A N-acetilcisteína na prevenção da nefropatia induzida por contraste: as evidências são definitivas ou necessitamos de mais estudos?

Abstract

Métodos como angiografias coronárias representam inquestionáveis avanços no diagnóstico, no manejo e na estratificação de risco de uma série de condições clínicas, sendo, por isso, crescente o número de pacientes submetidos a esses exames 1-4. A nefropatia induzida por contraste (NIC) representa uma potencial complicação bem conhecida em angiografia e intervenções coronárias e essas interven-SUMMARY Acetylcysteine for Prevention of Contrast-Induced Nephropathy: Is the Evidence Definitive or Do We Need More Clinical Trials? Background: Contrast-induced nephropathy (CIN) is a potential complication of angiography and coronary interventions that use radiological contrast, especially in high-risk patients. Acetylcysteine may have a protective effect on the development of this pathology. Objectives: Narrative review which has the following objectives: to define the development context of CIN and the risk factors; to define the mechanism of action proposed for CIN prevention and the compilation of the main and current randomized trials and systematic reviews and meta-analyses conducted to sustain this idea. Methods: Bibliographic research of MEDLINE, EMBASE, Cochrane CENTRAL to screen the most relevant randomized trials and systematic reviews and meta-analyses. Results: The randomized trial results are conflictive and the results of all systematic reviews and meta-analyses are controversial, despite most studies suggesting beneficial use of acetylcysteine for CIN prevention. Conclusion: It will be necessary to conduct better designed randomized clinical trials with adequate sample size population to obtain more consistent results. DESCRIPTORS: Kidney diseases/chemically induced. Acetylcysteine. Contrast media/adverse effects. Angiography. Clinical trials.