Iodinated contrast media decrease renomedullary blood flow. A possible cause of contrast media-induced nephropathy.
The renal medulla has been implicated as a key target for contrast media-induced nephropathy (CIN). Although the effects of contrast media (CM) on whole kidney blood flow are well characterized, the effect of CM on renal medullary blood flow has been controversial. It has been reported that an extremely high dose of a high osmolar CM (iothalamate; 2900 mg I/kg bw) injected rapidly increased the renal outer medullary blood flow (OMBF). However, more clinical relevant doses consistently result in a sustained decrease in medullary blood flow. Furthermore, simultaneous measurements using both laser-Doppler flowmetry and hydrogen washout yield similar results of a decrease in OMBF after CM administration. CM induced a transient 28% decrease in the laser-Doppler signal from the outer medulla, while the hydrogen washout rate in the same region was reduced by approximately 50%. Furthermore, CM administration consistently results in decreased medullary oxygen tension (PO2). The renal medulla works already during normal physiological conditions at the verge of hypoxia, and the majority of the studies published so far are in agreement with the hypothesis that CIN may have its origin in a further reduction in blood flow and/or oxygen availability of this region of the kidney.
Liss
Per
P
Department of Oncology, Radiology and Clinical Immunology, Uppsala University, University Hospital, SE 751 85 Uppsala, Sweden.
Hansell
Peter
P
Carlsson
Per-Ola
PO
Fasching
Angelica
A
Palm
Fredrik
F
D000241:Adenosine / Q000378:metabolism; D000818:Animals; D003287:Contrast Media / Q000009:adverse effects*; D007455:Iodine / Q000009:adverse effects*; D007674:Kidney Diseases / Q000139:chemically induced* / Q000378:metabolism; D012079:Renal Circulation / Q000187:drug effects*
D003287:Contrast Media; D007455:Iodine; D000241:Adenosine