Au Trang H, Bruckner Anne, Mohiuddin Syed M, Hilleman Daniel E
Alegent-Creighton Health, Omaha, NE, USA
Creighton University School of Pharmacy and Health Professions, Omaha, NE, USA.
Ann Pharmacother. 2014 Oct;48(10):1332-42. doi: 10.1177/1060028014541996. Epub 2014 Jul 3.
Contrast-induced nephropathy (CIN) is a complication which may develop after exposure to iodinated contrast media. The resulting acute kidney injury (AKI) is associated with an increase in both short- and long-term morbidity and mortality, increased hospital length of stay, and greater health care costs. The pathophysiological mechanism associated with the development of CIN remains unknown. This narrative review summarizes the pathophysiology, risk factors, and current evidence for the prevention of CIN.
A MEDLINE literature search (2004-May 2014) was performed using search terms contrast-induced nephropathy and prevention. Additional references were identified from literature citations, review articles, and meta-analyses.
Abstracts of English-language human clinical trials that examined therapies for the prevention of CIN were evaluated. Studies that did not investigate a preventative intervention for CIN were excluded. Emphasis was placed on recent publications.
A multitude of therapies focused on the prevention of CIN have been investigated. Unfortunately, many of these studies have produced negative and/or inconsistent results. There is a paucity of adequately designed clinical studies evaluating strategies for the prevention of CIN. However, the best data supports use of preprocedural hydration with isotonic solution as the standard of care for prophylaxis.
Given the poor prognosis associated with CIN, there is need for improved methods to prevent it. At present, the best tools to protect patients from unnecessary risk for CIN are careful assessment of renal function, judicious use of procedures that utilize contrast media, and adequate hydration with isotonic solution.
对比剂肾病（CIN）是在接触碘化造影剂后可能发生的一种并发症。由此导致的急性肾损伤（AKI）与短期和长期发病率及死亡率增加、住院时间延长以及更高的医疗费用相关。与CIN发生相关的病理生理机制仍不清楚。本叙述性综述总结了CIN的病理生理学、危险因素及目前预防CIN的证据。
使用检索词“对比剂肾病”和“预防”进行了MEDLINE文献检索（2004年至2014年5月）。从文献引用、综述文章和荟萃分析中识别出其他参考文献。
对检查预防CIN治疗方法的英文人类临床试验摘要进行了评估。未调查CIN预防干预措施的研究被排除。重点关注近期发表的文献。
已经研究了多种预防CIN的治疗方法。不幸的是，这些研究中有许多产生了阴性和/或不一致的结果。评估CIN预防策略的设计充分的临床研究很少。然而，现有最佳数据支持将使用等渗溶液进行术前水化作为预防的标准治疗方法。
鉴于CIN预后较差，需要改进预防方法。目前，保护患者免受CIN不必要风险的最佳措施是仔细评估肾功能、谨慎使用使用造影剂的检查程序以及用等渗溶液进行充分水化。
