Contrast nephropathy, pathophysiology and prevention

Heleen M. Oudemans-van Straaten*

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review


Contrast nephropathy is a common cause of iatrogenic acute renal failure. Its incidence rises with the growing use of intra-arterial contrast in diagnostic and interventional procedures. Aim of the present review is to summarize the knowledge about pathophysiology and prevention. Nephrotoxicity is related to osmolality, dose and route of the contrast and only occurs in synergy with other factors, such as previous renal impairment and cardiovascular disease. With an interplay of these factors, contrast nephropathy has an impact on morbidity and mortality. Pathophysiological mechanisms are intrarenal vasoconstriction, leading to medullary ischemia, direct cytotoxicity, oxidative tissue damage and apoptosis. Several measures are of proven benefit in patients at risk. Among them are discontinuation of potentially nephrotoxic drugs, hydration, preferably with isotonic sodium bicarbonate, use of low osmolal contrast, oral or intravenous N-acetylcysteine and intravenous theophylline. In patients with severe cardiac and renal dysfunction undergoing cardiac interventions, periprocedural hemofiltration may be considered.

Original languageEnglish
Pages (from-to)1054-1065
Number of pages12
JournalInternational Journal of Artificial Organs
Issue number12
Publication statusPublished - 1 Dec 2004

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