Abstract

AGUIRRE CAICEDO, Marcelo. Nefropatía por medios de contraste. Acta Med Colomb [online]. 2007, vol.32, n.2, pp.68-79. ISSN 0120-2448.

Nephropathy due to contrast means is an important cause of acute renal failure in the hospital environment, generating hight costs in the health care system, a significant morbidity and considerable mortality, it is considered to be an iatrogenic disorder that produces an absolute increase L (>0.5 mg) or relative increase (>25%) of serum creatinine as compared to the basal pattern and takes place within 24 to 48 hours after exposure to a contrast mean, in absence of another cause of acute renal insufficiency. There are many risk factors that can predispose to its clinical presentation. Many preventive strategies have been tried to reduce the load in terms of morbidity and mortality derived from this pathologic condition, however, the results are not encouraging. Some of these strategies have been clearly ineffective such as peptide manitol, natriuretic atrial peptide, theophiline, prostaglandin E and endotheline antagonists, whereas others such as furosemide and dopamine are potentially harmful. The evidence supports the use of the intravenous infusion of saline solution 0.9% a Icc/kg(hour, 12 hours before and 12 hours after giving the contrast mean, with a strict suveillance of the water balance. On the other hand, the data obtained from clinical trials to assess the effects of N-acetilcisteine in the prevention of nephropathy due to contrast means, are not concluding, (even contradictory); however, the lack of secondary effects and the potential beneficial effect, allows its use on a routine basis as a preventive measure especially in high risk patents. Additional to that, if the lack of time does not allow previous hydration, the literature rather supports the use of isotomic intravenous bicarbonate one hour before the procedure, and continuing during 6 hours after it.

Keywords : nephropathy; contrast; Nephroprotection; saline solution; N-acetilcisteine; bicarbonate.

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