Li Qingqing, Pan Shengqi
Department of Intensive Care Medicine, Qingdao Municipal Hospital, Qingdao, People's Republic of China.
Int J Gen Med. 2022 Feb 15;15:1537-1546. doi: 10.2147/IJGM.S341072. eCollection 2022.
A decrease in renal function that follows intravascular administration of contrast medium (CM) within a few days is reported as contrast-induced acute kidney injury (CI-AKI). In clinical practice, the imaging procedure is frequently deferred when clinicians consider that the renal risks caused by CM outweigh the benefits of enhanced imaging. However, with an in-depth understanding of AKI and contrast medium, scholars have realized that the decrease in renal function after CM is caused by contrast medium factors and noncontrast medium factors (such as anemia and hemodynamic instability). Therefore, acute kidney injury caused by CM has been overestimated in the past. The term "contrast-associated acute kidney injury (CA-AKI)" has been increasingly used to indicate AKI after intravascular administration of contrast medium compared with CI-AKI. CA-AKI can increase the risk of death and chronic kidney disease. However, its pathophysiological mechanism has not been fully elucidated, and the effectiveness of various preventive and therapeutic measures have been questioned. These present challenges for us. In this article, we will review the diagnostic criteria, epidemiology, risk factors, pathophysiological mechanisms and treatment of CA-AKI to provide optimized imaging procedures in clinical practice.
血管内注射造影剂（CM）后数天内出现的肾功能下降被报道为造影剂诱导的急性肾损伤（CI-AKI）。在临床实践中，当临床医生认为CM引起的肾脏风险超过增强成像的益处时，成像检查程序常常会被推迟。然而，随着对急性肾损伤和造影剂的深入了解，学者们意识到CM后肾功能下降是由造影剂因素和非造影剂因素（如贫血和血流动力学不稳定）引起的。因此，过去对CM引起的急性肾损伤存在高估。与CI-AKI相比，“造影剂相关急性肾损伤（CA-AKI）”这一术语越来越多地用于表示血管内注射造影剂后的急性肾损伤。CA-AKI会增加死亡风险和慢性肾脏病的风险。然而，其病理生理机制尚未完全阐明，各种预防和治疗措施的有效性也受到质疑。这些给我们带来了挑战。在本文中，我们将综述CA-AKI的诊断标准、流行病学、危险因素、病理生理机制和治疗方法，以在临床实践中提供优化的成像检查程序。
