[Iodinated contrast agent-induced nephropathy].
Contrast-induced nephropathy (CIN) is a well-known complication of therapeutic and diagnostic procedures requiring contrast administration and accounts for 10% of acute renal failure in hospitalized patients. Although the incidence of this complication is relatively low, its consequences can be catastrophic. The development of CIN is associated with increased length of hospital stay, an increased requirement for acute dialysis, and an increased risk of death. Preexisting renal dysfunction, age, diabetes, congestive heart failure, and volume of administered contrast are all associated with a risk of developing CIN. Despite a large number of clinical trials that have evaluated prophylaxis strategies for CIN, no uniform strategies have been developed so far. The use of N-acetyl-L-cysteine (NAC) or theophylline in specific subgroups of patients has been shown to reduce dialysis requirement and mortality in patients undergoing angiographic procedures. Hemofiltration has also shown positive results. In this review we will discuss the epidemiology and the risk factors for CIN and the evidence for commonly employed prophylaxis strategies, and we will provide general recommendations with respect to CIN prevention and management.A practicable strategy to prevent CIN includes: correct identification of individuals at greatest risk, thorough evaluation of whether other diagnostic maneuvers could be employed instead (i.e., sonography), application of low-osmolar contrast media at the minimum acceptable dose, stopping potential nephrotoxic drugs (NSAID), hydration with sodium chloride 0.9% 1 ml/kg per h i.v. 12 h before and after CM application, administration of acetylcysteine 600 mg twice the day before and after (in cases of emergency investigation and high-risk patients 1200 mg i.v.), and theophylline (250-350 mg) the day before and the day after CM application (in cases of emergency investigation 5 mg/kg i.v.).
Erley
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St. Joseph-Krankenhaus Berlin, Bäumerplan 24, 12101 Berlin, Deutschland. christiane.erley@sjk.de
D000111:Acetylcysteine / Q000008:administration & dosage / Q000627:therapeutic use; D058186:Acute Kidney Injury / Q000139:chemically induced / Q000517:prevention & control / Q000628:therapy; D000367:Age Factors; D000792:Angiography / Q000009:adverse effects; D002986:Clinical Trials as Topic; D003287:Contrast Media / Q000009:adverse effects*; D048909:Diabetes Complications; D016166:Free Radical Scavengers / Q000008:administration & dosage / Q000627:therapeutic use; D005919:Glomerular Filtration Rate / Q000187:drug effects / Q000502:physiology; D006333:Heart Failure / Q000150:complications; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced* / Q000150:complications / Q000503:physiopathology / Q000517:prevention & control* / Q000628:therapy; D017582:Renal Replacement Therapy; D012307:Risk Factors; D013806:Theophylline / Q000008:administration & dosage / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed / Q000009:adverse effects; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use