Title |
Update on the renal toxicity of iodinated contrast drugs used in clinical medicine
|
---|---|
Published in |
Drug, Healthcare and Patient Safety, May 2017
|
DOI | 10.2147/dhps.s122207 |
Pubmed ID | |
Authors |
Michele Andreucci, Teresa Faga, Raffaele Serra, Giovambattista De Sarro, Ashour Michael |
Abstract |
An important side effect of diagnostic contrast drugs is contrast-induced acute kidney injury (CI-AKI; a sudden decrease in renal function) occurring 48-72 hours after injection of a contrast drug that cannot be attributed to other causes. Its existence has recently been challenged, because of some retrospective studies in which the incidence of AKI was not different between subjects who received a contrast drug and those who did not, even using propensity score matching to prevent selection bias. For some authors, only patients with estimated glomerular filtration rate <30 mL/min/1.73 m(2) are at significant risk of CI-AKI. Most agree that when renal function is normal, there is no CI-AKI risk. Many experimental studies, however, are in favor of the existence of CI-AKI. Contrast drugs have been shown to cause the following changes: renal vasoconstriction, resulting in a rise in intrarenal resistance (decrease in renal blood flow and glomerular filtration rate and medullary hypoxia); epithelial vacuolization and dilatation and necrosis of proximal tubules; potentiation of angiotensin II effects, reducing nitric oxide (NO) and causing direct constriction of descending vasa recta, leading to formation of reactive oxygen species in isolated descending vasa recta of rats microperfused with a solution of iodixanol; increasing active sodium reabsorption in the thick ascending limbs of Henle's loop (increasing O2 demand and consequently medullary hypoxia); direct cytotoxic effects on endothelial and tubular epithelial cells (decrease in release of NO in vasa recta); and reducing cell survival, due to decreased activation of Akt and ERK1/2, kinases involved in cell survival/proliferation. Prevention is mainly based on extracellular volume expansion, statins, and N-acetylcysteine; conflicting results have been obtained with nebivolol, furosemide, calcium-channel blockers, theophylline, and hemodialysis. |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 100 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Student > Bachelor | 19 | 19% |
Researcher | 8 | 8% |
Student > Doctoral Student | 8 | 8% |
Student > Ph. D. Student | 7 | 7% |
Student > Master | 6 | 6% |
Other | 22 | 22% |
Unknown | 30 | 30% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 36 | 36% |
Biochemistry, Genetics and Molecular Biology | 8 | 8% |
Nursing and Health Professions | 6 | 6% |
Pharmacology, Toxicology and Pharmaceutical Science | 4 | 4% |
Agricultural and Biological Sciences | 2 | 2% |
Other | 13 | 13% |
Unknown | 31 | 31% |