Zusammenfassung
Die Kontrastmittelnephropathie (contrast-induced nephropathy, CIN) ist eine Komplikation der Gabe jodhaltiger Kontrastmittel. Sie ist für ca. 10% aller akuten Nierenversagen bei hospitalisierten Patienten verantwortlich. Trotz der niedrigen Inzidenz der Erkrankung können die Konsequenzen katastrophal sein: Verlängerung des Krankenhausaufenthalts, Dialysepflichtigkeit (ca. 0,8% vorübergehend, hiervon 13% dauerhaft) und Mortalitätssteigerung bis auf das 5-fache. Eine vorbestehende Niereninsuffizienz (insbesondere bei Diabetes mellitus), eine Herzinsuffizienz und die Art und Menge der gegebenen jodhaltigen Kontrastmittel sind einige der Risikofaktoren. Bisher konnten keine einheitlichen Richtlinien zur Prophylaxe entwickelt werden. Positive Effekte finden sich u. a. für die Gabe von N-Acetylcystein oder Theophyllin und für die Hämofiltration.
Zur Verhütung einer CIN sind folgende Maßnahmen praktikabel und empfehlenswert:
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strenge Indikationsstellung;
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evtl. Einsatz alternativer Verfahren (Sonographie, MRT, CO2-Angio etc.);
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Gabe von niedrigosmolarem Kontrastmittel in der geringstmöglichen Menge;
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Pausierung von NSAID und Metformin;
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Hydratation (NaCl 0,9% 1 ml/kg/h i.v. 12 h vor bis 12 h nach KM-Applikation);
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ACC 600 mg p.o. 2-mal tgl. am Vor- u. Untersuchungstag oder bei Notfalluntersuchungen und/oder Hochrisikopatienten i.v.-Gabe von 1200 mg i.v. direkt vor Intervention;
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Theophyllin p.o. am Abend vor und am Morgen des Untersuchungstages (250–350 mg) bei Notfalluntersuchung/ungenügender Vorbereitungszeit: Theophyllin 5 mg/kg KG i.v.-Kurzinfusion 30 min vor Untersuchung;
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Verlaufskontrolle des Serumkreatinins 24 und 48 h nach Untersuchung.
Abstract
Contrast-induced nephropathy (CIN) is a well-known complication of therapeutic and diagnostic procedures requiring contrast administration and accounts for 10% of acute renal failure in hospitalized patients. Although the incidence of this complication is relatively low, its consequences can be catastrophic. The development of CIN is associated with increased length of hospital stay, an increased requirement for acute dialysis, and an increased risk of death. Preexisting renal dysfunction, age, diabetes, congestive heart failure, and volume of administered contrast are all associated with a risk of developing CIN. Despite a large number of clinical trials that have evaluated prophylaxis strategies for CIN, no uniform strategies have been developed so far. The use of N-acetyl-L-cysteine (NAC) or theophylline in specific subgroups of patients has been shown to reduce dialysis requirement and mortality in patients undergoing angiographic procedures. Hemofiltration has also shown positive results. In this review we will discuss the epidemiology and the risk factors for CIN and the evidence for commonly employed prophylaxis strategies, and we will provide general recommendations with respect to CIN prevention and management.
A practicable strategy to prevent CIN includes: correct identification of individuals at greatest risk, thorough evaluation of whether other diagnostic maneuvers could be employed instead (i.e., sonography), application of low-osmolar contrast media at the minimum acceptable dose, stopping potential nephrotoxic drugs (NSAID), hydration with sodium chloride 0.9% 1 ml/kg per h i.v. 12 h before and after CM application, administration of acetylcysteine 600 mg twice the day before and after (in cases of emergency investigation and high-risk patients 1200 mg i.v.), and theophylline (250–350 mg) the day before and the day after CM application (in cases of emergency investigation 5 mg/kg i.v.).
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Erley, C. Mit jodhaltigen Kontrastmitteln induzierte Nephropathie. Radiologe 47, 761–767 (2007). https://doi.org/10.1007/s00117-007-1549-x
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DOI: https://doi.org/10.1007/s00117-007-1549-x
Schlüsselwörter
- Chronische Nierenerkrankung
- Kontrastmittelnephropathie
- Angiographie
- Kontrastmittelgabe
- Computertomographie (CT)
- Kontrastmittel