Контраст-индуцированная нефропатия: патогенез, факторы риска, стратегия профилактики (часть II)
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 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.
Об авторе
Г. В. Волгина
Московский государственный медико-стоматологический университет, г. Москва
Россия
Россия
Список литературы
1. Abizaid A.S., Clark C.E., Mintz G.S. et al. Effects of dopamine and aminophylline on contrast induced acute renal failure after coronary angioplasty in patients with preexisting renal insufficiency. Am J Cardiol 1999; 83: 260-263.
2. Agrawal M., Stouffer G.A. Contrast induced nephropathy after angiography. Am Med Sci 2002; 323(5): 252-255.
3. Allaqaband S., Tumuluri R., Malik A.M. et al. Prospective randomized study of N-acetylcysteine, fenoldopam, and saline for prevention of radiocontrast-induced nephropathy. Cathet Cardiovasc Intervent 2002; 57: 279-283.
4. Aspelin P., Aubry P., Fransson S.G. et al. Nephrotoxic effects in high-risk patients undergoing angiography. N Engl J Med 2003; 348(6): 491-489.
5. Barrett B.J., Parfrey P.S. Prevention of nephrotoxicity induced by radiocontrast agents. N Engl J Med 1994; 331: 1449-1450.
6. Barrett B.J. Contrast nephrotoxicity. J Am Soc Nephrol 1994; 5: 125-137.
7. Boccalandro F., Amhad M., Smalling R.W., Sdringola S. Oral acetylcysteine does not protect renal function from moderate to high doses of intravenous radiographic contrast. Cathet Cardiovasc Intervent 2003;58: 336-341.
8. Briguori C., Manganelli F., Scarpato P. et al. Acetylcysteine and contrast agent-associated nephrotoxicity. J Am Coll Cardiol 2002; 40: 298-303.
9. Chalmers N., Jackson R.W. Comparison of iodixanol and iohexol in renal impairment. Br J Radiol 1999; 72: 701-703.
10. Cox C.D., Tsikouris J.P. Preventing contrast nephropathy: what is the best strategy? A review of the literature. J Clin Pharmacol 2004; 44: 327-337.
11. Diaz-Sandoval L.J., Kosowsky B.D., Losordo D.W. Acetylcysteine to prevent angiography-related renal tissue injury (the APART trial). Am Coll Cardiol 2002; 89(3): 356-358.
12. Erley C.M., Duda S.H., Rehfuss D. et al. Prevention of radiocontrast-media-induced nephropathy in patients with pre-existing renal insufficiency by hydration in combination with the adenosine antagonist theophylline. Nephrol Dial Transplant 1999;14: 1146-1149.
13. Erley C.M., Duda S.H., Schlepckow S. et al. Adenosine antagonist theophylline prevents the reduction of glomerular filtration rate after contrast media application. Kidney Int 1994; 45: 1425-1431.
14. Esnault V.L. Radiocontrast media-induced nephrotoxicity in patients with renal failure: rationale for a new double-blind, prospective, randomized trial testing calcium channel antagonists. Nephrol Dial Transplant 2002;17: 1362-1364.
15. Esplugas E., Cequier A., Gomez-Hospital J.A. et al. Comparative tolerability of contrast media used for coronary interventions. Drug Saf 2002; 25(15): 1079-1098.
16. Gare M., Haviv Y.S., Ben-Yehuda A. et al. The renal effect of low-dose dopamine in high-risk patients undergoing coronary angiography. J Am Coll Cardiol 1999; 34: 1682-1688.
17. Gupta R.K., Kapoor A., Tewari S. et al. Captopril for prevention of contrast-induced nephropathy in diabetic patients: a randomised study. Indian Heart J 1999; 51: 521-526.
18. Hans S.S., Hans B.A., Dhillon R., Dmuchowski C., Glover J. Effect of dopamine on renal function after arteriography in patients with preexisting renal insufficiency. Am Surg 1998; 64: 432-436.
19. Heyman S.N., Reichman J., Brezis M. Pathophysiology of radiocontrast nephropathy: a role for medullary hypoxia. Invest Radiol 1999; 34: 685-691.
20. Huber W., Ilgmann K., Page M. Effect of theophylline on contrast material-induced nephropathy in patients with chronic renal insufficiency: controlled, randomized, double-blinded study. Radiology 2002; 223: 772-779.
21. Huber W., Jeschke B., Page M. et al. Reduced incidence of radiocontrast-induced nephropathy in ICU patients under theophylline prophylaxis: a prospective comparison to series of patients at similar risk. Intensive Care Med 2001; 27: 1200-1209.
