Iodinated contrast medium: Is there a re(n)al problem? A clinical vignette-based review

Critical Care

Stephan Ehrmann¹  Vincent Robert-Edan²  Karim Lakhal² 

[1] Médecine Intensive Réanimation, CIC INSERM 1415, CRICS-TriggerSep Network, CHRU Tours, Tours France and Centre d’étude des Pathologies Respiratoires INSERM U1100, Université de Tours, Tours, France;Service d’Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, Boulevard Jacques-Monod, Saint-Herblain, 44093, Nantes, France;

关键词: Contrast media (MeSH: D003287);    Intensive care units (MeSH D007362);    Drug-related side effects and adverse reactions (MeSH D064420);    Tomography scanners;    X-ray computed (MeSH: D015898);    Percutaneous coronary interventions (MeSH: D062645);    Contrast-induced nephropathy;    Post-contrast acute kidney injury;   

DOI  :  10.1186/s13054-020-03365-9

来源: Springer

【 摘 要 】

As we were taught, for decades, that iodinated contrast-induced acute kidney injury should be dreaded, considerable efforts were made to find out effective measures in mitigating the renal risk of iodinated contrast media. Imaging procedures were frequently either downgraded (unenhanced imaging) or deferred as clinicians felt that the renal risk pertaining to contrast administration outweighed the benefits of an enhanced imaging. However, could we have missed the point? Among the abundant literature about iodinated contrast-associated acute kidney injury, recent meaningful advances may help sort out facts from false beliefs. Hence, there is increasing evidence that the nephrotoxicity directly attributable to modern iodinated CM has been exaggerated. Failure to demonstrate a clear benefit from most of the tested prophylactic measures might be an indirect consequence. However, the toxic potential of iodinated contrast media is well established experimentally and should not be overlooked completely when making clinical decisions. We herein review these advances in disease and pathophysiologic understanding and the associated clinical crossroads through a typical case vignette in the critical care setting.

【 授权许可】

CC BY