University of Texas Southwestern Medical Center, Dallas, TX, USA.
Pediatr Nephrol. 2010 Feb;25(2):191-204. doi: 10.1007/s00467-009-1204-z. Epub 2009 May 15.
Contrast-induced nephropathy (CIN) is the third most common cause of acute kidney injury in hospitalized patients. Diagnostic and interventional cardiovascular procedures generate nearly half the cases. Elderly patients and those with chronic kidney disease, diabetes, and cardiovascular disease are at greatest risk. Procedure-related risk factors include large volumes of contrast and agents with a high osmolality. Renal medullary ischemia arising from an imbalance of local vasoconstrictive and vasodilatory influences coupled with increased demand for oxygen-driven sodium transport may be the key to its pathogenesis. Contrast agents may also have a direct cytotoxic effect that operates through the generation of reactive oxygen species. Pre- and post-procedure administration of normal saline, isotonic sodium bicarbonate, N-acetylcysteine, and a variety of other pharmacologic agents have been used to prevent or mitigate CIN. While normal saline is generally accepted as protective against CIN, uncertainty still surrounds the role of sodium bicarbonate and N-acetylcysteine. Dialytic therapies before, during, and after exposure to contrast have been tested with mixed results. Logistical and economic disincentives argue against these modalities.
对比剂肾病（CIN）是住院患者急性肾损伤的第三大常见原因。诊断和介入心血管程序产生了近一半的病例。老年患者和患有慢性肾脏病、糖尿病和心血管疾病的患者风险最大。与程序相关的风险因素包括大量对比剂和高渗透压的药物。局部血管收缩和血管舒张影响之间的不平衡导致的肾髓质缺血，加上对氧驱动的钠转运的需求增加，可能是其发病机制的关键。对比剂也可能具有通过产生活性氧物质而起作用的直接细胞毒性作用。在程序前后施用生理盐水、等渗碳酸氢钠、N-乙酰半胱氨酸和各种其他药物已被用于预防或减轻 CIN。虽然生理盐水通常被认为可预防 CIN，但碳酸氢钠和 N-乙酰半胱氨酸的作用仍存在不确定性。在接触对比剂之前、期间和之后进行透析治疗的结果喜忧参半。后勤和经济上的不利因素反对使用这些方法。
