Ces radiol. 2007, 61(1):27-31
Contrast agent-induced nephropathy: is there any option for specific influence factor? What do we think about N-acetylcysteineSpecial focus
- 1 Klinika kardiologie IKEM, Praha
- 2 Základna radiodiagnostiky a intervenční radiologie IKEM, Praha
The deleterious effect of contrast agents on renal function, particularly in patients with preexisting renal disease, is well known. Potential preventive options include selection of a modern non-ionic contrast agent, reduction of the volume administered, and targeted regulation of the patient's homeostasis and metabolism. Regarding to various recommendations, patients will clearly benefit from adequate hydration and, possibly, from N-acetylcysteine administration. The role of N-acetylcysteine has not been clearly defined to date. The paper summarizes some opinions appearing in the literature as perceived in the light of the authors' own experience with administering the agent in various situations.
Keywords: N-acetylcysteine, non-ionic contrast agent, contrast-induced nephropathy
Accepted: April 20, 2006; Published: March 1, 2007 Show citation
References
- Go AS, Chertow GM, D Fan, McCulloch CE, Hsu C. Chronic kidney disease and risk of death, cardiovascular events, and hospitalization. N Engl J Med 2004; 351: 1296-1305.
Go to original source...
Go to PubMed...
- Jabor A, Hornová L, Bořil P, Moravcová H, Fischlová D. Rovnice MDRD: pro a proti. Klin Biochem Metab 2005; 4: 172-176.
Go to original source...
- Di Mari J, Megyesi J, Udvarhelyi N, Price P, Davis R, Safirstein R. N-acetylcysteine ameliorates ischemic renal failure. Am J Physiol 1997; 272: F292-F298.
Go to original source...
Go to PubMed...
- Bergstroem L, Kagedal B, Paulsen. Pharmacokinetics of N-acetylcysteine in man. Eur J Clin Pharmacol 1986; 31: 217-222.
Go to original source...
Go to PubMed...
- Tepel M, van der Giet M, Schwarzfeld C, Laufer U, Liermann D, Zidek W. Prevention of radiographic-contrast-agent-induced reductions in renal function by acetylcysteine. N Engl J Med 2000; 343: 180-184.
Go to original source...
Go to PubMed...
- Durham JD, Caputo C, Dokko J, Zaharakis T, Pahlavan M, Keltz J, Dutka P, Marzo K, Mesaka JK, Fishbane S. A randomized controlled trial of N-acetylcysteine to prevent contrast nephropathy in cardiac angiography. Kidney Int 2002; 62: 2202-2207.
Go to original source...
Go to PubMed...
- Fishbane S, Durham JH, Marzo K, Rudnick M. N-acetylcysteine in the prevention of radiocontrast-induced nephropathy. J Am Soc Nephrol 2004; 15: 251-260.
Go to original source...
Go to PubMed...
- Hoffmann U, Banas B, Fischereder M, Kramer BK. N-acetylcysteine in the prevention of radiocontrast-induced nephropathy: clinical trials and end points. Kidney Blood Press Res 2004; 27: 161-166.
Go to original source...
Go to PubMed...
- Morcos SK. Prevention of contrast media-induced nephrotoxicity after angiographic procedures. J Vasc Interv Radiol 2005; 16: 13-23.
Go to original source...
Go to PubMed...
- Tepel M, Zidek W. N-acetylcysteine in nephrology; contrast nephropathy beyond. Curr Opinion Nephrol Hypertens 2004; 13: 649-654.
Go to original source...
Go to PubMed...
- Thomsen HS. Contrast-medium induced nephrotoxicity: Are all answers for acetylcysteine? Eur Radiol 2001; 11: 2351-2353.
Go to original source...
Go to PubMed...
- Sochman J, Kolc J, Vrana M, Fabian J. Cardioprotective effects of N-acetylcysteine: the reduction in the extent of infarction and occurence of reperfusion arrhythmias in the dog. Int J Cardiol 1990; 28: 191-196.
Go to original source...
Go to PubMed...
- Sochman J, Vrbska J, Musilova B, Rocek M. Infarct size limitation: acute N-acetylcysteine defense (ISLAND trial). Preliminary analysis and report after the first 30 patients. Clin Cardiol 1996; 19: 94-100.
Go to original source...
Go to PubMed...
- Sochman J. N-acetylcysteine in acute cardiology: 10 years later. What do we know and what would we like to know? J Am Coll Cardiol 2002; 39: 1422-1428.
