Pathophysiology of contrast medium-induced nephropathy
Pathophysiology of contrast medium-induced nephropathy
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DOI：
10.1111/j.1523-1755.2005.00377.x
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发表时间：
2005-07-01
影响因子：
19.6
通讯作者：
Liss, P
中科院分区：
文献类型：
--
作者：
Persson, PB;Hansell, P;Liss, P
背景造影剂肾病（CIN）是急性肾功能衰竭的一个众所周知的原因，但CIN的发展仍然知之甚少。已经进行了许多研究，目的是阐明CIN的病理生理学。这些导致了多种解释，有时是相互矛盾的结论。本综述通过强调复杂的病理生理学实体，包括流变学特性改变、肾血流动力学紊乱、局部缺氧、自分泌和旁分泌因子[腺苷、内皮素和活性氧（ROS）]和直接细胞毒性作用，对被认为介导CIN的机制进行了批判性调查。此外，还阐明了造影剂理化性质的重要性。最近开发的等渗造影剂是二聚体，而不是广泛使用的非离子低渗造影剂的单体。二聚体具有不同于其他造影剂的理化特征，这可能具有临床重要性，而不仅仅是渗透压摩尔浓度。市售二聚体的粘度比血液高得多。许多实验研究提供证据表明，与非离子型单体造影剂相比，二聚体造影剂对肾功能的干扰更大。临床试验产生了相互矛盾的结果。
Background. Contrast medium-induced nephropathy (CIN) is a well-known cause of acute renal failure, but the development of CIN remains poorly understood. A number of studies have been performed with the one aim, to shed some light onto the pathophysiology of CIN. These have led to manifold interpretations and sometimes contradicting conclusions.Methods. This review critically surveys mechanisms believed to mediate CIN by highlighting the complex pathophysiologic entity, including altered rheologic properties, perturbation of renal hemodynamics, regional hypoxia, auto- and paracrine factors [adenosine, endothelin, and reactive oxygen species (ROS)], and direct cytotoxic effects. Moreover, the importance of physicochemical properties of contrast media are made clear.Results. The more recently developed iso-osmolar contrast media are dimers, not monomers as the widely used nonionic low osmolar contrast media. The dimers have physicochemical features different from other contrast media which may be of clinical importance, not only with respect to osmolality. The viscosity of the commercially available dimers is considerably higher than blood.Conclusion. Many experimental studies provide evidence for a greater perturbation in renal functions by dimeric contrast media in comparison to nonionic monomeric contrast media. Clinical trials have yielded conflicting results.