Contrast-induced kidney injury: focus on modifiable risk factors and prophylactic strategies.
Contrast-induced nephropathy, also known as contrast-induced acute kidney injury, is associated with rapid and often irreversible decline in kidney function following the administration of iodinated contrast agents. Contrast-induced nephropathy is the third leading cause of acute kidney injury in hospitalized patients, and substantially increases mortality, morbidity, and length of hospitalization. Contrast-induced nephropathy follows a predictable time of onset and is potentially preventable. It has been the subject of numerous studies addressing characteristics of the populations at risk and prophylactic strategies. This evidence-based review summarizes recent literature and provides a nephrologists' perspective on contrast-induced nephropathy, focusing on: the pathophysiology of contrast-induced nephropathy; identification of populations at risk; correlation between contrast-induced nephropathy and the type of contrast agent used; and finally, measures to prevent contrast-induced nephropathy, including intravenous fluids, sodium bicarbonate, N-acetylcysteine, and hemofiltration/hemodialysis.
Kagan
Anna
A
Medicine/Nephrology, Baylor College of Medicine, Houston, Texas 77030, USA.
Sheikh-Hamad
David
D
D000111:Acetylcysteine / Q000627:therapeutic use; D000208:Acute Disease; D000818:Animals; D003131:Combined Modality Therapy; D003287:Contrast Media / Q000009:adverse effects*; D019610:Cytoprotection; D019317:Evidence-Based Medicine; D005440:Fluid Therapy; D006440:Hemofiltration; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced / Q000503:physiopathology / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D006435:Renal Dialysis; D018570:Risk Assessment; D012307:Risk Factors; D017693:Sodium Bicarbonate / Q000627:therapeutic use; D016896:Treatment Outcome
D003287:Contrast Media; D017693:Sodium Bicarbonate; D000111:Acetylcysteine