Meschi Michele, Detrenis Simona, Savazzi Giorgio
Dipartimento di Clinica Medica, Nefrologia e Scienze della Prevenzione, Azienda Ospedaliero-Universitaria, Parma.
Recenti Prog Med. 2008 Mar;99(3):155-62.
Contrast-induced nephropathy is an impairment in renal function following intravascular exposure to radiographic contrast media (CM). Kidney damage may be limited to an asymptomatic increase in serum creatinine or reveal itself as acute renal failure, which can require renal replacement therapy. The aim of the present review is to describe the most recent knowledge concerning this matter. Viscosity and/or osmolality of iodinated CM might be involved in the activation of intrarenal vasoconstriction, with a subsequent decrease in glomerular filtration rate. Reduced bioavailability of physiological vasodilators, such as prostaglandins and nitric oxide, could predispose to acute renal damage. The volemic expansion and hydration of the patient, by the peri-procedural infusion of saline solutions constitutes even today the most effective prophylactic mechanism. It is probable, in fact, that in this way the dilution of CM and the inhibition of the activation of intrarenal vasoconstrictive mechanisms are obtained.
对比剂肾病是血管内接触放射造影剂（CM）后出现的肾功能损害。肾脏损伤可能仅限于血清肌酐无症状升高，也可能表现为急性肾衰竭，后者可能需要肾脏替代治疗。本综述的目的是描述关于这一问题的最新知识。碘化CM的粘度和/或渗透压可能参与肾内血管收缩的激活，随后肾小球滤过率降低。生理血管扩张剂如前列腺素和一氧化氮的生物利用度降低可能易导致急性肾损伤。即使在今天，通过围手术期输注盐溶液使患者血容量扩充和水化仍是最有效的预防机制。事实上，通过这种方式可能实现CM的稀释以及肾内血管收缩机制激活的抑制。
