Kontrastmittelnephropathie

Under a contrast-induced nephropathy is defined as the deterioration of renal function after intravenous administration of x-ray contrast agents. This is temporary, as a rule. The diagnosis is based on a progressive increase in serum creatinine within 24-48 hours after contrast administration. Treatment is supportive. A fluid resuscitation with isotonic saline before and after administration of the contrast agent can contribute to prevention.

A contrast medium-induced nephropathy is an acute tubular necrosis caused by an iodinated X-ray contrast agents, all of which are nephrotoxic. However, the risk is lower with the newer contrast agents that are nonionic and have a lower osmolality than the older drugs, their osmolality is / kg at about 1400-1800 mOsm. For example niedrigosmolare substances of the second generation (z. B. iohexol, iopamidol, ioxaglate) have an osmolality of about 500-850 mOsm / kg, which is still higher than the Blutosmolalität. Iodixanol, the first of the even newer isoosmolalen Siubstanzen, has an osmolality of 290 mOsm / kg, about equal to that of blood.

Under a contrast-induced nephropathy is defined as the deterioration of renal function after intravenous administration of x-ray contrast agents. This is temporary, as a rule. The diagnosis is based on a progressive increase in serum creatinine within 24-48 hours after contrast administration. Treatment is supportive. A fluid resuscitation with isotonic saline before and after administration of the contrast agent can contribute to prevention. A contrast medium-induced nephropathy is an acute tubular necrosis caused by an iodinated X-ray contrast agents, all of which are nephrotoxic. However, the risk is lower with the newer contrast agents that are nonionic and have a lower osmolality than the older drugs, their osmolality is / kg at about 1400-1800 mOsm. For example niedrigosmolare substances of the second generation (z. B. iohexol, iopamidol, ioxaglate) have an osmolality of about 500-850 mOsm / kg, which is still higher than the Blutosmolalität. Iodixanol, the first of the even newer isoosmolalen Siubstanzen, has an osmolality of 290 mOsm / kg, about equal to that of blood. The exact mechanism of toxicity of X-ray contrast agents is unknown. But it is believed that a relationship between renal vasoconstriction and direct cytotoxic effects there, possibly by formation of reactive O2 groups that cause acute tubular necrosis. Most patients have no symptoms. Renal function normalizes usually return. Risk factors of Kontrastmittelnephropathie risk factors for nephrotoxicity are the following: Older age already existing chronic kidney disease diabetes heart failure Multiple myeloma High doses (eg> 100 ml.) Of a hyperosmolar contrast medium (for example, during percutaneous coronary intervention.) Also, factors affecting the reduce renal perfusion, such as lack of volume or co-administration of NSAIDs, diuretics or ACE inhibitors increase the risk. Co-administration of nephrotoxic drugs (eg. As aminoglycosides) liver failure diagnosis serum creatinine measurement, the diagnosis is based on a progressive increase in serum creatinine within 24-48 h after contrast administration. After a transfemoral artery catheterization can be difficult to distinguish a contrast-induced nephropathy by renal artery embolism. Among the factors that point to a renal artery embolism, can include the following: Delayed onset of elevated creatinine> 48 h after treatment presence of other atheroembolic findings (eg livedo reticularis of the lower limbs or bluish discoloration of the toes.) Prevailing poor kidney function may deteriorate gradually Transient eosinophilia or Eosinophilurie and low-C3 complement levels (measured when Atheroembolien be seriously considered) therapy supportive treatment therapy is supportive. Prevention The prevention of Kontrastnephropathie involves possible, avoiding x-ray contrast agents (eg. As no CT to diagnose appendicitis), and when X-ray contrast media are needed in patients at high risk of a non-ionic substance with the lowest osmolality in low doses should be used become. When an X-ray contrast agent is used, is a weak volume expansion with an isotonic saline solution (i. E. 154 mEq / l) is ideal. It is given 1 ml / kg / h starting 6-12 h before the X-ray contrast agent is administered for 6-12 h and continued after the procedure. A sodium bicarbonate (NaHCO3) – solution can also be infused, but has no proven advantage over normal saline. The volume administration may be particularly effective in patients with low pre-existing kidney disease and low-dose contrast agents. In heart failure, fluid resuscitation should be avoided. Before and after the investigation nephrotoxic drugs should be avoided. Acetylcysteine, an antioxidant is sometimes given to patients at high risk, but has no proven benefit. The protocols are different; but acetylcysteine ??600 mg p.o. 2 times a day on the day before and the day of the examination, can be given in conjunction with a saline infusion. The continuous venous hemofiltration has no proven need benefit compared with other less invasive procedures in the prevention of acute kidney injury in patients suffering from chronic kidney disease, and high doses of contrast media, and is also impractical. Therefore, this method is not recommended. Patients undergoing regular hemodialysis at a stage renal disease and require an X-ray contrast agent, usually need no additional prophylactic hemodialysis after the procedure, unless they have a significant residual renal function (eg. As produce> 100 ml / day urine ). Conclusion Although most patients recover after use of iodinated contrast media without clinical consequences, all these funds but nephrotoxic. A contrast-induced nephropathy should be suspected if the serum creatinine 24-48 h increased by a contrast method. The risk of contrast medium-induced nephropathy is to be reduced by low application and small amounts of the X-ray contrast agent and by extension of the volume in particular in patients at risk.

Health Life Media Team

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