Nephrotoxicity Related to Contrast Media

Abstract

The numbers of contrast media (CM)-enhanced examinations are increasing. The annual sale of iodine for CM now represents 60 million CM doses a year world-wide. In spite of improvements in chemical structure, CM are still the third leading cause of hospital-acquired acute renal failure. The definition of contrast nephropathy (CN) is discussed, as well as the mechanisms involved in the pathogenesis. Low osmolar contrast media (LOCM) are less nephrotoxic than high osomolar contrast media (HOCM) and cause fewer osmotoxic side-effects such as pain and heat sensations. The non-ionic dimeric contrast media which are iso-osmolar to plasma (IOCM) cause even fewer haemodynamic side-effects and result in better opacification of the urinary tract than LOCM. The nephrotoxicity of IOCM is low. The risk factors for CN and methods for prevention of CN are discussed.

Comparison of Iodixanol and Iohexol in Patients Undergoing Intravenous Pyelography: A Prospective Controlled Study

“…In spite of the improvements in the chemical structure of contrast media, CN is still the third leading cause of hospital-acquired acute renal failure. [5] Both pre-existing renal insufficiency and diabetes mellitus have been demonstrated to significantly increase the risk of CN (so-called high-risk patients). [6,7] During the past decade, nonionic (low-osmolality) CM have become increasingly popular for radiographic procedures requiring intravascular contrast because they are associated with a decreased incidence of systemic and organ toxicity compared to conventional ionic (high-osmolarity, iothalamate meglumine injection USP 60%) contrast media.…”

“…[1][2][3][4][5] Routine IVP was performed in nephrology and urology. [3,4] However, the use of iodinated contrast medium (CM) resulting in CN may not be entirely avoidable.…”

Prevenção de nefrotoxicidade por contraste com solução de bicarbonato: resultados preliminares e revisão da literatura

“…The use of theophylline or aminophylline has been assessed in nine clinical trials, and the results were conflicting. [41][42][43][44] Other vasodilating drugs that showed no benefit as compared with placebo in preventing CN were the atrial natriuretic peptide, 45 endothelin antagonists, 46 prostaglandin E 1 , 47 ACE inhibitors 2,48 , and L-arginine. 49 In reality, endothelin antagonists not only did not benefit but also increased the risk of CN for users.…”

“…That theory is supported by the reduction in those adverse effects with the use of a low-osmolality contrast medium. 2,12 Another possible mechanism could be the direct action of increased osmolality on blood vessel musculature, causing vasoconstriction, an apparently calciummediated phenomenon. That fact is supported by the decrease in vasoconstriction observed with the use of calcium channel blockers in patients receiving iodinated contrast medium.…”

“…In the United States, they are used in more than 10 million procedures annually, which obviously increase the likelihood of developing contrast-induced nephropathy (CN). [1][2] That entity is the third cause of acute kidney injury acquired at hospitals in the United States, with a prevalence of approximately 11%. 3 Rihal et al have found a prevalence of acute kidney injury after coronary angiography of 3.3%, showing that patients with chronic kidney disease are at higher risk for developing that condition, and that contrast nephropathy increases the risk of in-hospital and late deaths in those patients.…”