Advances in the Understanding of the Nephrotoxicity of Radiocontrast Media

Morcos, Sameh K.; Nahas, A. Meguid El

doi:10.1159/000044930

Cited by 18 publications

(14 citation statements)

References 40 publications

(52 reference statements)

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“…30 Furthermore, the mechanisms responsible for reduction in renal perfusion involve tubular and vascular events. 31,32 On the other hand, contrast medium produces marked natriuresis and diuresis, which can activate the tubuloglomerular feedback response, 33 leading to vasoconstriction of the glomerular afferent arterioles and causing a decrease in GFR. The present study results suggest that the pre-existing decreasing GFR and its further reduction after administration of contrast might be the factor most involved in the development of CIN.…”

Section: Discussionmentioning

confidence: 99%

Valuable Markers for Contrast-Induced Nephropathy in Patients Undergoing Cardiac Catheterization

Katô

Sato

Yamamoto

et al. 2008

Circ J

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ontrast-induced nephropathy (CIN) is a recognized complication of both coronary angiography (CAG) and percutaneous coronary intervention (PCI), and is associated with prolonged hospitalization and adverse clinical outcomes. [1][2][3][4][5] Several risk factors for CIN have been identified: chronic kidney disease (CKD), diabetes mellitus (DM), congestive heart failure, intravascular volume depletion, and using a large amount of contrast media are important predisposing factors. 2-4 CKD is also a risk factor of mortality in patients with cardiovascular disease. [6][7][8] The development of CIN is low in patients with normal renal function, varying from 0% to 10%, but its incidence is increased to 20% in patients with baseline serum creatinine (Cr) between 1.5 and 2.0 mg/dl. 9 In the patient with renal insufficiency, we make every effort to prevent CIN, but it can be difficult to distinguish patients with borderline serum Cr from whose renal function can not be preserved. There are several new renal markers; that is, serum cystatin C and urinary human liver-type fatty acid-binding protein (L-FABP). Serum cystatin C is a cysteine protease inhibitor produced by nearly all human cells and excreted into the Circulation Journal Vol.72, September 2008 bloodstream. It has 120 amino acids with a molecular weight of 13 kDa. The protein is freely filtrated by the renal glomerulus and then metabolized by the proximal tubule, so it is an improved marker of the glomerular filtration rate (GFR) compared with the serum Cr level. 10,11 Urinary L-FABP is expressed in human proximal tubules and engaged in free fatty acid metabolism, and its excretion reflects stress on the proximal tubules. It has been reported that there is a significant correlation of urinary L-FABP with the extent of tubulointestinal damage. 12 The goals of present study were to (1) investigate whether or not the serum cystatin C level before cardiac catheterization is a more useful marker of CIN than the serum Cr level, and establish a cut-off level for the determination of CIN, and (2) examine the differences in the changes of the new markers, serum cystatin C and urinary L-FABP, compared with those of the classical markers, urinary 1 and 2 microglobulins (MGs), N-acetyl--D-glucosaminidase (NAG), and microalbumin (Alb) in patients who underwent elective CAG with and without developing CIN. MethodsThe study was performed from

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Section: Discussionmentioning

confidence: 99%

Valuable Markers for Contrast-Induced Nephropathy in Patients Undergoing Cardiac Catheterization

Katô

Sato

Yamamoto

et al. 2008

Circ J

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“…The mechanisms responsible for reduction in renal perfusion involve activation of the tubulo-glomerular feedback response and the release of endogenous vasoactive mediators such as endothelin and adenosine. A reduction in the intra-renal production of the vasodilators nitric oxide and prostacyclin may also contribute to the pathogenesis of CMN [24,38].…”

Section: Pathophysiologymentioning

confidence: 99%

Adverse reactions to iodinated contrast media

2001

Eur Radiol

223

126

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Adverse reactions to iodinated contrast media (ICM) are more likely to develop in patients with asthma, a history of allergy or contrast reaction and in those who are debilitated or medically unstable. These reactions can be divided into renal and general, and the latter are subdivided into acute and delayed. Acute general reactions can be minor, intermediate or severe. Fatal reactions are rare. The introduction of low-osmolality agents has caused an overall reduction in the number of non-fatal contrast reactions. Prompt recognition and treatment of acute adverse side effects to ICM is invaluable and may prevent a reaction from becoming severe. Familiarity with cardiopulmonary resuscitation is essential for successful management of life-threatening reactions. Contrast-media-induced renal impairment can be reduced with the use of low-osmolality contrast media and extracellular volume expansion. The use of ICM in diabetic patients receiving metformin should be carried out with care to avoid metformin-induced lactic acidosis. However, this problem is mainly observed in patients with diabetic nephropathy.

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“…They are characterized by the proximal epithelial cell's vacuolization, interstitial inflammation and increase of enzymuria after using this agent. These alterations disappear in a few days (9) .…”

Section: Discussionmentioning

confidence: 92%

“…Studies demonstrate that the hydration regime using saline isotonic solution and hypotonic serum (sodium chloride 0.45% plus glucose 5%) 12 hours before, and after the ICM use, is more effective that hydration with physiologic solution in 0.9% (1,(4)(5)(6)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) . Regarding medicines, some studies shown the use of acetylcysteine (antioxidant) associated to hydration as an attenuating therapy against acute renal failure in risk patients (21) .…”

Section: Preventionmentioning

confidence: 99%

Nefroproteção relacionada ao uso de meio de contraste iodado: atenção de enfermagem

Bianco

Araújo

2008

Acta paul. enferm.

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OBJETIVO: Analisar estudos publicados sobre Nefropatia induzida por contraste, sua prevenção e o papel do enfermeiro nesta ação, bem como, propor intervenções de enfermagem. MÉTODOS: Foi realizada revisão de literatura nas bases de dados MEDLINE, SciELO, LILACS, publicados de 1977 a 2007. RESULTADOS: Em âmbito nacional não encontramos estudos quando associamos aos descritores nefroproteção e meio de contraste iodado a palavra enfermagem. Identificamos que na prática clínica o procedimento de hidratação antes do uso de meio de contraste é o mais utilizado. CONCLUSÃO: Sabendo-se que os meios de contraste podem gerar diferentes tipos de reações adversas nos pacientes, torna-se importante o enfermeiro estar habilitado cientificamente, para reconhecer estas injúrias e, assim, implementar intervenções pertinentes, eficazes e que minimizem as complicações.

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Advances in the Understanding of the Nephrotoxicity of Radiocontrast Media

Cited by 18 publications

References 40 publications

Valuable Markers for Contrast-Induced Nephropathy in Patients Undergoing Cardiac Catheterization

Valuable Markers for Contrast-Induced Nephropathy in Patients Undergoing Cardiac Catheterization

Adverse reactions to iodinated contrast media

Nefroproteção relacionada ao uso de meio de contraste iodado: atenção de enfermagem

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