Contrast nephropathy

Abstract

Contrast nephropathy will increase mortality up to 30% following angiographic procedures. Before performing such procedures a careful reassessment of the risk/benefit ratio should be performed. Mannitol and diuretics play no role in prevention. Hydration and correction of abnormal electrolyte levels should be done in all patients. Pre-treatment with acetylcysteine and theophylline is a well-accepted strategy and should always be utilized. If creatinine levels are above 2.5 to 3 mg/dl, fenoldopam may provide additional protection, particularly in diabetic patients. However, the role of fenoldopam is controversial. Prophylactic hemodialysis may prove to be an additional tool in the fight against this disease in selected patients.

Figures

Figure 1

Mechanisms of contrast-induced nephropathy. Asterisk and crosses show the site of action of various agents. (GFR = glomerulate filtration rate; *low osmolar agents, hydration; **fenoldopam [use not universally accepted]; Calcium channel blockers [use not universally accepted]; +theophylline; ++N-acetylcysteine)

Figure 2

Suggested algorithm to decrease the incidence of contrast nephropathy prophylactic dialysis. (+Its role is still controversial, and not yet defined; !!Not universally accepted).