Contrast nephropathy and prevention

Česká verzia

Authors: V. Teplan ^1,2
Authors place of work: Klinika nefrologie Transplantcentra IKEM Praha, přednosta prof. MUDr. Ondřej Viklický, CSc. ¹; Subkatedra nefrologie IPVZ Praha, vedoucí prof. MUDr. Vladimír Teplan, DrSc. ²
Published in the journal: Vnitř Lék 2012; 58(7 a 8): 93-96
Category: 80th Birthday MUDr. Miroslav Mydlík, DrSc.

Summary

Contrast-induced nephropathy (CIN) is a serious complication of radio-contrast vascular examination, mainly in high-risk patients with decreased renal function. In prevention, we have to know risk factors strongly influencing follow-up. All potential nephrotoxic drugs should be excluded. We recommend adequate intravenous hydration, supplemented individually with bicarbonate and N-acetylcystein. Studies designed to explore options in CIN prevention included trimetazidine (TMZ) belonging to cytoprotective antiischemic agents used in the treatment of angina pectoris. Trimetazidine affects reperfusion at the cellular and mitochondrial levels, and has antioxidant and metabolic activity via several mechanisms at the cellular level, that is, it shows characteristics making it a clear candidate for CIN prophylaxis. In serious cases hemofiltration could be used to help eliminate contrast solution as soon as posible. Beside serum creatinine, NGAL detected in urine may help in early diagnosis of tubular damage.

Key words:
contrast-induced nephropathy – risk patients – hydratation – trimetazidine – NGAL

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