Contrast-induced nephropathy

Abstract

Radiological procedures utilizing intravascular iodinated contrast media are being widely applied for both diagnostic and therapeutic purposes and represent one of the main causes of contrast-induced nephropathy (CIN) and hospital-acquired renal failure. Although the risk of CIN is low (0.6-2.3 %) in the general population, it may be very high (up to 50 %) in selected subsets, especially in patients with major risk factors such as advanced chronic kidney disease and diabetes mellitus, and in those undergoing emergency percutaneous coronary interventions (PCI). Due to the lack of any effective treatment, prevention of this iatrogenic disease, which is associated with significant in-hospital and long-term morbidity and mortality and increased costs, is the key strategy. However, prevention of CIN continues to elude clinicians and is a main concern during PCI, as patients undergoing these procedures often have multiple comorbidities. The purpose of this study is to examine the pathophysiology, risk factors and clinical course of CIN, as well as the most recent studies dealing with its prevention and potential therapeutic interventions, especially during PCI.

Acute kidney injury in patients with myocardial infarction undergoing percutaneous coronary intervention using radial versus femoral access

“…ST-elevation MI, which also predicts AKI, was less common in the RA group. Patients with ST-elevation MI present more frequently with hemodynamic impairment (heart failure in 11.2% in ST-elevation MI patients compared to 2.1% in non-ST-elevation MI patients; p < 0.0001), which may explain the higher rate of AKI in the FA group [19, 20, 22]. Heart failure, which predisposes to AKI, was less frequent in the RA group [23].…”

Influence of minor deterioration of renal function after PCI on outcome in patients with ST‐elevation myocardial infarction

“…Our finding has some potential clinical implications. We speculate that early nephroprotective strategies for contrast‐induced renal injury, such as low volume of contrast, crystalloid infusions, radial approach to prevent bleeding and other complications, measures for optimal hemodynamics, and discontinuation of nephrotoxic drugs, might provide a significant long‐term benefit . The possibility of early identification of the patients who will probably develop DRF is clinically important.…”

“…They are at especially high risk, not only of contrast‐induced acute renal injury, but also of minor renal injury . Acute deterioration of renal function in MI patients is multifactorial . The most important reasons are considered to be the volume of contrast used during PCI and the pre‐procedural renal function .…”

Limb ischemic preconditioning protects against contrast-induced acute kidney injury in rats via phosphorylation of GSK-3β

“…To date, the only generally accepted prophylactic approach for CI-AKI is peri-procedural intravenous hydration, although this method is often logistically challenging in patients who require emergency angiography and angioplasty, and in those with severe renal and/or cardiac dysfunction [6]. There is, therefore, a clear clinical need for novel prevention and treatment strategies that can decrease the incidence of CI-AKI following angiography and other procedures that require Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/freeradbiomed CM.…”