title: Why is diabetes mellitus a risk factor for contrast-induced nephropathy?
abstract: Contrast-induced nephropathy (CIN) remains a leading cause of iatrogenic acute kidney injury, as the usage of contrast media for imaging and intravascular intervention keeps expanding. Diabetes is an important predisposing factor for CIN, particularly in patients with renal functional impairment. Renal hypoxia, combined with the generation of reactive oxygen species, plays a central role in the pathogenesis of CIN, and the diabetic kidney is particularly susceptible to intensified hypoxic and oxidative stress following the administration of contrast media. The pathophysiology of this vulnerability is complex and involves various mechanisms, including a priori enhanced tubular transport activity, oxygen consumption, and the generation of reactive oxygen species. The regulation of vascular tone and peritubular blood flow may also be altered, particularly due to defective nitrovasodilation, enhanced endothelin production, and a particular hyperresponsiveness to adenosine-related vasoconstriction. In addition, micro- and macrovascular diseases and chronic tubulointerstitial changes further compromise regional oxygen delivery, and renal antioxidant capacity might be hampered. A better understanding of these mechanisms and their control in the diabetic patient may initiate novel strategies in the prevention of contrast nephropathy in these susceptible patients.
authors.affiliation: Department of Medicine, Hadassah Hospital, Mt. Scopus and the Hebrew University Medical School, P.O. Box 24035, Jerusalem 91240, Israel.
authors.forename: Samuel N
authors.initials: SN
authors.lastname: Heyman
authors.affiliation: Department of Nephrology, Charité Campus Mitte, Berlin 10115, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Rosenberger
authors.affiliation: Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA.
authors.forename: Seymour
authors.initials: S
authors.lastname: Rosen
authors.affiliation: Joslin Diabetes Center, Harvard Medical School, Boston, MA 02215, USA.
authors.forename: Mogher
authors.initials: M
authors.lastname: Khamaisi
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000503:physiopathology*; D000818:Animals; D003287:Contrast Media / Q000009:adverse effects*; D003920:Diabetes Mellitus / Q000503:physiopathology*; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced* / Q000503:physiopathology*; D012307:Risk Factors
chemical_list: D003287:Contrast Media