Contrast media-induced

Unlabeled Uses Prevention of contrast media-induced nephrotoxicity... 

Ide JM, Lancelot E, Pines E, Corot C. Prophylaxis of iodinated contrast media-induced nephropathy a pharmacological point of view. Invest Radiol 2004 39(3) 155-70. 

Yoshioka T Fogo A, Beckman JK. Reduced activity of antioxidant enzymes underlies contrast media-induced renal injury in volume depletion. Kidney Int 1992 41 1008-1015. 

Parvez Z, Rahman MA, Moncada R. Contrast media-induced lipid peroxidation in the rat kidney. Invest Radiol 1989 24 697-702. 

Bader BD, Berger ED, Heede MB, et al. What is the best hydration regimen to prevent contrast media-induced nephrotoxicity Clin Nephrol 2004 62 1-7. 

A report from Italy has suggested that intravenous saline 0.4% before and after administration of the contrast medium, an infusion of dopamine 3 micrograms/kg/ minute for 24 hours after the contrast medium, intravenous furosemide 80 mg 30 minutes before the contrast medium, or intravenous mannitol (20%) 250 ml 1 horn-before and 1 hour after the contrast medium each prevented the reduction in renal function caused by the nonionic agents iobitridol, ioversol, or iodixanol (193). However, the protocol of the study was not described, and previous studies have shown that dopamine, furosemide, and mannitol do not offer good protection against contrast media-induced nephrotoxicity. On the other hand, volume expansion with intravenous saline has been found to offer some protection (190). 

Morcos SK. Contrast media-induced nephrotoxicity— questions and answers. Br J Radiol 1998 71(844) 357-65. 

Berger ED, Bader BD, Bosker J, Risler T, Erley CM. Kontrastmittelinduziertes Nierenversagen lasst sich durch Hamodialyse nicht verhindern. [Contrast media-induced kidney failure cannot be prevented by hemodialysis.] Dtsch Med Wochenschr 2001 126(7) 162-6. 

Morcos SK, Thomsen HS, Webb JAW. Contrast-media-induced nephrotoxicity a consensus report. Appl Radiol 2002 31(Suppl) 62-74. 

The frequency of contrast-media induced AKl is variable, but is judged to represent between 2 to 10% of all AKl patients. The incidence clusters in high-risk patients (see below) and cases of AKI that develop while hospitalized [10,101,102], with contrast-induced nephropathy being the third leading cause of hospital-acquired renal failure [3]. At present, the majority of CIN reports involve its frequency after percutaneous coronary interventions where it may be present in nearly 15% of patients [103]. While the majority of patients with contrast-associated nephropathy present... 

The use of iodinated contrast media (CM) continues to be a common cause of hospital-acquired acute renal failure (ARF) and its development increases the in-hospital mortality significantly [1, 2,3, 4] as well as increasing the length of hospital stay [5]. Contrast media-induced nephropathy (CMIN) is defined as an otherwise unexplained acute deterioration of renal function after intravascular administration of iodinated CM. Although the clinical features and the histopathological findings of CMIN have been well described [6-9], its pathogenesis, prevention and best treatment modality remain uncertain. 

Table 1. Risk factors for contrast media-induced nephropathy.

Erley CM, Osswald H. Prevention of contrast media-induced renal impairment by adenosine antagonists in humans. Drug Dev Res 1998 45 172-175. 

CMIN contrast media induced nephropathy DPCPX l,3-dipropyl-8-cyclopentylxan thine... 

Raven QL, Walton T, Howe AM, Macon EJ. Role of acetylcysteine in the prevention of contrast-media-induced nephrotoxicity. Am J Health-Syst Pharm 2003 60 2232-2235. 

Waybill MM, Waybill PN. Contrast media-induced nephrotoxicity identification of patients at risk and algorithms for prevention. J Vase Intervent Radiol 2001 12 3-9. 

CMIN contrast-media induced nephropathy FACS fluorescence-activated cell sorting... 

Use validated protocols to evaluate patients who are at risk for contrast media-induced renal failure, and use a clinically appropriate method for reducing risk of renal injury based on the patient s kidney function evaluation. 

Technical Considerations Catheterization of the bronchial arteries is best approached from the femoral artery. Since most patients with lung cancer are older and the aorta is tortuous and atherosclerotic, a 5-F catheter with good torque control in a shepherd s crook (reverse curve) or forward seeking configuration is recommended. A finely tapered tip catheter for access which would allow a 3-F microcatheter coaxial system is optimal to bypass the spinal artery. The use of nonionic contrast media should minimize pain and the risk of contrast media-induced complications. The digital subtraction technique is of value for the identification of the anterior spinal artery with small branches to the spinal cord. 

Activation of complement by contrast media to produce the anaphylatoxins C3a and C5a has also been proposed as the mechanism for contrast media-induced histamine release. These pro-inflammatory complement fragments act via specific receptors on endothelial and mast cells and can induce a shock-like reaction similar to that seen in type 1 allergic responses. As yet, however. 

From at least the early 1980s, studies relevant to the possibility of monitoring contrast media-induced histamine release either directly or indirectly via measurement of urinary methy Ihistamine have been pursued. Although concentrations of histamine and its metabolite have been shown to increase in some patients who had an adverse reaction to a contrast medium, diagnostic tests for these mediators have not often been used and it was not until an assay for tryptase (see Sect. 4.5.1) became widely available that routine measurement... 

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