Why is diabetes mellitus a risk factor for contrast-induced nephropathy?
Why is diabetes mellitus a risk factor for contrast-induced nephropathy?
复制标题
为什么糖尿病是对比诱导肾病的危险因素？
DOI：
10.1155/2013/123589
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发表时间：
2013
影响因子：
--
通讯作者：
Khamaisi M
中科院分区：
文献类型：
--
作者：
Heyman SN;Rosenberger C;Rosen S;Khamaisi M
随着造影剂在成像和血管内介入中的应用不断扩大，造影剂诱导的肾病(CIN)仍然是医源性急性肾损伤的主要原因。糖尿病是CIN的重要易感因素，尤其是在有肾功能损害的患者中。肾脏缺氧和活性氧的产生在CIN的发病机制中起着核心作用，糖尿病肾脏在使用造影剂后特别容易受到加剧的缺氧和氧化应激的影响。这种脆弱性的病理生理机制是复杂的，涉及多种机制，包括先天增强的肾小管转运活性、氧气消耗和活性氧物种的产生。血管张力和管周血流的调节也可能改变，特别是由于硝基血管扩张缺陷、内皮素产生增加以及对腺苷相关血管收缩的特殊高反应性。此外，微血管和大血管疾病以及慢性肾小管间质改变进一步损害了局部氧输送，肾脏的抗氧化能力可能受到阻碍。更好地了解这些机制及其在糖尿病患者中的控制，可能会在预防这些易感患者的造影剂肾病方面启动新的策略。
Contrast-induced nephropathy (CIN) remains a leading cause of iatrogenic acute kidney injury, as the usage of contrast media for imaging and intravascular intervention keeps expanding. Diabetes is an important predisposing factor for CIN, particularly in patients with renal functional impairment. Renal hypoxia, combined with the generation of reactive oxygen species, plays a central role in the pathogenesis of CIN, and the diabetic kidney is particularly susceptible to intensified hypoxic and oxidative stress following the administration of contrast media. The pathophysiology of this vulnerability is complex and involves various mechanisms, including a priori enhanced tubular transport activity, oxygen consumption, and the generation of reactive oxygen species. The regulation of vascular tone and peritubular blood flow may also be altered, particularly due to defective nitrovasodilation, enhanced endothelin production, and a particular hyperresponsiveness to adenosine-related vasoconstriction. In addition, micro- and macrovascular diseases and chronic tubulointerstitial changes further compromise regional oxygen delivery, and renal antioxidant capacity might be hampered. A better understanding of these mechanisms and their control in the diabetic patient may initiate novel strategies in the prevention of contrast nephropathy in these susceptible patients.
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影响因子：
4.2
作者：
Goldfarb, M;Rosenberger, C;Heyman, SN
通讯作者：
Heyman, SN
影响因子：
15.9
作者：
HEYMAN, SN;BREZIS, M;ROSEN, S
通讯作者：
ROSEN, S
影响因子：
2.8
作者：
Huber, W;Schipek, C;Classen, M
通讯作者：
Classen, M
DOI：
10.1159/000313957
发表时间：
2011-01-01
期刊：
EXPERIMENTAL MODELS FOR RENAL DISEASES: PATHOGENESIS AND DIAGNOSIS
影响因子：
--
作者：
Heyman, Samuel N.;Rosenberger, Christian;Rosen, Seymour
通讯作者：
Rosen, Seymour
影响因子：
6.1
作者：
Heyman, Samuel N.;Evans, Roger G.;Rosenberger, Christian
通讯作者：
Rosenberger, Christian