1998
DOI: 10.1259/bjr.71.844.9659127
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Contrast media-induced nephrotoxicity--questions and answers.

Abstract: The intravascular administration of contrast media (CM) can produce acute haemodynamic changes in the kidney characterized by an increase in renal vascular resistance and a decrease in the glomerular filtration rate (GFR). These changes may lead to clinically significant reduction in renal function in patients with pre-existing risk factors such as diabetic nephropathy, congestive heart failure and dehydration. The pathophysiology of the renal haemodynamic effects of CM involves activation of the tubuloglomeru… Show more

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Cited by 174 publications
(154 citation statements)
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“…This may result in marked shrinkage and rigidification of red blood cells obstructing microcirculation (49 -51) and vascular endothelial injuries resulting in thrombotic occlusions (52,53). A nonosmolality-dependent release of vasoconstrictors has also been postulated (1). A direct toxic effect on tubular cells might also be possible (54).…”
Section: Discussionmentioning
confidence: 99%
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“…This may result in marked shrinkage and rigidification of red blood cells obstructing microcirculation (49 -51) and vascular endothelial injuries resulting in thrombotic occlusions (52,53). A nonosmolality-dependent release of vasoconstrictors has also been postulated (1). A direct toxic effect on tubular cells might also be possible (54).…”
Section: Discussionmentioning
confidence: 99%
“…All hypertonic solutions significantly increased elimination half-life, increasing with the osmolality of the agents. Apart from the direct exposure of red blood cells, endothelial cells, and tubular cells to the hypertonic solutions injected into the renal artery, the CM also represent an osmotic load to the kidneys with secondary diuresis and natriuresis (1,55,56). Osmotic load may activate the tubuloglomerular feedback mechanism mediating vasoconstrictive agents, increase medullary oxygen demand for active reabsorption of the increased tubular sodium load resulting in hypoxic injuries, or increase intratubular pressure with elevation of interstitial pressure and secondary vascular compression beneath the rigid renal capsula.…”
Section: Discussionmentioning
confidence: 99%
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“…In the case of elective outpatients at risk for ICM-induced nephropathy, the test will be repeated at a date closer to the examination. Furthermore, we believe that another refresher course on the subject, scheduled for 2009 for both physicians and nurses in our area, may be more effective than sending out formal and informal reminders for them to fill in the patient history/ [27]). A tal proposito screening sheet completely (including GFR calculation).our population.…”
Section: Discussionementioning
confidence: 99%
“…This is particularly true in the elderly (renal function decreases "physiologically" by 1 ml/min per year after the age of 20-30 years [26]) and in subjects with vascular disease or undergoing treatment with nephrotoxic agents (such as chemotherapy). On the other hand, it is important to minimise the risk of renal impairment due to the imprudent use of contrast media (ICM-induced nephrotoxicity is reported to be the third leading cause of acute renal failure in a hospital setting [27]). For these reasons, we believe the protocol should necessarily involve the nephrologist for patients at risk.…”
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confidence: 99%