Contrast agents (also called contrast agents) are chemical products injected (or taken) into human tissues or organs to enhance image observation. The density of these products is higher or lower than that of the surrounding tissues, and the contrast formed can show the images of blood vessels and body cavities, which are widely used in enhanced CT, coronary angiography, interventional procedures, etc. There are various types of contrast agents, and the most commonly used contrast agents are mostly iodine-containing preparations.
Contrast agents are generally hypertonic, excreted in the body through the kidneys, and have nephrotoxicity, which can cause renal damage and acute renal failure. Contrast agent renal injury is defined as acute renal hypoperfusion caused by iodine contrast agents. An increase in serum creatinine of ≥ 25% compared to pre-contrast within 48-72 hours after contrast and an absolute increase of ≥ 0.5 mg/dl (44.2 umol/L) can be diagnosed as contrast renal injury.
Risk factors for the occurrence of contrast renal injury are.
(i) The presence of renal insufficiency.
② diabetes mellitus.
③ congestive heart failure.
④ age ≥ 75 years.
⑤ anemia.
(vi) reduced blood volume or dehydration.
⑦ hypotension.
⑧Concurrent application of other nephrotoxic drugs.
(⑨) Those who receive multiple radiographic contrast agents within a short period of time.
⑩High blood calcium, etc. For this part of the patients should weigh the pros and cons clinically, and actively prevent and treat contrast renal injury.
Commonly used prevention and control measures are.
1, preoperative comprehensive assessment of the pros and cons, avoid unnecessary application of contrast agents, avoid the application of nephrotoxic drugs, such as aminoglycosides, glycopeptide antibiotics, etc.
2. Hydration and alkalinization are generally considered to be the prevention and control measures for contrast renal injury, which generally starts 12 hours before contrast and lasts until 6-24 hours after contrast.
3.Select isotonic, non-ionic contrast agent and reduce the amount of contrast agent.
4.The application of antioxidants, such as oral N acetylcysteine.
5.The application of statins, which play a protective role by inhibiting the activity of NF-KB.
6, hemodialysis and hemofiltration, prophylactic dialysis does not reduce the incidence of contrast renal injury, when there is a serious contrast renal injury can be performed renal replacement therapy while observing the recovery of renal function.