Contrast-induced acute kidney injury: definition, epidemiology, and outcome.
Contrast-induced acute kidney injury: definition, epidemiology, and outcome.
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DOI：
10.1155/2014/859328
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发表时间：
2014
影响因子：
--
通讯作者：
Katzberg R
中科院分区：
文献类型：
--
作者：
Meinel FG;De Cecco CN;Schoepf UJ;Katzberg R
造影剂引起的急性肾损伤（CI-AKI）通常被定义为在给予碘化造影剂后较短时间内发生的肾功能下降。造影剂给药后AKI的发生率很大程度上取决于所使用的具体定义和临界值。虽然在大多数情况下AKI是自限性的，但对比后AKI存在永久性肾功能不全、透析和死亡的风险。由于肾功能的背景波动，造影剂引起AKI的风险，特别是静脉注射造影剂进行增强CT时，在较早的非对照研究中被夸大了。最近来自对照研究的证据表明，肾功能正常的患者可能不存在这种风险，但肾功能不全的患者可能存在这种风险。然而，即使在这些患者群体中，CI-AKI的风险可能比传统认为的要小得多。由于体积扩张是唯一具有令人信服的证据基础的预防策略，应鼓励自由水合以进一步降低风险。从对比增强检查中获得的诊断信息的益处仍然需要与个体患者和临床情况的CI-AKI潜在风险相平衡。
Contrast-induced acute kidney injury (CI-AKI) is commonly defined as a decline in kidney function occurring in a narrow time window after administration of iodinated contrast material. The incidence of AKI after contrast material administration greatly depends on the specific definition and cutoff values used. Although self-limiting in most cases, postcontrast AKI carries a risk of more permanent renal insufficiency, dialysis, and death. The risk of AKI from contrast material, in particular when administered intravenously for contrast-enhanced CT, has been exaggerated by older, noncontrolled studies due to background fluctuations in renal function. More recent evidence from controlled studies suggests that the risk is likely nonexistent in patients with normal renal function, but there may be a risk in patients with renal insufficiency. However, even in this patient population, the risk of CI-AKI is probably much smaller than traditionally assumed. Since volume expansion is the only preventive strategy with a convincing evidence base, liberal hydration should be encouraged to further minimize the risk. The benefits of the diagnostic information gained from contrast-enhanced examinations will still need to be balanced with the potential risk of CI-AKI for the individual patient and clinical scenario.
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