Contrast-induced nephropathy in patients undergoing elective and urgent procedures.
Contrast-induced nephropathy (CIN) is an acute and severe complication after contrast media administration. The most important step in preventing CIN is identifying high-risk patients. In this review, we evaluate and summarize the evidence regarding the CIN prophylaxis, including the withdrawal of the potentially nephrotoxic drugs, hydration by isotonic solution or NaHCO(3), pharmaceutical treatment with N-acetylcysteine (N-AC), adenosine antagonists, ascorbic acid, renal procedures including hemofiltration or dialysis, and to the optimal use of the contrast. We suggest it is possible to reduce the burden of CIN by carefully incorporating these recommendations. After review of published literature in this field, we conclude that the cornerstone of the CIN prevention should be combination of hydration (normal saline or NaHCO(3)) and the use of N-AC.
Mautone
Alessandro
A
Department of Cardiology, Bolzano General Hospital, Italy. alemautone@yahoo.it
Brown
Jeremiah R
JR
D000111:Acetylcysteine / Q000627:therapeutic use; D000208:Acute Disease; D058186:Acute Kidney Injury / Q000139:chemically induced*; D000241:Adenosine / Q000037:antagonists & inhibitors; D001205:Ascorbic Acid / Q000627:therapeutic use; D003287:Contrast Media / Q000009:adverse effects*; D017558:Elective Surgical Procedures; D004638:Emergency Treatment; D016166:Free Radical Scavengers / Q000627:therapeutic use; D013502:General Surgery; D005919:Glomerular Filtration Rate; D006801:Humans; D006875:Hydrotherapy; D011300:Preoperative Care; D006435:Renal Dialysis; D018570:Risk Assessment; D017693:Sodium Bicarbonate / Q000627:therapeutic use
D003287:Contrast Media; D016166:Free Radical Scavengers; D017693:Sodium Bicarbonate; D000241:Adenosine; D001205:Ascorbic Acid; D000111:Acetylcysteine