22. Jones A., Haynes W., MacGilchrist A.J. et al. N-acetyl-cysteine (NAC) is a potent peripheral vasodilator [abstract]. Gut 1994; 35(Suppl. 5): S10.
23. Kapoor A., Sinha N., Sharma R.K. et al. Use of dopamine in prevention of contrast induced acute renal failure: a randomized study. Int J Cardiol 1996; 53: 233-236.
24. Kapoor, Kumar S., Gulati S. et al. The role of theophylline in contrast-induced nephropathy: a case-control study Nephrol Dial Transplant 2002; 17: 1936-1941.
25. Katholi R.E., Taylor G.J., McCann W.P. et al. Nephrotoxicity from contrast media: attenuation with theophylline. Radiology 1995;195: 17-22.
26. Kay J., Chow W.H., Chan T.M. et al. Acetylcysteine for prevention of acute deterioration of renal function following elective coronary angiography and intervention: a randomized controlled trial. JAMA 2003; 289: 553-538.
27. Kini A.S., Mitre C.A., Kamran M. et al. Changing trends in incidence and predictors of radiographic contrast nephropathy after percutaneous coronary intervention with use of fenoldopam. Am J Cardiol 2002; 89: 999-1002.
28. Kini A.S., Mitre C.A., Kim M., Kamran M. et al. A protocol for prevention of radiographic contrast nephropathy during percutaneous coronary intervention: effect of selective dopamine receptor agonist fenoldopam. Cathet Cardiovasc Intervent 2002; 55: 169-173.
29. Koch J.A., Plum J., Grabensee B. et al. Prostaglandin E1: a new agent for the prevention of renal dysfunction in high risk patients caused by radiocontrast media? Nephrol Dial Transplant 2000; 15: 43-49.
30. Korr K.S., Reitman A. Renal implications of percutaneous coronary intervention. Semin Nephrol 2001; 21(1): 36-46.
31. Kurnik B.R., Allgren R.L., Genter F.C. et al. Prospective study of atrial natriuretic peptide for the prevention of radiocontrast-induced nephropathy. Am J Kidney Dis 1998; 31(4): 674-80.
32. Liss P., Carlsson P.O., Nygren A. et al. ET-A receptor antagonist BQ123 prevents radiocontrast media-induced renal medullary hypoxia. Acta Radiologica 2003; 44: 111-117.
33. Maddox T.G. Adverse reactions to contrast material: recognition, prevention, and treatment. Am Fam Physician 2002;66: 1229-1234.
34. Madyoon H., Croushore L., Weaver D., Mathur V. Use of fenoldopam to prevent radiocontrast nephropathy in high-risk patients. Cathet Cardiovasc Intervent 2001; 53: 341-345.
35. Marenzi G., Marana I., Lauri G. et al. The prevention of radiocontrast-agent-induced nephropathy by hemofiltration. N Engl J Med 2003; 349:1333-1340.
36. Mehran R., Aymong E.D., Nikolsky E. et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol 2004; 44: 1393-1399.
37. Merten G.J., Burgess W.P., Gray L.V. et al. Prevention of contrast-induced nephropathy with sodium bicarbonate: a randomized controlled trial. JAMA 2004; 291: 2328-2334.
38. Morcos S.K., Thomsen H.S., Webb J.A.W. and members of contrast media safety committee of the European Society of Urogenital Radiology (ESUR). Contrast media induced nephrotoxicity: A consensus report. Eur Radiol 1999; 9:1602-1613.
39. Muller C., Buerkle G., Buettner H. et al. Prevention of contrast media-associated nephropathy: randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty. Arch Intern Med 2002; 162: 329-336.
40. Murphy S.W., Barrett B.J., Parfrey P.S. Contrast nephropathy. J Am Soc Neprol 2000; 11: 177-182.
41. Neumayer H.H., Junge W., Kufner A., Wening A. Prevention of radiocontrast-media-induced nephrotoxicity by the calcium channel blocker nitrendipine: a prospective randomised clinical trial. Nephrol Dial Transplant 1989; 4: 1030-1036.
42. Rezkalla S.H. Contrast Nephropathy. Clinical Medicine 2003; (1): 301-304.
43. Rodicio J.L., Morales J.M., Ruilope L.M. Calcium antagonists and the kidney. Nephrol Dial Transplant 1990; 5: 81-86.
44. Rudnick M.R., Goldfarb S., Wexler L. et al. Nephrotoxicity of ionic and non-ionic contrast media in 1196 patients: a randomized trial. Kidney Int 1995; 47: 254-261.
