Hydrierung zur Prävention der Kontrastmittel-induzierten Nephropathie: Ein Update

Abstract

Contrast medium-induced nephropathy (CIN) continues to be one of the most common causes of hospital-acquired acute renal failure. Since most of the clinical studies on the prophylactic use of different drugs to prevent CIN produced disappointing results, hydration remains the mainstay of prophylaxis. A number of recent prospective randomized trials provided further evidence of the effectiveness of hydration and relevant information regarding the optimization of hydration protocols. It was shown that a bolus hydration solely during examination is not sufficient to prevent CIN. In addition, isotonic 0.9 % saline was superior to the commonly used half-isotonic 0.45 % saline in another trial. An outpatient hydration protocol including oral hydration before the examination followed by forced intravenous hydration over 6 hrs. beginning 30 to 60 min. prior to examination seems to be comparable to the usual hydration over 24 hrs. Another hydration protocol, which could also be very attractive especially for outpatients, included the infusion of sodium bicarbonate. In a recent trial, hydration with sodium bicarbonate, given as a bolus for 1 hr. prior to examination followed by an infusion for 6 hrs. after examination, was more effective than hydration with sodium chloride for the prophylaxis of CIN. However, there is still a lack of large-scale, multi-center trials comparing different hydration protocols and investigating their influence on clinically relevant endpoints such as mortality or the need for dialysis.

No Increased Risk for Contrast-Induced Nephropathy after Multiple CT Perfusion Studies of the Brain with a Nonionic, Dimeric, Iso-Osmolal Contrast Medium

“…5 Mechanisms responsible for the reduction in renal perfusion involve vascular and tubular effects (eg, increase in intratubular pressure and tubular obstruction). 9 Characteristics of CM, such as osmolality 10,11 or chemical composition, 12 might influence the risk for CIN. The route of administration may also contribute to the pathogenesis of CIN.…”

Transvenous Renal Transplant Biopsy via a Transfemoral Approach

“…An alternative to the administration of iodinated contrast agents could be the use of carbon dioxide (CO 2 ) as a non-nephrotoxic contrast agent in patients with kidney transplants (45), but we did not consider CO 2 angiography due to a number of disadvantages (poor image quality, delivery system, safety issues) in accordance with the recommendations of the CIN Consensus Working Panel (46). Generally, guidelines for the prevention of CIN should be followed in all patients undergoing TFRTB to minimize the risk of further transplant failure (47,48).…”

Ormond’s Disease or Secondary Retroperitoneal Fibrosis? An Overview of Retroperitoneal Fibrosis

“…In up to 15 % of cases calcifications inside the retroperitoneal fibrosis can be identified [11]. Iodinated contrast media should be given under consideration of the contraindications [36]. The fibrous tissue enhances to a variable degree, depending on the stage of the disease.…”