Radiocontrast-induced acute renal failure.
The intravascular administration of iodinated radiocontrast media can lead to acute renal dysfunction. Even small changes in renal function have been associated with increased morbidity and mortality, making the prevention of radiocontrast nephropathy of paramount importance. This review summarizes the principal risk factors for radiocontrast nephropathy and evidence-based preventive strategies that should be used to limit its occurrence. Risk factors for radiocontrast nephropathy include preexistent kidney disease, diabetes mellitus, dose of radiocontrast used, advanced congestive heart failure, and intravascular volume depletion. Proven preventive measures include volume expansion with intravenous saline or sodium bicarbonate and the use of low-osmolar or iso-osmolar radiocontrast media. Studies evaluating N-acetylcysteine have been conflicting, with meta-analyses suggesting a small beneficial effect. Studies of other pharmacologic agents have not demonstrated clinical benefit.
Weisbord
Steven D
SD
Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15240, USA.
Palevsky
Paul M
PM
D000111:Acetylcysteine / Q000008:administration & dosage / Q000627:therapeutic use; D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy; D000465:Algorithms; D000818:Animals; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography; D003404:Creatinine / Q000097:blood; D018818:Fenoldopam / Q000008:administration & dosage / Q000627:therapeutic use; D005919:Glomerular Filtration Rate; D006801:Humans; D007049:Iatrogenic Disease; D007683:Kidney Tubular Necrosis, Acute / Q000139:chemically induced / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy; D015201:Meta-Analysis as Topic; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic; D017582:Renal Replacement Therapy; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D012965:Sodium Chloride / Q000008:administration & dosage; D014283:Triiodobenzoic Acids / Q000008:administration & dosage; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use
D003287:Contrast Media; D014283:Triiodobenzoic Acids; D014665:Vasodilator Agents; D012965:Sodium Chloride; D003404:Creatinine; C044834:iodixanol; D018818:Fenoldopam; D000111:Acetylcysteine