Genovesi Eugenio, Romanello Mattia, De Caterina Raffaele
Istituto e Scuola di Specializzazione in Cardiologia, Università degli Studi "G. d'Annunzio", Chieti.
G Ital Cardiol (Rome). 2016 Dec;17(12):984-1000. doi: 10.1714/2612.26891.
The intravascular administration of contrast media is an important tool in cardiovascular imaging, especially in percutaneous coronary interventions (PCI). Owing to the widespread use of these procedures, contrast-induced acute kidney injury (CI-AKI) has become one of the most common types of acute renal failures. CI-AKI is mainly mediated by mechanisms of oxidative damage, and its onset is associated with prolonged hospitalization and significant morbidity and mortality. Preexisting chronic kidney disease, diabetes, age, heart failure, and characteristics related to the procedure (primary or elective PCI, type and amount of contrast medium) are the most important risk factors for the development of post-PCI CI-AKI.For this serious complication, prevention is more important than treatment, and various preventive measures have been widely tested in recent years. However, none of the strategies so far evaluated, with the exception of pre-procedural hydration with isotonic saline, has been shown to effectively prevent CI-AKI in randomized trials in large populations. In this review, we discuss the incidence, risk factors, main pathogenetic mechanisms and current strategies for the prevention of CI-AKI.
血管内注射造影剂是心血管成像中的一项重要工具，尤其是在经皮冠状动脉介入治疗（PCI）中。由于这些操作的广泛应用，造影剂诱导的急性肾损伤（CI-AKI）已成为最常见的急性肾衰竭类型之一。CI-AKI主要由氧化损伤机制介导，其发生与住院时间延长以及显著的发病率和死亡率相关。既往存在的慢性肾脏病、糖尿病、年龄、心力衰竭以及与手术相关的特征（原发性或择期PCI、造影剂的类型和剂量）是PCI术后发生CI-AKI的最重要危险因素。对于这种严重并发症，预防比治疗更重要，近年来各种预防措施已得到广泛测试。然而，到目前为止评估的策略中，除了术前用等渗盐水进行水化外，在大样本随机试验中均未显示能有效预防CI-AKI。在本综述中，我们讨论了CI-AKI的发病率、危险因素、主要发病机制以及当前的预防策略。
