Prevention of contrast media nephrotoxicity--the story so far.
Contrast media nephrotoxicity (CMN) in patients with pre-existing renal impairment remains a clinically significant problem. The first step to reduce the chance of CMN is to identify patients at risk through the use of screening questionnaires and renal function measurement. Patients at risk requiring injection of contrast medium (CM) because of important clinical indications should receive a small dose of either non-ionic iso-osmolar dimeric or non-ionic low osmolar monomeric CM and hydration. Intravenous infusion (1 ml/kg body weight/h) of 0.9% saline starting 4 h before CM injection and continuing for at least 12 h afterwards is effective in reducing the incidence of CMN. Prophylactic haemodialysis does not lower the risk of this complication. The value of pharmacological manipulation with renal vasodilators (calcium channel blockers, dopamine, atrial natriuretic peptide, fenoldopam (selective dopamine-1 receptor agonist), prostaglandin E(1), non-selective adenosine receptors antagonist (theophylline), non-selective endothelin receptor antagonist or the antioxidant acetylcysteine has not been fully proven. However, haemofiltration for several hours before and after contrast medium injection offers good protection against CMN in patients with advanced renal disease.
Morcos
S K
SK
Department of Diagnostic Imaging, Sheffield Teaching Hospitals NHS Trust, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK. sameh.morcos@sth.nhs.uk
D000111:Acetylcysteine / Q000627:therapeutic use; D000527:Alprostadil / Q000627:therapeutic use; D009320:Atrial Natriuretic Factor / Q000627:therapeutic use; D003287:Contrast Media / Q000009:adverse effects*; D004298:Dopamine / Q000627:therapeutic use; D018491:Dopamine Agonists / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D065128:Endothelin Receptor Antagonists; D018818:Fenoldopam / Q000627:therapeutic use; D006440:Hemofiltration / Q000379:methods; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced* / Q000517:prevention & control; D006435:Renal Dialysis / Q000379:methods; D012307:Risk Factors; D014665:Vasodilator Agents / Q000627:therapeutic use
D003287:Contrast Media; D018491:Dopamine Agonists; D065128:Endothelin Receptor Antagonists; D014665:Vasodilator Agents; D009320:Atrial Natriuretic Factor; D000527:Alprostadil; D018818:Fenoldopam; D004298:Dopamine; D000111:Acetylcysteine