The clinical and renal consequences of contrast-induced nephropathy.
The clinical and renal consequences of contrast-induced nephropathy.
复制标题
DOI：
10.1093/ndt/gfl213
复制
发表时间：
2006-06-01
期刊：
影响因子：
--
通讯作者：
Finn, William F
中科院分区：
文献类型：
--
作者：
Finn, William F
造影剂肾病（CIN）是血管内注射造影剂后的肾功能损害，通常定义为基线血清肌酐浓度升高>25%或0.5 mg/dl（44 μ mol/l）。CIN的发病率在过去三十年中似乎没有明显变化，并且它仍然是医院获得性急性肾衰竭（ARF）的第三大原因。在一般人群中，CIN的发病率估计为1- 2%。然而，在一些高风险患者亚组中，如糖尿病和既存肾损害患者，发生CIN的风险可能高达50%。经皮冠状动脉介入治疗后发生CIN的患者无论在造影剂暴露前是否存在慢性肾脏疾病，其短期和长期死亡率都会增加。在ARF不严重到需要透析以及需要透析的CIN患者中均观察到长期生存率降低。治疗仅限于支持性措施，同时等待肾损害的解决。有时，这种情况不会发生。由于缺乏治疗选择，并且由于CIN与严重的短期和长期后遗症相关，因此需要强调预防措施，识别高风险患者并对参与这些患者护理的所有医生进行教育，以降低CIN的发生率。
Contrast-induced nephropathy (CIN), an impairment of renal function following intravascular injection of contrast media, is commonly defined as an increase in the baseline serum creatinine concentration of >25% or 0.5 mg/dl (44 micromol/l). The incidence of CIN does not appear to have changed appreciably in the last three decades, and it continues to be the third leading cause of hospital-acquired acute renal failure (ARF). In the general population, the incidence of CIN is estimated to be 1-2%. However, the risk for developing CIN may be as high as 50% in some high-risk patient subgroups, such as those with diabetes mellitus and pre-existing renal impairment. Patients who develop CIN after percutaneous coronary intervention sustain an increase in both short- and long-term mortality whether or not chronic kidney disease was present prior to contrast exposure. The diminished long-term survival in patients with CIN has been observed for both, those whose ARF is not severe enough to require dialysis as well as those requiring dialysis. Treatment is limited to supportive measures while awaiting the resolution of the renal impairment. At times, this does not occur. Because of the lack of treatment options and because CIN is associated with serious short- and long-term sequelae, emphasis needs to be directed at preventative measures, identification of high-risk patients and education of all physicians involved in the care of these patients in order to reduce the incidence of CIN.