Contrast-induced nephropathy (CIN)
Journal Title: Postępy Nauk Medycznych - Year 2010, Vol 23, Issue 12
Abstract
The rapid development of percutaneuos coronarography and vascular interventional technologies has led to a dramatic increase in the number of patients receiving contrast media with which might lead to acute kidney injury (AKI). Contrast-induced nephropathy (CIN) is the third leading cause of acute kidney injury (AKI) in hospitalized patients. CIN is defined as an increase in serum creatinine by either > 0,5 mg/dl (>44 umol/l) or by 25% from baseline within 48 hours where contrast administration, after other causes of renal impairment had been excluded. Contrast-induced nephropathy is associated with significantly increased morbidity and moratlity , extentended length of hospital stay and increased costs. A risk score for prediction of CIN includes: hypotension, congestive heart failure, older age, diabetes mellitus, contrast media volume, chronic kidney disease, anemia. Contrast media can be differentiated according to their physicochemical characteristic as follows: iodine content, osmolatlity (hyper-, low- and iso-osmolal), level of ionization (ionic, non-ionic), degree of polymerization (monomeric, dimeric). There are two main causes of CIN: the direct toxic effect of contrast media on the kidney tubules and the tissue hypoxia of the renal medulla, secondary to the hemodynamic effects (vasoconstrictor effects are not balanced by effective vasodilatatory reserve). Estimation of glomerular renal function requires calculation of the glomerular filtration rate (GFR) and cannot be based on serum creatinine levels. Cystatin C is an alternative marker for the early diagnosis and prognosis of contrast-inducted nephropathy. According to the current guidelines the hydratation with isotonic saline and N-acetylcysteine (NAC) or 8.4% sodium bicarbonate is an effective and low-cost tool in preventing CIN in all high-risk patients. Use of low-osmolar contrast media (LOCM) or iso-osmolar contrast media is recommended in patients with mild, moderate or severe chronic kidney disease.
Authors and Affiliations
Dariusz Winek
Keywords
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