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肾脏与对比剂:法国肾脏病学会(SFNDT、FIRN、CJN)和法国放射学会(SFR)遵循 ESUR 指南的共同观点。

Kidney and contrast media: Common viewpoint of the French Nephrology societies (SFNDT, FIRN, CJN) and the French Radiological Society (SFR) following ESUR guidelines.

机构信息

Department of Nephrology, Bourgoin-Jallieu Hospital, 38300 Bourgoin-Jallieu, France.

Department of Nephrology and Renal Transplantation, Hôpital de la Conception, Assistance Publique Hôpitaux de Marseille, 13005 Marseille, France; C2VN, INSERM 1263, INRAE 1260, Aix-Marseille Univ, 13005 Marseille, France.

出版信息

Diagn Interv Imaging. 2021 Mar;102(3):131-139. doi: 10.1016/j.diii.2021.01.007. Epub 2021 Jan 30.

Abstract

Contrast medium administration is classically considered to cause or worsen kidney failure, but recent data may moderate this assertion. The European Society of Urogenital Radiology recently published guidelines re-evaluating the precautions before administering contrast media. Kidney injury does not constitute a contra-indication to the administration of iodinated contrast medium, as long as the benefit-risk ratio justifies it. Intravenous hydration with 0.9% NaCl or 1.4% sodium bicarbonate is the only validated measure for the prevention of post-iodine contrast nephropathy. This is necessary for intravenous or intra-arterial administration of iodinated contrast agent without first renal pass when the glomerular filtration rate is less than 30mL/min/1.73m, for intra-arterial administration of iodinated contrast agent with first renal passage when the glomerular filtration rate is less than 45mL/min/1.73m, or in patients with acute renal failure. The use of iodinated contrast medium should allow the carrying out of relevant examinations based on an analysis of the benefit-risk ratio and the implementation of measures to prevent toxicity when necessary.

摘要

造影剂的使用被认为会导致或加重肾功能衰竭,但最近的数据可能会对这一观点进行修正。欧洲泌尿生殖放射学会最近发布了重新评估使用造影剂前的注意事项的指南。只要受益风险比合理,肾损伤并不构成使用碘造影剂的禁忌证。静脉内输注 0.9%氯化钠或 1.4%碳酸氢钠是预防碘造影剂肾病的唯一有效措施。当肾小球滤过率(GFR)<30mL/min/1.73m 时,需要在静脉内或动脉内给予碘造影剂而无首过肾脏清除时,或当 GFR<45mL/min/1.73m 时给予有首过肾脏清除的碘造影剂,或在急性肾衰竭患者中,需要进行这种静脉内水化。使用碘造影剂时,应根据受益风险比进行分析,并在必要时采取措施预防毒性,以进行相关检查。

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