Pathophysiology of Contrast-Induced Acute Kidney Injury (CIAKI)

Abstract

: Contrast-induced acute kidney injury (CIAKI) is a severe complication associated with the use of iodinated contrast media (CM); a sudden but potentially reversible fall in glomerular filtration rate (GFR) typically occurring 48-72 hours after CM administration. Principal risk factors related with the presentation of CIAKI are preexisting chronic kidney disease and diabetes mellitus. Studies on CIAKI present considerable complexity because of differences in CM type and dose, controversies in definition and baseline comorbidities. Despite that, it should be noted that CIAKI poses a serious health problem because it is a very common cause of hospitalacquired AKI, linked to increased morbidity and mortality and utilizing growing healthcare resources. The pathogenesis of CIAKI is heterogeneous and, thus, is incompletely understood. Three basic mechanisms appear to simultaneously occur for CIAKI development: Renal vasoconstriction and medullary hypoxia, tubular cell toxicity and reactive oxygen species formation. The relative contribution of each one of these mechanisms is unknown but they ultimately lead to epithelial and endothelial cell apoptosis and GFR reduction. Further research is needed in order to better clarify CIAKI pathophysiology and accordingly introduce effective preventive and therapeutic strategies.

Effect of statins on post-contrast acute kidney injury: a multicenter retrospective observational study

“…The pathophysiology of PC-AKI is not exactly understood, and several studies trying to fill gaps in knowledge are underway [ 16 – 19 ]. Three basic mechanisms have been proposed that act together on PC-AKI: reactive oxygen species formation, tubular cell toxicity, and medullary hypoxia with renal vasoconstriction [ 16 , 17 , 20 , 21 ]. Statins, known for their lipid-lowering effects, also have other non-lipid modifiable effects, named pleiotropic effects [ 22 ], of which the most important effects are reducing oxidative stress [ 23 – 26 ] and anti-inflammatory [ 27 ].…”

A novel risk assessment model of contrast‐induced nephropathy after percutaneous coronary intervention in patients with diabetes

“…Contrast agent, one of the most commonly used drugs in interventional radiology, is mainly used for visualizing blood flow and body cavities 1 . Contrast‐induced acute injury is one of the main causes of acute renal failure during hospitalization, and it is a serious complication of coronary angiography (CAG) and percutaneous coronary intervention (PCI) 2 . Contrast‐induced nephropathy (CIN) is a serious complication during the procedure of CAG and PCI 3,4 .…”

Proposta de Protocolo para Redução dos Riscos e Otimização da Sensibilidade nos Exames de Imagem em Pessoas com Diabetes

“…Estas alterações culminam em apoptose celular endotelial e epitelial e diminuição da TFG. 18 Na Tabela 2 encontram-se os fatores de risco para ocorrência de LRA pós-contraste. 13,17 É considerado contraste intra-arterial com primeira passagem renal aquele que chega às artérias renais relativamente não diluido (administração de contraste no coração esquerdo, aorta torácica e supra-renal ou artérias renais), e contraste intra-arterial com segunda passagem renal o contraste que chega às artérias renais após diluição na circulação periférica e pulmonar (administração contraste no coração direito, artérias pulmonares, carótidas, subclávias, Tabela 1 -Gestão da metformina de acordo com os níveis de TFGe coronárias, mesentéricas ou infra-renais).…”