Contrast medium-induced nephrotoxicity: pathophysiology and prevention.
Contrast medium-induced nephrotoxicity (CMN) is a common form of iatrogenic acute renal failure. Typically, patients experience changes in serum creatinine or creatinine clearance between 1 and 5 days after exposure to a contrast medium, but they rarely require dialysis. The mechanism for CMN is not understood, but renal insufficiency, dehydration, and congestive heart failure are risk factors. The frequency of CMN with high-osmolality versus low-osmolality media is controversial. Prophylaxis can reduce CMN. Of many different strategies, hydration with normal saline before and after exposure offers the best protection with the fewest adverse effects.
Gerlach
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Department of Pharmacy, The Ohio State University Medical Center, Columbus 43210, USA.
Pickworth
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D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000188:drug therapy / Q000503:physiopathology; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003287:Contrast Media / Q000009:adverse effects*; D003681:Dehydration / Q000188:drug therapy; D004234:Diuretics, Osmotic / Q000627:therapeutic use; D004298:Dopamine / Q000627:therapeutic use; D006333:Heart Failure / Q000188:drug therapy; D006801:Humans; D008353:Mannitol / Q000627:therapeutic use; D009994:Osmolar Concentration; D051437:Renal Insufficiency / Q000188:drug therapy; D012307:Risk Factors; D012965:Sodium Chloride / Q000627:therapeutic use
D002316:Cardiotonic Agents; D003287:Contrast Media; D004234:Diuretics, Osmotic; D008353:Mannitol; D012965:Sodium Chloride; D004298:Dopamine