Go to original source...
Go to PubMed...
- Sochman J, Krizova B. Prevention of contrast agent-induced renal impairment in patients with chronic renal insufficiency and heart disease by N-acetylcysteine in high intravenous dose: A pilot-ministudy. Pol Heart J 2006; 64: 559-564.
- Yoshimasa Y, Fogo A, Beltman JK. Reduced activity of antioxidant enzymes underlies contrast media-induced renal injury in volume depletion. Kidney Int 1992; 41: 1008-1015.
Go to original source...
Go to PubMed...
- Russo D, Minutolo R, Cianciaruso B, Memoli B, Conte G, De Nicola L. Early effects of contrast media on renal haemodynamics and tubular function in chronic renal failure. J Am Soc Nephrol 1995; 61: 1451-1458.
Go to original source...
Go to PubMed...
- Brezis M, Heyman SN, Epstein FH. Determinants of intrarenal oxygenation. II. Haemodynamic effects. Am J Physiol 1994; 267: 1063-1068.
Go to original source...
Go to PubMed...
- Heyman SN, Brezis M, Epstein FH, Spokes K, Silva P, Rosen S. Early medullary hypoxic injury from radiocontrast and indomethacin. Kidney Int 1991; 40: 632-642.
Go to original source...
Go to PubMed...
- Agmon Y, Peleg H, Greenfeld Z, Rosen S, Brezis M. Nitric oxide and prostanoids protect the renal outer medulla from radiocontrast toxicity in the rat. J Clin Invest 1994; 94: 1069-1075.
Go to original source...
Go to PubMed...
- Cantley LG, Spokes K, Clark BA, Mc Mahon EG, Carter J, Epstein FH. Role of endotelin and prostaglandins in radiocontrast-induced renal artery constriction. Kidney Int 1993; 44: 1217-1223.
Go to original source...
Go to PubMed...
- Solomon RC. Contrast-medium-induced acute renal failure. Kidney Int 1998; 53: 230-242.
Go to original source...
Go to PubMed...
- Weisberg LS, Kurnik PB, Kurnik BR. Radiocontrast-induced nephropathy in humans. Role of renal vasoconstriction. Kidney Int 1992; 41: 1408-1415.
Go to original source...
Go to PubMed...
- Rudnick MR, Goldfarb S, Wexler L, Ludbrook PA, Murphy MJ, Halpern EF, Hill JA, Winniford M, Cohen MB, Van Fossen DB. Nephrotoxicity of ionic and nonionic contast media in 1196 patients: A randomized trial. The Iohexol Cooperative Study. Kidney Int 1995; 47: 254-261.
Go to original source...
Go to PubMed...
- Dangas G, Iakovou I, Nikolsky E, Aymong ED, Mintz GS, Kipshidze NN, Lansky AJ, Moussa I, Stone GW, Moses JW, Leon MB, Mehran R. Contrast-induced nephropathy after percutaneous coronary interventions in relation to chronic kidney disease and hemodynamic variables. Am J Cardiol 2005; 95: 13-19.
Go to original source...
Go to PubMed...
- Nikolsky E, Mehran R, Turcot D, Aymong ED, Mintz GS, Lasic Z, Lansky AJ, Tsounias E, Moses JW, Stone GW, Leon MB, Dangas D. Impact of chronic kidney disease on prognosis of patients with diabetes mellitus treated with percutaneous coronary intervention. Am J Cardiol 2004; 94: 300-305.
Go to original source...
Go to PubMed...
- Davidson CJ, Hlatky M, Morris KG, Pieper K, Skelton TN, Schwab SJ, Bashore TM. Cardiovascular and renal toxicity of a nonionic radiographic contrast agent after cardiac catheterization. Ann Int Med 1989; 110: 119-124.
Go to original source...
Go to PubMed...
- Katholi RE, Taylor GJ, McCann WP, Woods WT, Womack KA, McCoy CD, Katholi CR, Moses HW, Mishel GJ, Lucore CL. Nephrotoxicity from contrast media. Attenuation with theophylline. Radiology 1995; 195: 7-22.
Go to original source...
Go to PubMed...
- Manske CL, Sprafka JM, Strony JT. Contrast nephropathy in azotemic diabetic patients undergoing coronary angiography. Am J Med 1990; 89: 615-620.
Go to original source...
Go to PubMed...
- Nunez BD, Allon M. Effect of cardiac catheterization on renal function. Clin Nephrol 1990; 34: 263-266.
