Massicotte Anne
Department of Pharmacy, The Ottawa Hospital, Ottawa, Ontario, Canada.
Pharmacotherapy. 2008 Sep;28(9):1140-50. doi: 10.1592/phco.28.9.1140.
Contrast medium-induced nephropathy (CIN) is the third leading cause of acute renal failure in hospitalized patients. The exact mechanism by which contrast media induce renal failure is complex and not completely understood. Alteration in renal hemodynamics and direct toxicity to tubular cells have been proposed. The most important risk factor for development of CIN is preexisting renal insufficiency. Identification of patients with risk factors for development of CIN is essential, as measures for prevention of CIN can be instituted. Administration of fluids such as sodium chloride has been the traditional cornerstone of preventive therapy. Alkalization of tubular fluid with intravenous sodium bicarbonate has dramatically reduced the frequency of CIN in patients with baseline impaired renal function. Based on available evidence, use of sodium bicarbonate constitutes the most reliable and effective option. Prevention of CIN has also been achieved with periprocedural use of N-acetylcysteine, but not as consistently as with sodium bicarbonate. Although many studies evaluated different N-acetylcysteine dosages and routes of administration, the optimal regimen has yet to be determined. Combinations of these preventive therapies are just emerging and require further research.
造影剂肾病（CIN）是住院患者急性肾衰竭的第三大主要原因。造影剂导致肾衰竭的确切机制复杂且尚未完全明确。肾血流动力学改变以及对肾小管细胞的直接毒性已被提出。发生CIN的最重要危险因素是预先存在的肾功能不全。识别有发生CIN危险因素的患者至关重要，因为可以采取预防CIN的措施。给予诸如氯化钠等液体一直是预防性治疗的传统基石。静脉注射碳酸氢钠使肾小管液碱化已显著降低了基线肾功能受损患者中CIN的发生率。基于现有证据，使用碳酸氢钠是最可靠且有效的选择。围手术期使用N - 乙酰半胱氨酸也实现了对CIN的预防，但不如使用碳酸氢钠那样始终有效。尽管许多研究评估了不同的N - 乙酰半胱氨酸剂量和给药途径，但最佳方案尚未确定。这些预防性治疗的联合应用刚刚出现，需要进一步研究。
