Asif Arif, Epstein David L, Epstein Murray
Department of Medicine, Divison of Nephrology, University of Miami School of Medicine, 1600 NW 10th Avenue, Miami, FL 33136, USA.
J Clin Pharmacol. 2004 Dec;44(12):1342-51. doi: 10.1177/0091270004269842.
Radiocontrast-induced nephropathy remains the third leading cause of hospital-acquired acute renal failure. Once established, this syndrome is associated with increased morbidity and mortality as well as increased health care costs. Recently, studies have been initiated to evaluate the potential of a selective dopamine-1 receptor agonist (fenoldopam) in ameliorating radiocontrast-induced renal failure. Selective dopamine-1 receptor agonists exhibit many desirable renal effects that support their use for the prophylaxis of radiocontrast-induced nephropathy, including decreases in renal vascular resistance and increases in renal blood flow, glomerular filtration, and sodium and water excretion. Several reports have documented a beneficial effect of fenoldopam administration in attenuating radiocontrast-induced nephropathy. In contrast, a recent multicenter, randomized study did not demonstrate a renoprotective effect of fenoldopam against radiocontrast-induced nephropathy. The presence of multiple confounders, however, precludes a definitive conclusion regarding the ability of fenoldopam to protect against radiocontrast-induced nephropathy. Additional studies are needed to properly evaluate the role of fenoldopam in radiocontrast-induced nephropathy prophylaxis.
造影剂诱发的肾病仍然是医院获得性急性肾衰竭的第三大主要原因。一旦发生，这种综合征会导致发病率和死亡率上升，同时医疗费用也会增加。最近，人们开始研究选择性多巴胺-1受体激动剂（非诺多泮）在改善造影剂诱发的肾衰竭方面的潜力。选择性多巴胺-1受体激动剂具有许多理想的肾脏效应，这支持了它们用于预防造影剂诱发的肾病，包括降低肾血管阻力、增加肾血流量、肾小球滤过率以及钠和水的排泄。几份报告记录了使用非诺多泮在减轻造影剂诱发的肾病方面的有益作用。相比之下，最近一项多中心随机研究并未证明非诺多泮对造影剂诱发的肾病具有肾脏保护作用。然而，存在多个混杂因素，这使得无法就非诺多泮预防造影剂诱发的肾病的能力得出明确结论。需要进行更多研究来正确评估非诺多泮在预防造影剂诱发的肾病中的作用。
