Sessa Concetto, Zanoli Luca, Noto Giovanni, Alessandrello Ivana, Galeano Dario, Giglio Elisa, Giuffrida Alfio Edoardo, Distefano Giulio, Ficara Vincenzo, Messina Roberta Maria, Musumeci Stella, Scollo Viviana, Zirino Fortunata, Zuppardo Carmelo, Morale Walter
U.O.C. Nefrologia e Dialisi, P.O. Maggiore "Nino Baglieri", Modica, Ragusa (RG).
Nefrologia, Dipartimento di Medicina Clinica e Sperimentale, Università di Catania, Catania (CT).
G Ital Nefrol. 2023 Oct 26;40(5):2023-vol5.
Intravenous iodinated contrast media are commonly used in clinical practice, ranging from medical imaging to interventional radiology (IR) procedures and endovascular interventions. Compared with patients with normal renal function, nephropathic patients have an increased risk of acute kidney injury (AKI). Nevertheless, this condition cannot represent a limit to diagnostics or endovascular interventions. Despite the literature of the last five years, conflicting management and approaches for nephropathic patients persist, including the use of contrast agents and treatments replacing renal functions, which are often mistakenly considered as part of preventive strategies. Though the issue has been widely discussed, specialists often cope with uncertainty in handling properly the administration of contrast media and renal counselling requests. Furthermore, there is a general difficulty in distinguishing the Post-Contrast Acute Kidney Injury (PC-AKI) from the Contrast-Associated Acute Kidney Injury (CI-AKI). The present review aims to provide an update on the issue and examine strategies to reduce the acute kidney injury risk after the administration of contrast media. These strategies include the early identification of high-risk individuals, the choice of the contrast media and the proper dosage, the suspension of nephrotoxic drugs, the follow-up of the high-risk individuals, and the early identification of AKI.
静脉注射碘化造影剂在临床实践中普遍使用，涵盖从医学影像到介入放射学（IR）程序及血管内介入治疗。与肾功能正常的患者相比，肾病患者发生急性肾损伤（AKI）的风险增加。然而，这种情况并不构成诊断或血管内介入治疗的限制。尽管过去五年有相关文献，但针对肾病患者的管理和方法仍存在冲突，包括造影剂的使用以及替代肾功能的治疗方法，这些常常被错误地视为预防策略的一部分。尽管该问题已得到广泛讨论，但专家们在正确处理造影剂给药和肾脏咨询请求时往往面临不确定性。此外，区分造影剂后急性肾损伤（PC-AKI）和造影剂相关急性肾损伤（CI-AKI）通常存在困难。本综述旨在提供该问题的最新情况，并探讨降低造影剂给药后急性肾损伤风险的策略。这些策略包括早期识别高危个体、选择造影剂及合适剂量、停用肾毒性药物、对高危个体进行随访以及早期识别急性肾损伤。
