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Том 8 №2 2006 год - Нефрология и диализ

Контраст-индуцированная нефропатия: патогенез, факторы риска, стратегия профилактики (часть II)


Волгина Г.В.

Аннотация: Пациент 62 лет с хроническим гломерулонефритом и артериальной гипертензией с 40-летнего возраста страдал ИБС: стенокардией напряжения ФК II-III. Перенес инфаркт миокарда (в 48 и 61 год), осложнившийся хронической постинфарктной аневризмой передне-перегородочной и верхушечной областей левого желудочка сердца и развитием хронической сердечной недостаточности II ФК (NYHA). Больного продолжала беспокоить стенокардия, в связи с чем ему было предложено проведение коронарной ангиографии с целью дальнейшего оперативного лечения (аорто-коронарное шунтирование). Перед процедурой коронарной ангиографии уровни Cr в сыворотке крови 397 мкмоль/л (СКФ по Кокрофту-Голту 16 мл/мин/1,73 м ), гемоглобина - 94 г/л. Через двое суток после проведения ангиографического исследования уровень Cr в сыворотке крови превысил 1000 мкмоль/л и стали нарастать симптомы хронической сердечной недостаточности: появились одышка в покое, тахикардия, влажные мелкопузырчатые хрипы в легких, отеки ног, двухсторонний гидроторакс, увеличение размеров печени. Проводившееся лечение гемодиализом не привело к восстановлению исходной функции почек, и через 9 месяцев пациент умер при явлениях прогрессирующей сердечной недостаточности. Несомненно, резкое ухудшение состояния, приведшее к летальному исходу, было спровоцировано введением рентгеноконтрастного средства при коронарографическом исследовании, развитием ОПН на фоне предшествующего нарушения функции почек. Учитывая трудности, возникающие при обследовании и лечении подобных пациентов, в данном обзоре поставлена задача проанализировать современные данные снижения риска контраст-индуцированной нефропатии.

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Ключевые слова: контраст-индуцированная нефропатия, факторы риска, методы профилактики

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