, uncertainty still surrounds the role of sodium bicarbonate and N-acetylcysteine. Dialytic therapies before, during, and after exposure to contrast have been tested with mixed results. Logistical and economic disincentives argue against these modalities.
引用
收藏
页码:191 / 204
页数:14
相关论文
共 139 条
[11]  
Attallah N, 2004, CLIN NEPHROL, V62, P273
[12]   Acetylcysteine in the prevention of contrast-induced nephropathy - A case study of the pitfalls in the evolution of evidence [J].
Bagshaw, SM ;
McAlister, FA ;
Manns, BJ ;
Ghali, WA .
ARCHIVES OF INTERNAL MEDICINE, 2006, 166 (02) :161-166
[13]   Theophylline for prevention of contrast-induced nephropathy - A systematic review and meta-analysis [J].
Bagshaw, SM ;
Ghali, WA .
ARCHIVES OF INTERNAL MEDICINE, 2005, 165 (10) :1087-1093
[14]   A rapid protocol for the prevention of contrast - Induced renal dysfunction: the RAPPID study [J].
Baker, CSR ;
Wragg, A ;
Kumar, S ;
De Palma, R ;
Baker, LRI ;
Knight, CJ .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2003, 41 (12) :2114-2118
[15]   RADIOCONTRAST MEDIUM-INDUCED DECLINES IN RENAL-FUNCTION - A ROLE FOR OXYGEN FREE-RADICALS [J].
BAKRIS, GL ;
LASS, N ;
GABER, AO ;
JONES, JD ;
BURNETT, JC .
AMERICAN JOURNAL OF PHYSIOLOGY, 1990, 258 (01) :F115-F120
[16]   METAANALYSIS OF THE RELATIVE NEPHROTOXICITY OF HIGH-OSMOLALITY AND LOW-OSMOLALITY IODINATED CONTRAST-MEDIA [J].
BARRETT, BJ ;
CARLISLE, EJ .
RADIOLOGY, 1993, 188 (01) :171-178
[17]   Contrast-induced nephropathy in patients with chronic kidney disease undergoing computed tomography - A double-blind comparison of iodixanol and iopamidol [J].
Barrett, Brendan J. ;
Katzberg, Richard W. ;
Thomsen, Henrik S. ;
Chen, Nan ;
Sahani, Dushyant ;
Soulez, Gilles ;
Heiken, Jay P. ;
Lepanto, Luigi ;
Ni, Zhou-Hui ;
Nelson, Rendon .
INVESTIGATIVE RADIOLOGY, 2006, 41 (11) :815-821
[18]   Impact of nephropathy after percutaneous coronary intervention and a method for risk stratification [J].
Bartholomew, BA ;
Harjai, KJ ;
Dukkipati, S ;
Boura, JA ;
Yerkey, MW ;
Glazier, S ;
Grines, CL ;
O'Neill, WW .
AMERICAN JOURNAL OF CARDIOLOGY, 2004, 93 (12) :1515-1519
[19]   Gadolinium deposition in nephrogenic fibrosing dermopathy [J].
Boyd, Alan S. ;
Zic, John A. ;
Abraham, Jerrold L. .
JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY, 2007, 56 (01) :27-30
[20]   MECHANISMS OF DISEASE - HYPOXIA OF THE RENAL MEDULLA - ITS IMPLICATIONS FOR DISEASE [J].
BREZIS, M ;
ROSEN, S .
NEW ENGLAND JOURNAL OF MEDICINE, 1995, 332 (10) :647-655