Abstract
Contrast-induced acute kidney injury (CI-AKI) is the third most common hospital-acquired AKI after AKI induced by renal perfusion insufficiency and nephrotoxic drugs, taking great adverse effects on the prognosis and increasing hospital stay and medical cost. Diabetes nephropathy (DN) is a common chronic complication of DM (diabetes mellitus), and DN is an independent risk factor for chronic kidney disease (CKD) and CI-AKI. The incidence of CI-AKI significantly increases in patients with renal injury, especially in DM-related nephropathy. The etiology of CI-AKI is not fully clear, and research studies on how DM becomes a facilitated factor of CI-AKI are limited. This review describes the mechanism from three aspects. ① Pathophysiological changes of CI-AKI in kidney under high-glucose status (HGS). HGS can enhance the oxidative stress and increase ROS which next causes stronger vessel constriction and insufficient oxygen supply in kidney via vasoactive substances. HGS also aggravates some ion pump load and the latter increases oxygen consumption. CI-AKI and HGS are mutually causal, making the kidney function continue to decline. ② Immunological changes of DM promoting CI-AKI. Some innate immune cells and pattern recognition receptors (PRRs) in DM and/or DN may respond to some damage-associated molecular patterns (DAMPs) formed by CI-AKI. These effects overlap with some pathophysiological changes in hyperglycemia. ③ Signaling pathways related to both CI-AKI and DM. These pathways involved in CI-AKI are closely associated with apoptosis, inflammation, and ROS production, and some studies suggest that these pathways may be potential targets for alleviating CI-AKI. In conclusion, the pathogenesis of CI-AKI and the mechanism of DM as a predisposing factor for CI-AKI, especially signaling pathways, need further investigation to provide new clinical approaches to prevent and treat CI-AKI.
Highlights
Radiology and its extensive techniques play increasingly significant role in the diagnosis and treatment of many diseases, which makes the administration of iodine contrast media become very common. e terminology of acute kidney injury (AKI) caused by iodine contrast media had changed several times in these years
3 Signaling pathways related to both CI-AKI and diabetes mellitus (DM). ese pathways involved in CI-AKI are closely associated with apoptosis, inflammation, and reactive oxygen species (ROS) production, and some studies suggest that these pathways may be potential targets for alleviating CI-AKI
We can see that some innate immune cells and pattern recognition receptors (PRRs) in DM and/or diabetes nephropathy (DN) may respond to some damage-associated molecular patterns (DAMPs) formed by CI-AKI, secrete cytokines, and aggravate or inhibit inflammation. ese effects overlap with some pathophysiological changes in hyperglycemia, providing new research ideas in DM that promotes CI-AKI and the related mechanisms (Figure 3)
Summary
Contrast-induced acute kidney injury (CI-AKI) is the third most common hospital-acquired AKI after AKI induced by renal perfusion insufficiency and nephrotoxic drugs, taking great adverse effects on the prognosis and increasing hospital stay and medical cost. E incidence of CI-AKI significantly increases in patients with renal injury, especially in DM-related nephropathy. 1 Pathophysiological changes of CI-AKI in kidney under high-glucose status (HGS). HGS can enhance the oxidative stress and increase ROS which causes stronger vessel constriction and insufficient oxygen supply in kidney via vasoactive substances. Ese pathways involved in CI-AKI are closely associated with apoptosis, inflammation, and ROS production, and some studies suggest that these pathways may be potential targets for alleviating CI-AKI. The pathogenesis of CI-AKI and the mechanism of DM as a predisposing factor for CI-AKI, especially signaling pathways, need further investigation to provide new clinical approaches to prevent and treat CI-AKI
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