Contrast nephropathy, pathophysiology and prevention.
Contrast nephropathy is a common cause of iatrogenic acute renal failure. Its incidence rises with the growing use of intra-arterial contrast in diagnostic and interventional procedures. Aim of the present review is to summarize the knowledge about pathophysiology and prevention. Nephrotoxicity is related to osmolality, dose and route of the contrast and only occurs in synergy with other factors, such as previous renal impairment and cardiovascular disease. With an interplay of these factors, contrast nephropathy has an impact on morbidity and mortality. Pathophysiological mechanisms are intrarenal vasoconstriction, leading to medullary ischemia, direct cytotoxicity, oxidative tissue damage and apoptosis. Several measures are of proven benefit in patients at risk. Among them are discontinuation of potentially nephrotoxic drugs, hydration, preferably with isotonic sodium bicarbonate, use of low osmolal contrast, oral or intravenous N-acetylcysteine and intravenous theophylline. In patients with severe cardiac and renal dysfunction undergoing cardiac interventions, periprocedural hemofiltration may be considered.
Oudemans-van Straaten
H M
HM
Department of Intensive Care, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands. h.m.oudemans-vanstraaten@olvg.nl
D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000503:physiopathology; D000818:Animals; D017209:Apoptosis; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D003287:Contrast Media / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D016232:Endothelins / Q000097:blood; D006440:Hemofiltration; D006801:Humans; D009994:Osmolar Concentration; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use; D010953:Plasma Volume; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013806:Theophylline / Q000627:therapeutic use
D002121:Calcium Channel Blockers; D003287:Contrast Media; D016232:Endothelins; D010726:Phosphodiesterase Inhibitors; D003404:Creatinine; D013806:Theophylline