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5/6th Nephrectomy in Combination with High Salt Diet and Nitric Oxide Synthase Inhibition to Induce Chronic Kidney Disease in the Lewis Rat
Published on: July 3, 2013
[Contrast induced nephropathy]
1Klinische Abteilung für Nephrologie und Dialyse, Medizinische Universitätsklinik III, Medizinische Universität Wien, Austria. walter.hoerl@meduniwien.ac.at
Wiener Klinische Wochenschrift
|March 6, 2009
Summary
Contrast media nephropathy is a serious risk for patients with chronic kidney disease and diabetes. Effective prophylaxis, including hydration and reduced contrast volume, is crucial for prevention.
Area of Science:
- Nephrology
- Radiology
- Pharmacology
Context:
- Contrast media induced nephropathy (CMN) is a common complication, especially in high-risk patients like those with chronic kidney disease (CKD) and diabetes.
- CMN is associated with increased in-hospital mortality and poor long-term prognosis.
- Risk factors and clinical course of CMN are understood, necessitating effective prophylactic strategies.
Purpose:
- To review and discuss the known prophylactic measures against contrast media induced nephropathy.
- To evaluate the efficacy of various interventions, including hydration, fluid composition, and pharmacological agents.
- To highlight the importance of reducing contrast media volume and administration route.
Summary:
- Hydration, particularly intravenous, is key to preventing CMN by reducing renovasoconstriction and tubulotoxic effects. Isotonic sodium bicarbonate may be more beneficial than saline.
- While N-acetylcysteine is widely used due to low cost and side effects, its efficacy is debated. Theophylline shows renoprotective effects, especially in ICU patients.
- Reducing contrast volume and considering iso-osmolar or low-osmolar agents are vital. Prophylactic hemodialysis/hemofiltration may benefit advanced CKD patients.
Impact:
- Effective prophylaxis can mitigate the risk of CMN, reducing mortality and improving long-term outcomes for at-risk patients.
- Understanding optimal hydration and fluid composition is essential for clinical practice guidelines.
- The increasing use of contrast media necessitates continued research into novel and effective prevention strategies for CMN.
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