Krzyżak Damian, Basiak Marcin, Dec Adrianna, Hachuła Marcin, Okopień Bogusław
Department of Internal Medicine and Clinical Pharmacology, Faculty of Medical Sciences, Medical University of Silesia in Katowice, Medyków 18, 40-752 Katowice, Poland.
Pharmaceuticals (Basel). 2025 Mar 28;18(4):485. doi: 10.3390/ph18040485.
The phenomenon of contrast-induced nephropathy (CIN) and contrast-associated nephropathy (CAN) has been acknowledged for an extensive duration. Recently, there has been a significant rise in research on the topic due to the enhanced availability of imaging investigations. This theory has been thoroughly validated and extensively reported in the scholarly literature. The primary risk factors are chronic kidney disease, diabetes, sepsis, critical illness, circulatory shock, anemia, advanced age, inadequate hydration, and the use of nephrotoxic medications. The principal preventive strategies are the use of iso-osmolar contrast agents and sufficient hydration, which includes the use of intravenous isotonic saline. The administration of N-acetylcysteine has been shown to decrease the occurrence of CIN without impacting outcomes like mortality or the need for dialysis. Recently, a growing number of scholarly studies have contested this phenomenon, or at least, questioned its clinical significance, rendering it primarily a biochemical occurrence. This review aims to evaluate the previously listed studies. Overestimating the possible dangers of post-contrast nephropathy may diminish the sensitivity of imaging tests that may otherwise utilize contrast, so substantially lowering their clinical relevance. This hypothesis is critically significant to science, medicine, and patients, warranting attention despite the necessity for additional research to validate it. The present study demonstrates that the frequency and importance of CIN may be overestimated.
对比剂肾病（CIN）和对比剂相关肾病（CAN）现象已被认识很长时间。最近，由于影像学检查的可用性增加，关于该主题的研究显著增多。这一理论已在学术文献中得到充分验证和广泛报道。主要危险因素包括慢性肾脏病、糖尿病、脓毒症、危重病、循环性休克、贫血、高龄、水化不足以及使用肾毒性药物。主要预防策略是使用等渗对比剂和充分水化，包括静脉输注等渗盐水。已表明给予N - 乙酰半胱氨酸可降低CIN的发生率，且不影响死亡率或透析需求等结局。最近，越来越多的学术研究对这一现象提出质疑，或者至少对其临床意义表示怀疑，使其主要成为一种生化现象。本综述旨在评估先前列出的研究。高估对比剂后肾病的潜在风险可能会降低可能使用对比剂的影像学检查的敏感性，从而大幅降低其临床相关性。这一假设对科学、医学和患者至关重要，尽管需要更多研究来验证，但值得关注。本研究表明，CIN的发生率和重要性可能被高估了。
