Kontrastmittel-induzierte Nephropathie

Zusammenfassung

Weltweit wird ein Zuwachs an diagnostischen und therapeutisch-angiologischen oder kardiologischen Katheteruntersuchungen unter Verwendung von Röntgenkontrastmitteln beobachtet, die erwartungsgemäß von einer Zunahme an Fällen von Röntgenkontrastmittel-induzierter Nephropathie begleitet wird. In diesem Artikel wird eine Übersicht über Pathogenese, Klinik und prophylaktischen Maßnahmen zur Prävention der Röntgenkontrastmittel-induzierten Nephropathie gegeben. Die wichtigsten prophylaktischen Maßnahmen bestehen in der Identifizierung von Risikopatienten, in einer strengen Indikationsstellung für den Einsatz von Kontrastmitteluntersuchungen und Prüfung alternativer diagnostischer Verfahren wie z. B. Angio-MRT, die Verwendung nicht-ionischer, niedrig-osmolarer oder - neuerdings - iso-osmolarer Kontrastmittel, und eine großzügige Hydrierung mit 0,9 %iger NaCl-Lösung vor/während der Intervention mit additiver Gabe von Acetylcystein.

Summary

The use of diagnostic and therapeutic catheterization is increasing and so is the exposure to radiocontrast media. As a consequence, an increasing incidence of contrast media-associated nephropathy is being observed. This article reviews pathogenesis, clinical symptoms and preventive measures of contrast media-associated nephropathy. Most important prophylactic measures is identification of high-risk patients, careful selection to be exposed to contrast media, application of non-ionic low osmolality or - most recently - iso-osmolality contrast media, adjusted hydration with isotonic saline before/during catheter interventions, and potentially the administration of acetylcysteine.

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