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Том 19 №3 2017 год - Нефрология и диализ

Современные представления о контраст-индуцированном остром почечном повреждении. Взгляд интервенционного радиолога


Хильчук А.А. Власенко С.В. Щербак С.Г. Сарана А.М. Бабунашвили А.М.

Аннотация: Клинически значимое контраст-индуцированное повреждение (КИ-ОПП) является тяжелым осложнением рентген-эндоваскулярных процедур и связана с высокими показателями заболеваемости, смертности и значимыми социо-экономическими потерями. Повреждение почек после выполнения коронароангиографии или чрескожного коронарного вмешательства может развиться в 1-2% случаев общей популяции и у почти 50% пациентов с высоким риском развития КИ-ОПП. Основным и частым фактором, предрасполагающим к развитию контраст-индуцированного острого почечного повреждения, является уже имеющееся снижение почечной функции. Раннее выявление пациентов высокого риска развития КИ-ОПП со сниженной почечной функцией крайне важно для своевременного начала профилактических мер и последующего снижения вероятности повреждения почечной паренхимы с дальнейшим ухудшением почечной функции. Быстрая или почти мгновенная реакция некоторых биологических маркеров на субклиническое острое почечное повреждение помогает в диагностике нефропатии и на сегодняшний день является перспективным направлением исследования. Несмотря на небольшое количество имеющихся различий в рекомендациях, существует несколько строгих позиций в профилактике и лечении контраст-индуцированной нефропатии. Внутривенная нагрузка 0,9% раствором NaCl является единственной доказанной эффективной мерой профилактики КИ-ОПП, в то время как иная фармакологическая поддержка требует дальнейшего изучения и проведения большего количества проспективных исследований. Данная статья посвящена обзору современной литературы, посвященной причинам, профилактике и лечению КИ-ОПП с позиции доказательной медицины.

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Ключевые слова: нефропатия, повреждение почек, контрастные вещества, биомаркеры почечного повреждения, nephropathy, renal damage, contrast media, renal damage biomarkers

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