Acetylcysteine and contrast media nephropathy

Purpose of review Radiographic contrast media are used at an increasing rate for several diagnostic and therapeutic applications. Therefore, contrast agent-induced nephropathy will become more important, including the risk of patient impairment and costs. The prevention of radiographic contrast-induced nephropathy is mandatory. Radiographic contrast agent-induced nephropathy is caused by vasoconstriction-mediated renal medullary ischaemia and direct toxic damage to renal tubular epithelial cells. These effects may be partly mediated by the generation of reactive oxygen species. Data from experimental studies indicate that antioxidants, e.g. acetylcysteine, may prevent radiocontrast-induced nephropathy. Recent findings Two prospective, randomized, placebo-controlled studies in patients with moderate renal insufficiency confirmed that the prophylactic oral administration of acetylcysteine, at a dose of 600 mg twice a day along with hydration, prevents the reduction in renal function after radiocontrast administration. Summary The use of acetylcysteine together with hydration is the treatment of choice to protect against radiographic contrast media-induced nephropathy.