45. Russo D., Testa A., Della Volpe L., Sansone G. Randomised prospective study on renal effects of two different contrast media in humans: protective role of a calcium channel blocker. Nephron 1990; 55: 254-257.
46. Shammas N.W., Kapalis M.J., Harris M. et al. Aminophylline does not protect against radiocontrast nephropathy in patients undergoing percutaneous angiographic procedures. J Invas Cardiol 2001; 13: 738-740.
47. Shyu K.G., Cheng J.J., Kuan P. Acetylcysteine protects against acute renal damage in patients with abnormal renal function undergoing a coronary procedure. J Am Coll Cardiol 2002; 40: 1383-1388.
48. Solomon R., Werner C., Mann D., D'Elia J., Silva P. Effects of saline, mannitol, and furosemide on acute decreases in renal function induced by radiocontrast agents. N Engl J Med 1994; 331(21): 1416-1420.
49. Spangberg-Viklund B., Berglund J., Nikonoff T. et al. Does prophylactic treatment with felodipine, a calcium antagonist, prevent low-osmolar contrast induced renal dysfunction in hydrated diabetic and nondiabetic patients with normal or moderately reduced renal function? Scand J Urol Nephrol 1996; 30: 63-68.
50. Stemer G., Frennby B., Kukus J., Nyman U. Does post-angiographic hemodialysis reduce the risk of contrast medium nephropathy? Scand Urol Nephrol 2000; 34: 323-326.
51. Stevens M, McCullough P, Tobin K. et al. A prospective randomized trial of prevention measures in patients at high risk for contrast nephropathy. J Am Coll Cardiol 1999; 33: 403-411.
52. Stone G., McCullough P., Tumlin J. et al. Fenoldopam mesylate for the prevention of contrast-induced nephropathy: a randomized controlled trial. JAMA 2003; 290: 2284-2291.
53. Stone G.W., McCullough P., Tumlin J. et al. A prospective, randomized placebo-controlled multicenter trial evaluating fenoldopam mesylate for the prevention of contrast induced nephropathy: the CONTRAST trial [abstract]. J Am Coll Cardiol 2003; 41(6): 84A-85A.
54. Tepel M., van der Giet M., Schwarzfeld C. et al. Prevention of radiographic-contrast-agent-induced reductions in renal function by acetylcysteine. N Engl J Med 2000;343:180-184.
55. Thomsen H.S., Morcos S.K. Contrast media and the kidney: European Society of Urogenital Radiology (ESUR) Guidelines. British Journal of Radiology 2003; 76: 513-518.
56. Trivedi H.S., Moore H., Nasr S. et al. A randomized prospective trial to assess the role of saline hydration on the development of contrast nephrotoxicity. Nephron Clin Pract 2003; 93(1): 29-34.
57. Tumlin J.A., Wang A., Murray P.T., Mathur V.S. Fenoldopam mesylate blocks reductions in renal plasma flow after radiocontrast dye infusion: a pilot trial in the prevention of contrast nephropathy. Am Heart J 2002; 143: 894-903.
58. Wang A., Holcslaw T., Bashore T.M. et al. Exacerbation of radiocontrast nephrotoxicity by endothelin receptor antagonism. Kidney Int 2000; 57: 1675-1680.
59. Waybill M.M., Waybill P.N. Contrast media-induced nephrotoxicity: identification of patients at risk and algorithms for prevention. J Vasc Interv Radiol 2001; 12: 3-9.
60. Weinstein J.M., Heyman S., Brezis M. Potential deleterious effect of furosemide in radiocontrast nephropathy. Nephron 1992; 62: 413-415.
61. Weisberg L.S., Kurnik P.B., Kurnik B.R. Risk of radiocontrast nephropathy in patients with and without diabetes mellitus. Kidney Int 1994; 45: 259-265.
62. Wilfling M., Kampf D., Jun M.S., Junge W. Nitrendipine and nephrotoxicity of non-ionic contrast media: a randomized controlled clinical trial. J Am Soc Nephrol 1991; 3: 671-679.
Рецензия
Для цитирования:
Волгина Г.В. Контраст-индуцированная нефропатия: патогенез, факторы риска, стратегия профилактики (часть II). Нефрология и диализ. 2006;8(2):176-183.
For citation:
Volgina G.V. Contrast induced nephropathy: pathogenesis, risk factors, and prevention strategies. Nephrology and Dialysis. 2006;8(2):176-183. (In Russ.)
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