Prophylaxis of contrast-induced nephrotoxicity

Abstract

Contrast-induced nephrotoxicity (CIN) is a form of acute kidney injury that follows intravascular contrast media exposure. CIN may be preventable because its risk factors are well established and the timing of renal insult is commonly known in advance. However, contrast-induced nephrotoxicity is still the third leading cause of iatrogenic renal failure. This important complication accounts up to 10% of acute renal failure cases in hospitalized patients and it is associated with increased short- and long-term morbidity and mortality. Prolonged hospitalization follows and overall increases healthcare resource utilization. This paper will discuss the various prophylactic procedures tested in clinical trials.

Figure 1

Presumed renoprotective effects of Mesna in tubule lumen. Radiocontrast agents (RCA) are filtered into the primary urine. In the tubule lumen, RCAs are concentrated 100-fold by water reabsorption. High RCA concentration stimulates the production of reactive oxygen (ROS) in the tubule cells leading to epithelial cell necrosis and tubule obstruction. By hydration, RCAs are less concentrated and tubule obstruction can be washed out. While N-acetylcysteine acts mainly from the basal side, Mesna can prevent ROS production in the tubule cells from both apical and basal sides. Finally Mesna may prevent contrast-agent-induced nephrotoxicity by glutathione regeneration. Graphic: G.Hintze.