Chmielewski Michał, Serafin Zbigniew, Kamińska Dorota, Skrobisz Katarzyna, Kozak Oliwia, Olczyk Piotr, Rutkowski Przemysław, Adamczak Marcin, Szurowska Edyta, Krajewska Magdalena
Department of Nephrology, Transplantology, and Internal Medicine, Medical University of Gdansk, Poland.
Department of Rheumatology, Clinical Immunology, Geriatrics, and Internal Medicine, Medical University of Gdansk, Poland.
Pol J Radiol. 2024 Mar 21;89:e161-e171. doi: 10.5114/pjr.2024.136950. eCollection 2024.
Radiological procedures utilising intravascular contrast media (ICM) are fundamental to modern medicine, enhancing diagnostics and treatment in diverse medical fields. However, the application of ICM has been constrained in patients with compromised kidney function due to perceived nephrotoxic risks, called contrast-induced nephropathy or contrastinduced acute kidney injury. Historical evidence marked ICM as a possible contributor to kidney damage. This led to restrictive guidelines advocating limited ICM use in patients with impaired renal function, preventing crucial radiographic interventions in patients with acute kidney injury (AKI) and chronic kidney disease. Recent advances challenge these traditional views. In particular, no direct causal relationship has been confirmed between contrast admi-nistration and elevated serum creatinine concentrations in humans. Furthermore, contemporary research models and meta-analyses do not associate AKI with contrast usage. This paper, prepared by a cross-disciplinary team of nephrologists and radiologists, presents updated guidelines for ICM application amid renal function impairments, emphasising the reduced nephrotoxic risks currently understood and loosening the previous restrictive approach in patients with renal dysfunction.
使用血管内造影剂（ICM）的放射学检查程序是现代医学的基础，可增强不同医学领域的诊断和治疗效果。然而，由于存在所谓的造影剂肾病或造影剂诱发的急性肾损伤等肾毒性风险，ICM在肾功能受损患者中的应用受到限制。历史证据表明ICM可能是导致肾损伤的一个因素。这导致了限制性指南，主张在肾功能受损患者中限制使用ICM，从而阻止了对急性肾损伤（AKI）和慢性肾病患者进行关键的放射学干预。最近的进展对这些传统观点提出了挑战。特别是，在人类中尚未证实造影剂给药与血清肌酐浓度升高之间存在直接因果关系。此外，当代研究模型和荟萃分析并未将AKI与造影剂使用联系起来。本文由肾病学家和放射学家组成的跨学科团队撰写，提出了肾功能受损情况下ICM应用的更新指南，强调了目前已知的降低肾毒性风险，并放宽了先前对肾功能不全患者的限制性方法。
