%0 Journal Article
%T The Choice of the Iodinated Radiographic Contrast Media to Prevent Contrast-Induced Nephropathy
%A Michele Andreucci
%A Teresa Faga
%A Antonio Pisani
%A Massimo Sabbatini
%A Domenico Russo
%A Ashour Michael
%J Advances in Nephrology
%D 2014
%R 10.1155/2014/691623
%X In patients with preexisting renal impairment, particularly those who are diabetic, the iodinated radiographic contrast media may cause contrast-induced nephropathy (CIN) or contrast-induced acute kidney injury (CI-AKI), that is, an acute renal failure (ARF), usually nonoliguric and asymptomatic, occurring 24 to 72 hours after their intravascular injection in the absence of an alternative aetiology. Radiographic contrast media have different osmolalities and viscosities. They have also a different nephrotoxicity. In order to prevent CIN, the least nephrotoxic contrast media should be chosen, at the lowest dosage possible. Other prevention measures should include discontinuation of potentially nephrotoxic drugs, adequate hydration with i.v. infusion of either normal saline or bicarbonate solution, and eventually use of antioxidants, such as N-acetylcysteine, and statins. 1. Introduction Iodinated radiographic contrast media [1] are widely used in clinical practice, for both diagnostic and therapeutic procedures such as radiography, percutaneous cardiac and arterial interventions, and contrast-enhanced computed tomography (CT). The intravascular injection of CM is usually safe in healthy subjects with normal renal function. But in patients with preexisting renal impairment the CM may express their nephrotoxicity. Since the clinical need for diagnostic and therapeutic procedures using CM is increased in particular in patients with cardiovascular diseases whose renal function is frequently impaired [2], the occurrence of renal damage by CM is quite frequent. Contrast-induced nephropathy (CIN) is defined as an acute renal failure (ARF) occurring 24 to 72 hours after the intravascular injection of radiographic contrast media in the absence of an alternative aetiology [3]. The KDIGO Group [4] ¡°proposes that the term contrast-induced acute kidney injury (CI-AKI) be used for patients developing AKI secondary to intravascular radiocontrast media exposure¡± rather than CIN. But CIN is still widely used in the literature. It is also questioned whether to use the term ARF to indicate renal impairment by CM. The KDIGO Group also underlines that ¡°the term ¡°acute kidney injury/impairment¡± has been proposed to encompass the entire spectrum of the syndrome from minor changes in markers of renal function to requirement for renal replacement therapy (RRT)¡± [4]. However, most authors keep defining AKI as an ¡°ARF,¡± sometimes ¡°renal insufficiency,¡± even without the need for dialysis. It is usually a nonoliguric, asymptomatic, and transient decline in renal function. The renal
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