The Pathophysiology and the Management of Radiocontrast-Induced Nephropathy.

Eunjung Cho,Gang-Jee Ko

doi:10.3390/diagnostics12010180

Eunjung Cho, Gang-Jee Ko

Open Access

https://doi.org/10.3390/diagnostics12010180

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Abstract

Contrast-induced nephropathy (CIN) is an impairment of renal function that occurs after the administration of an iodinated contrast medium (CM). Kidney dysfunction in CIN is considered transient and reversible in most cases. However, it is the third most common cause of hospital-acquired acute kidney injury and is associated with increased morbidity and mortality, especially in high-risk patients. Diagnostic and interventional procedures that require intravascular CM are being used with increasing frequency, especially among the elderly, who can be particularly susceptible to CIN due to multiple comorbidities. Therefore, identifying the exact mechanisms of CIN and its associated risk factors is crucial not only to provide optimal preventive management for at-risk patients, but also to increase the feasibility of diagnostic and interventional procedure that use CM. CM induces kidney injury by impairing renal hemodynamics and increasing the generation of reactive oxygen species, in addition to direct cytotoxicity. Periprocedural hydration is the most widely accepted preventive strategy to date. Here, we review the latest research results on the pathophysiology and management of CIN.

Highlights

Contrast-induced nephropathy (CIN) is an impairment of kidney function that occurs after the administration of iodinated contrast medium (CM)
Diagnostic and interventional procedures that require intravascular CM are being used with increasing frequency, especially among the elderly, who can be susceptible to CIN due to multiple comorbidities such as chronic kidney disease (CKD) and diabetes mellitus
A meta-analysis comparing the risk of CIN between iodixanol (IOCM) and iopromide (LOCM) in eight randomized controlled trials (RCTs) with 3532 patients undergoing coronary angiography (CAG) with or without percutaneous coronary intervention (PCI) found no significant difference in the incidence of CIN, but adverse cardiovascular events were significantly fewer in the iodixanol group than the iopromide group [41]

Summary

Introduction

Contrast-induced nephropathy (CIN) is an impairment of kidney function that occurs after the administration of iodinated contrast medium (CM). We used combinations of the following search terms: contrast, iodinated contrast media, nephropathy, risk, score, incidence, guideline, definition, intravenous, intra-arterial, biomarker, chronic kidney disease, diabetes, metformin, angiotensin, pathophysiology, oxidative stress, Rho, ROCK, sirtuin, SIRT1, Nrf, NLRP3 inflammasome, prevention, hydration, RenalGuard system, sodium bicarbonate, N-acetylcysteine, and statin. Both in vivo and in vitro experimental studies and clinical studies were reviewed

Terminology and Definition

Risk Factors

Pathophysiology

Management

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