Contrast-induced nephropathy: Pathogenesis and prevention

Robert E. Cronin

Research output: Contribution to journalReview article

38 Scopus citations

Abstract

Contrast-induced nephropathy (CIN) is the third most common cause of acute kidney injury in hospitalized patients. Diagnostic and interventional cardiovascular procedures generate nearly half the cases. Elderly patients and those with chronic kidney disease, diabetes, and cardiovascular disease are at greatest risk. Procedure-related risk factors include large volumes of contrast and agents with a high osmolality. Renal medullary ischemia arising from an imbalance of local vasoconstrictive and vasodilatory influences coupled with increased demand for oxygen-driven sodium transport may be the key to its pathogenesis. Contrast agents may also have a direct cytotoxic effect that operates through the generation of reactive oxygen species. Pre- and post-procedure administration of normal saline, isotonic sodium bicarbonate, N-acetylcysteine, and a variety of other pharmacologic agents have been used to prevent or mitigate CIN. While normal saline is generally accepted as protective against CIN, uncertainty still surrounds the role of sodium bicarbonate and N-acetylcysteine. Dialytic therapies before, during, and after exposure to contrast have been tested with mixed results. Logistical and economic disincentives argue against these modalities.

Original languageEnglish (US)
Pages (from-to)191-204
Number of pages14
JournalPediatric Nephrology
Volume25
Issue number2
DOIs
StatePublished - Feb 1 2010

Keywords

  • Contrast media
  • Hemofiltration
  • Kidney
  • Pathogenesis
  • Prevention

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Nephrology

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