nidНефрология и диализNephrology and Dialysis1680-44222618-9801Российское диализное обществоnid-1546Research ArticleШКОЛА НЕФРОЛОГАEDUCATIONAL MATERIALSКонтраст-индуцированная нефропатия: патогенез, факторы риска, стратегия профилактики (часть II)Contrast induced nephropathy: pathogenesis, risk factors, and prevention strategiesВолгинаГ. В.VolginaG. V.volginagv@mail.ruМосковский государственный медико-стоматологический университет, г. МоскваRussian Federation20062306202582176183Copyright © Волгина Г.В., 20252025Волгина Г.В.Volgina G.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephro.ru/jour/article/view/1546

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 м2), 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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The authors declare that there are no conflicts of interest present.