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Was ist geischert in der Prävention der Kontrastmittelnephropathie?

Prevention of radiocontrast nephropathy — What are the facts?

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Zusammenfassung

Eine der wichtigsten Kontrastmittelnebenwirkungen ist die akute Verschlechterung einer bereits bestehenden Nierenfunktionseinschränkung. Die Inzidenz liegt in Abhängigkeit der Grunderkrankung zwischen 20% und 100%. In experimentellen und klinischen Studien wurden zahlreiche medikamentöse Therapieansätze zur Prävention der Kontrastmittelnephropathie untersucht. In der vorliegenden übersicht werden diese Maßnahmen hinsichtlich ihrer klinischen Relevanz bewertet. Als Schlußfolgerung dieser Studien kann als einzig gesicherte Maßnahme zur Protektion der Kontrastmittelnephropathie bei Risikopatienten (Ausgangskreatinin > 1,5 mg/dl) eine ausreichende Hydratation empfohlen werden. Sie wird mit 1 ml/kg KG/h mittels 0,45% NaCl zwölf Stunden vor und nach Kontrastmittelapplikation durchgeführt. Bei Patienten mit höhergradiger Nierenfunktionseinschränkung (Serumkreatinin > 3,5 mg/dl) und gleichzeitigem Vorliegen einer zusätzlichen Risikokonstellation (zum Beispiel Diabetes mellitus) wird eine Hämodialysebehandlung nach Kontrastmittelgabe empfohlen. Der Wertr der Dialysebehandlung ist allerdings nicht durch kontrollierte Studien gesichert.

Summary

Nephropathy is one of the most important side effects of radiocontrast in patients with impaired renal function. Incidence is reported from 20% to 100%, depending on underlying disease. For prevention of radiocontrast nephropathy a large number of substances were investigated in experimental and clinical studies. Clinical relevance of this findings will be assessed by this article. In summary of these studies hydration is the most relevant and significant measure for prevention of radiocontrast nephropathy in patients at risk (i. e. serum creatinine > 1,5 mg/dl). 1 ml/kg body weight/h with 0,45% NaCl 12 h before and after administration of radiocontrast should be supplied. Hemodialysis is recommended if impaired renal function (serum creatinine > 3,5 mg/dl) is accompanied by additional risk factors, e. g. diabetes mellitus. The impact of dialysis therapy is not clarified by clinical studies.

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  1. Abteilung für Innere Medizin IV-Nieren- und Hochdruckkrankheiten, Universitätsklinik des Saarlandes, D-66421, Homburg/Saar

    Christian Björn Friedrichsohn, Werner Riegel & Hans Köhler

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Friedrichsohn, C.B., Riegel, W. & Köhler, H. Was ist geischert in der Prävention der Kontrastmittelnephropathie?. Med Klin 92, 329–334 (1997). https://doi.org/10.1007/BF03044773

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