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Contrast-induced nephropathy.

Pontus B Persson1

  • 1Institute of Physiology, Humboldt University, Medizinische Fakultät (Charité), Tucholskystrasse 2,10117 Berlin, Germany. pontus.persson@charite.de

European Radiology
|February 16, 2006
PubMed
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Contrast medium-induced nephropathy (CIN) is a major cause of kidney failure. High-viscosity contrast media may increase kidney damage by altering renal blood flow and causing direct cellular injury.

Area of Science:

  • Nephrology
  • Radiology
  • Biochemistry

Background:

  • Contrast medium-induced nephropathy (CIN) is a significant cause of acute kidney injury.
  • The precise mechanisms underlying CIN remain incompletely understood.
  • Physicochemical properties of contrast media (CM), beyond osmolality, may influence renal outcomes.

Purpose of the Study:

  • To review clinical trial evidence regarding CIN.
  • To outline proposed mechanisms contributing to CIN.
  • To discuss the role of contrast media properties in renal function.

Main Methods:

  • Review of existing clinical trials on CIN.
  • Analysis of physicochemical properties of various contrast media (CM).
  • Examination of pathophysiological mechanisms implicated in CIN.

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Main Results:

  • Iso-osmolar CM, often dimers, possess higher viscosity than plasma.
  • Evidence suggests iso-osmolar CM may cause greater renal function perturbation than nonionic low-osmolar CM.
  • Conflicting clinical trial data exist regarding the safety of iso-osmolar CM.

Conclusions:

  • Altered rheology, renal hemodynamic changes, hypoxia, paracrine factors, and cytotoxicity contribute to CIN.
  • High-viscosity iso-osmolar CM may be particularly detrimental to renal tubules.
  • The use of CM, especially viscous iso-osmolar types, can negatively impact kidney function.