Experimental contrast-associated nephropathy and its clinical implications.

摘要: Acute renal failure after contrast media injection has been recognized for at least 35 years but the exact mechanism responsible injury remains an enigma. The clinical characteristics of contrast-induced nephropathy (CAN) are well-known although more recently nonoliguric presentation occurred increased frequency--in 70 to 90% cases. For CAN, one can expect asymptomatic increase in serum creatinine, mean peak occurring 4.2 days. If oliguric, fractional excretion sodium will be less than 1% and resistant either fluid challenge or loop diuretics. Preexisting insufficiency, with without diabetes mellitus, increases risk CAN 6- 10-fold recovery is expected, 10% all patients requiring dialytic support. Despite growing body published reports, lack a suitable animal model evaluate various proposed mechanisms compromised our ability devise technique preventing CAN. A popular scheme describe possible sequence by which ischemia nephrotoxins, both, induce acute failure. In particular, vascular (i.e., ischemia), appealing explanation since changes hemodynamics have confirmed several experiments. Unlike other beds vasoconstriction followed vasodilatation, initial effect on circulation progressive vasoconstriction, increasing resistance concomitant decrease both blood flow glomerular filtration rate.(ABSTRACT TRUNCATED AT 250 WORDS)