Prevention of Contrast-Induced Nephropathy through a Knowledge of Its Pathogenesis and Risk Factors

Abstract

Contrast-induced nephropathy (CIN) is an iatrogenic acute renal failure (ARF) occurring after the intravascular injection of iodinated radiographic contrast media. During the past several years, in many patients undergoing computed tomography, iodinated contrast media have not been used for the fear of ARF, thereby compromising the diagnostic procedure. But recent studies have demonstrated that CIN is rarely occurring in patients with normal renal function and that preexisting chronic renal failure and/or diabetes mellitus represent(s) predisposing condition(s) for its occurrence. After the description of CIN and its epidemiology and pathophysiology, underlying the important role played by dehydration and salt depletion, precautions for prevention of CIN are listed, suggested, and discussed. Maximum priority has to be given to adequate hydration and volume expansion prior to radiographic procedures. Other important precautions include the need for monitoring renal function before, during, and after contrast media injection, discontinuation of potentially nephrotoxic drugs, use of either iodixanol or iopamidol at the lowest dosage possible, and administration of antioxidants. A long list of references is provided that will enable readers a deep evaluation of the topic.

Contrast-induced acute kidney injury after primary percutaneous coronary interventions: Prevalence, predictive factors, and outcomes

“…В наблюдательных исследованиях продемонстри-ровано, что в популяции госпитализированных пациен-тов развитие ИКВ-ОПП ассоциируется с более продол-жительным пребыванием в стационаре и большей часто-той повторных госпитализаций по поводу ССЗ, прогрес-сированием ХБП, повышением риска смерти от ССЗ и других причин [25][26][27]. Результаты крупных исследова-ний в области ИКВ-ОПП подтверждают его неблагопри-ятное прогностическое значение [28][29][30][31].…”

Histopathological Evaluation of Contrast-Induced Acute Kidney Injury Rodent Models

“…Direct tubular toxicity of RCM is considered to participate in the pathomechanism of CI-AKI [5, 14, 156]. However, most of the direct toxicity data are based on in vitro studies, reporting about reduced cell viability in animal [157–162] or human cell cultures [33, 163].…”

“…Although contrast enhanced X-ray is the most common indication of RCM use (Figure 1), percutaneous coronary angiography (in the USA: 1.4–1.3 million/year between 1997 and 2010 [12]) is the primary cause of CI-AKI [4, 5]. Although hydration is considered to be the most effective preventive measure [13, 14], CI-AKI may develop in 3–25% of patients despite appropriate hydration [15] and further preventive measures such as antioxidants [2, 16] or statins [4, 17]. However, the affected patient population is much larger considering subclinical cases [9].…”

Intra-Arterial versus Intravenous Contrast and Renal Injury in Chronic Kidney Disease: A Propensity-Matched Analysis

“…We created a propensity score of having a CoA vs. CCT, and another of having CoA vs. NCCT using the following variables: age, sex, African American race, CKD stage, diabetes, statin, ACEI/ARB, diuretic, hypertension, malignancy, hemoglobin, and heart failure (HF). These variables have been previously reported to be associated with the development of AKI following contrast material administration [6]. Hemoglobin was missing in 9% of patients and we used mean value imputation along with a missing indicator.…”