Nephrol Dial Transplant (1999) 14: 2830-2834
© 1999 European Renal Association-European Dialysis and Transplant Association
Invited Comment
A primer in radiocontrast-induced nephropathy
Klinik und Poliklinik für Innere Medizin II, Klinikum der Universität Regensburg, Regensburg, Germany
Correspondence and offprint requests to: Dr Bernhard K. Krämer, Klinik und Poliklinik für Innere Medizin II, Klinikum der Universität Regensburg, D-93042 Regensburg, Germany.
Despite recent medical progress in supportive medical therapy, the frequency of hospital-acquired acute renal failure has increased in recent years from ~5% to 6.4% [1,2]. Even more distressing is the fact that mortality associated with acute renal failure has remained high, i.e. on average ~60% in more recent reports [1–11]. Radiocontrast-induced nephropathy (RCIN) is the third most common cause of hospital-acquired acute renal failure. When RCIN is defined as an increase in serum creatinine level of at least 25% to at least 2 mg/dl within 2 days, most disturbingly RCIN continues to be associated with death by an odds ratio of 5.5 even when adjustments are made for comorbid factors, e.g. age, liver disease and physiological severity score [10]. It appears that renal failure increases the risk of death from pre-existing nonrenal conditions, but also that major nonrenal morbidity will
Incidence of radiocontrast-induced nephropathy
Available modalities for prevention and treatment of radiocontrast-induced nephropathy
Hydration
Diuretics
Calcium-channel blockers
Nonionic radiocontrast medium
Preventive haemodialysis
Experimental strategies for prevention or treatment of radiocontrast-medium-induced nephropathy
Atrial natriuretic peptide
Endothelin receptor blockers
Prostaglandins
Testing these strategies in clinical trials
Atrial natriuretic peptide
Endothelin receptor blockers
Prostaglandin PGE1
The magnitude of the problem
Acknowledgments
References
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