Guastoni Carlo, De Servi Stefano, Covella Patrizia, Turri Corrado, Gidaro Barbaro, Bellotti Nicoletta, Stasi Antonia
U.O. Nefrologia A.O. Ospedale Civile di Legnano, Legnano - Italy.
G Ital Nefrol. 2012 Nov-Dec;29 Suppl 58:S33-45.
Contrast-induced nephropathy (CIN) is one of the most frequent causes of acute kidney injury in hospitalized patients. Its incidence depends on patient risk factors (chronic kidney disease, diabetes, cardiovascular diseases and older age) and procedure-related factors (high contrast dose, intraarterial administration). Chronic kidney disease, especially if associated with diabetes, is the main risk factor for CIN. Hydration before and after contrast administration is the only preventive therapy that is strongly recommended by guidelines in patients at risk. CIN prevention studies have focused mainly on cardiac patients with a moderate renal risk (GFR 60-40 mL/min) who underwent intraarterial contrast administration. Many clinical trials have evaluated the efficacy of hydration associated with sodium bicarbonate and of N-acetylcysteine (NAC) in CIN prevention. Sodium bicarbonate infusion has shown better efficacy than saline infusion, particularly when short infusion times are needed, such as in emergency procedures. NAC has not shown any clear effect, and some positive study results have not been confirmed in other trials. The discussion is still open on the efficacy of renal replacement therapies for the prevention of CIN in individuals at high renal risk (GFR <30 mL/min), in whom CIN could mark the entrance to chronic dialysis.
对比剂肾病（CIN）是住院患者急性肾损伤最常见的病因之一。其发病率取决于患者的危险因素（慢性肾脏病、糖尿病、心血管疾病及高龄）以及与检查操作相关的因素（高对比剂剂量、动脉内给药）。慢性肾脏病，尤其是合并糖尿病时，是CIN的主要危险因素。对于有风险的患者，对比剂注射前后进行水化是指南强烈推荐的唯一预防措施。CIN预防研究主要集中在中度肾风险（肾小球滤过率60 - 40 mL/分钟）且接受动脉内对比剂注射的心脏病患者。许多临床试验评估了水化联合碳酸氢钠以及N - 乙酰半胱氨酸（NAC）在预防CIN中的疗效。输注碳酸氢钠已显示出比输注生理盐水更好的疗效，特别是在需要短时间输注时，如急诊检查操作中。NAC尚未显示出任何明确效果，且一些阳性研究结果在其他试验中未得到证实。对于高肾风险（肾小球滤过率<30 mL/分钟）个体预防CIN的肾脏替代疗法的疗效，讨论仍在进行中，在这类患者中，CIN可能标志着进入慢性透析阶段。
