Wang Zhong, Wang Qiuhan, Gong Xuezhong
Department of Nephrology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200071, China.
Toxics. 2024 Aug 22;12(8):620. doi: 10.3390/toxics12080620.
The utilization of contrast media (CM) in clinical diagnostic imaging and interventional procedures has escalated, leading to a gradual increase in the incidence of contrast-induced acute kidney injury (CI-AKI). Presently, the scarcity of effective pharmacological treatments for CI-AKI poses significant challenges to clinical management. Firstly, we explore the pathogenesis of CI-AKI in this review. Beyond renal medullary ischemia and hypoxia, oxidative stress, cellular apoptosis, and inflammation, emerging mechanisms such as ferroptosis, release of neutrophil extracellular traps (NETs), and nitrosative stress, which offer promising avenues for the management of CI-AKI, are identified. Secondly, a comprehensive strategy for the early prevention of CI-AKI is introduced. Investigating the risk factors associated with CI-AKI is essential for the timely identification of high-risk groups. Additionally, exploring early sensitive biomarkers is crucial for early diagnosis. A synergistic approach that combines these sensitive biomarkers, CI-AKI risk factors, and disease risk prediction models enhances both the accuracy and efficiency of early diagnostic processes. Finally, we explore recent pharmacological and non-pharmacological interventions for the management of Cl-AKI. Beyond the traditional focus on the antioxidant N-acetylcysteine (NAC), we look at active compounds from traditional Chinese medicine, including tetramethylpyrazine (TMP), salvianolic acid B (Sal B), as well as emerging preventive medications like N-acetylcysteine amide (NACA), alprostadil, and others, which all showed potential benefits in animal and clinical studies for CI-AKI prevention. Furthermore, innovative strategies such as calorie restriction (CR), enhanced external counterpulsation (EECP), and mesenchymal stem cell therapy are highlighted as providing fresh insights into Cl-AKI prevention and management.
对比剂（CM）在临床诊断成像和介入手术中的使用有所增加，导致对比剂诱导的急性肾损伤（CI-AKI）的发病率逐渐上升。目前，CI-AKI缺乏有效的药物治疗方法，给临床管理带来了重大挑战。首先，我们在本综述中探讨CI-AKI的发病机制。除了肾髓质缺血、缺氧、氧化应激、细胞凋亡和炎症外，还发现了铁死亡、中性粒细胞胞外陷阱（NETs）释放和亚硝化应激等新机制，这些机制为CI-AKI的管理提供了有前景的途径。其次，介绍了CI-AKI早期预防的综合策略。调查与CI-AKI相关的危险因素对于及时识别高危人群至关重要。此外，探索早期敏感生物标志物对于早期诊断至关重要。将这些敏感生物标志物、CI-AKI危险因素和疾病风险预测模型相结合的协同方法提高了早期诊断过程的准确性和效率。最后，我们探讨了CI-AKI管理的最新药物和非药物干预措施。除了传统上关注的抗氧化剂N-乙酰半胱氨酸（NAC）外，我们还研究了中药活性成分，包括川芎嗪（TMP）、丹酚酸B（Sal B），以及新兴的预防药物，如N-乙酰半胱氨酸酰胺（NACA）、前列地尔等，这些在动物和临床研究中均显示出对预防CI-AKI有潜在益处。此外，热量限制（CR）、增强型体外反搏（EECP）和间充质干细胞治疗等创新策略被强调为为CI-AKI的预防和管理提供了新的见解。