- Parfrey PS, Griffiths SM, Barrett BJ, Paul MD, Genge M, Withers J, Farid N, McManamon PJ. Contrast material-induced-renal failure in patients with diabetes mellitus, renal insufficiency, or both. N Engl J Med 1989; 320: 143-149.
Go to original source...
Go to PubMed...
- Tepel M, van der Giet M, Statz M, Jankowski J, Zidek W. The antioxidant acetylcysteine reduces cardiovascular events in patients with end-stage renal failure: a randomized, controlled trial. Circulation 2003; 107: 992: 995.
Go to original source...
Go to PubMed...
- Shyu KG, Cheng JJ, Kuan P. N-acetylcysteine protects against acute renal damage in patients with abnormal renal function undergoing a coronary procedure. J Am Coll Cardiol 2002; 40: 1383-1388.
Go to original source...
Go to PubMed...
- Hoffmann U, Fischereder M, Kruger B, Drobnik W, Kramer BK. The value of N-acetylcysteine in the prevention of radiocontrast agent-induced nephropathy seems questionable. J Am Soc Nephrol 2004; 15: 407-410.
Go to original source...
Go to PubMed...
- Diaz-Sandoval LJ, Kosowsky BD, Losordo DW. Acetylcysteine to prevent angiography-related renal tissue injury. (The APART trial). Am J Cardiol 2002; 89: 356-358.
Go to original source...
Go to PubMed...
- Kandzari DE, Rebeiz AG, Wang A, Sketch MH Jr. Contrast nephropathy: an evidence-based approach to prevention. Am J Cardiovasc Drugs 2003; 3: 395-405.
Go to original source...
Go to PubMed...
- Kay J, Chow WH, Chan TM, Lo SK, Kwok OH, Yip A, Fan K, Lee CH, Lam WF. Acetylcysteine for prevention of acute deterioration of renal function following elective coronary angiography and interventions: A randomized controlled trial. JAMA 2003; 289: 553-558.
Go to original source...
Go to PubMed...
- Briguori C, Colombo A, Violante A, Balestrieri P, Manganelli F, Elia PP, Golia B, Lepore S, Riviezzo G, Scarpato P, Focaccio A, Librera M, Bonizzoni E, Ricciardelli B. Standard vs double dose of N-acetylcysteine to prevent contrast agent associated nephrotoxicity. Eur Heart J 2004; 25: 206-211.
Go to original source...
Go to PubMed...
- Briguori C, Manganelli F, Scarpato P, Elia PP, Golia B, Riviezzo G, Lepore S, Librera M, Villari B, Colombo A, Ricciardelli B. Acetylcysteine and contrast agent-associated nephrotoxicity. J Am Coll Cardiol 2002; 40: 298-303.
Go to original source...
Go to PubMed...
- Alonso A, Lau J, Jaber BL, Weintraub A, Sarnak MJ. Prevention of radiocontrast nephropathy with N-acetylcysteine in patients with chronic kidney disease: a meta-analysis of randomized, controlled trials. Am J Kidney Dis 2004; 43: 1-9.
Go to original source...
Go to PubMed...
- Birck R, Krzossok S, Markowetz F, Schnulle P, van der Woude FJ, Braun C. Acetylcysteine for prevention of contrast nephropathy: Meta-analysis. Lancet 2003; 362(9384): 598-603.
Go to original source...
Go to PubMed...
- Briguori C, Colombo A, Airoldi F, Violante A, Castelli A, Balestrieri P, Elia PP, Golia B, Lepore S, Riviezzo G, Scarpato P, Librera M, Focaccio A, Ricciardelli B. N-acetylcysteine versus fenoldopam mesylate to prevent contrast agent-associated nephrotoxicity. J Am Coll Cardiol 2004; 44: 762-765.
Go to original source...
Go to PubMed...
- Boesgaard S, Aldershvile J, Poulsen HE, Christensen S, Digepetersen H, Giese J. N-acetylcysteine inhibits angiotensin converting enzyme in vivo. J Pharmacol Exp Therap 1993; 265: 1239-1244.
Go to original source...
- Mayer M, Noble M. N-acetyl-L-cysteine is a pluripotent protector against cell death and enhancer of trophic-mediated cell survival in vitro. Proc Natl Acad Sci 1994; 7: 7496-7500.
Go to original source...
Go to PubMed...
This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits use, distribution, and reproduction in any medium, provided the original publication is properly cited. No use, distribution or reproduction is permitted which does not comply with these terms.