title: Side effects of radiographic contrast media: pathogenesis, risk factors, and prevention.
abstract: Radiocontrast media (RCM) are medical drugs used to improve the visibility of internal organs and structures in X-ray based imaging techniques. They may have side effects ranging from itching to a life-threatening emergency, known as contrast-induced nephropathy (CIN). We define CIN as acute renal failure occurring within 24-72 hrs of exposure to RCM that cannot be attributed to other causes. It usually occurs in patients with preexisting renal impairment and diabetes. The mechanisms underlying CIN include reduction in medullary blood flow leading to hypoxia and direct tubule cell damage and the formation of reactive oxygen species. Identification of patients at high risk for CIN is important. We have reviewed the risk factors and procedures for prevention, providing a long list of references enabling readers a deep evaluation of them both. The first rule to follow in patients at risk of CIN undergoing radiographic procedure is monitoring renal function by measuring serum creatinine and calculating the eGFR before and once daily for 5 days after the procedure. It is advised to discontinue potentially nephrotoxic medications, to choose radiocontrast media at lowest dosage, and to encourage oral or intravenous hydration. In high-risk patients N-acetylcysteine may also be given.
authors.affiliation: Nephrology Unit, Department of "Health Sciences", Campus "Salvatore Venuta", "Magna Graecia" University, Loc. Germaneto, 88100 Catanzaro, Italy.
authors.forename: Michele
authors.identifier: 0000-0002-7974-3792
authors.initials: M
authors.lastname: Andreucci
authors.affiliation: University of Vermont College of Medicine, Fletcher Allen Health Care, Burlington, VT, USA.
authors.forename: Richard
authors.identifier: 0000-0002-5943-4378
authors.initials: R
authors.lastname: Solomon
authors.affiliation: Nephrology Unit, Department of Medicine, Faculty of Medicine, Thammasat University, Rangsit Campus, Khlong Luang, Pathum Thani 12121, Thailand.
authors.forename: Adis
authors.initials: A
authors.lastname: Tasanarong
mesh_terms: D000818:Animals; D003287:Contrast Media / Q000009:adverse effects*; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced* / Q000517:prevention & control*; D011859:Radiography / Q000009:adverse effects*; D012307:Risk Factors; D013961:Thyroid Gland / Q000503:physiopathology
chemical_list: D003287:Contrast Media