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Contrast agent--associated nephrotoxicity.

Carlo Briguori1, Davide Tavano, Antonio Colombo

  • 1Laboratory of Interventional Cardiology, Clinica Mediterranea, Naples, Italy. carlo.briguori@hsr.it

Progress in Cardiovascular Diseases
|June 12, 2003
PubMed
Summary
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Radiocontrast media can cause acute kidney injury, a common cause of hospital-acquired renal failure. Strategies to prevent contrast-induced nephrotoxicity include hydration and using low-osmolality contrast agents.

Area of Science:

  • Nephrology
  • Radiology
  • Pharmacology

Background:

  • Radiocontrast media can induce acute kidney injury (AKI), a significant cause of hospital-acquired AKI.
  • Contrast-induced nephrotoxicity accounts for 10% of hospital-acquired AKI, ranking third in causes of renal function deterioration.
  • In-hospital mortality for AKI correlates with serum creatinine increase, ranging from 3.8% to 64%.

Purpose of the Study:

  • To review the mechanisms of contrast-induced nephrotoxicity.
  • To discuss current and emerging strategies for preventing contrast-associated AKI.
  • To highlight the potential roles of acetylcysteine and fenoldopam in prophylaxis.

Main Methods:

  • Literature review of studies on contrast-induced nephrotoxicity.
  • Analysis of mechanisms including direct tubular toxicity, medullary ischemia, and altered renal hemodynamics.

Related Experiment Videos

  • Evaluation of current preventative recommendations and novel prophylactic agents.

    • Main Results:

    • Mechanisms involve direct renal tubular cell toxicity, medullary ischemia, and hemodynamic alterations.
    • Current prevention focuses on hydration, low-osmolality contrast, and dose limitation.
    • Emerging evidence suggests prophylactic acetylcysteine and fenoldopam may be beneficial.

    Conclusions:

    • Contrast-induced nephrotoxicity is a significant clinical concern with variable mortality.
    • Optimal prevention strategies are still under investigation.
    • Acetylcysteine and fenoldopam show promise for preventing contrast-associated AKI.