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Contrast-induced nephropathy _46304

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					?Oliguria, sodium bicarbonate, checking, hydration, patients




?Contrast-induced nephropathy

?

Contrast-induced nephropathy (CIN) means no other reasons can be
explained by contrast applied new renal insufficiency, or renal
dysfunction, renal deterioration. At present, many believe that
exclude other CIN cause kidney damage, after intravenous injection of
iodine contrast agents within 72 hours after the occurrence of acute
kidney injury (AKI), General quantitative criteria for serum
creatinine (SCr) level 0.5 ~ 1 mg/dl (44.2 ~ 88.4 μ m o l/L) or
higher than the underlying value of 25% to 50%. Nearly five years of
application of the more sensitive, i.e., the standard defines the CIN
SCr elevated 0.5 mg/dl (44.2 μ m o l/L) or higher than 25% of the
underlying value. In contrast to all applications in the incidence of
CIN is about 1% to 6% in the previous renal insufficiency patients,
the incidence of up to 40%-50%. CIN is not only obvious extension of
stay, in patients with increased medical costs, a significant
increase in the mortality rate, especially after using contrast CIN
requires dialysis ' cumulative mortality of up to 45%. Weifang city
hospital paediatric spectacular figure

The pathogenesis of contrast nephropathy

Almost all accept intravascular contrast injection in patients with a
transient glomerular filtration rate (GFR) declined, but does occur
with clinical significance of AKI, depends on the existence of
certain patients with risk factors, such as chronic renal failure,
diabetes, congestive heart failure, high-dose use of contrast agents,
etc. CIN demonstrated more for non-oliguric-AKI, SCr level usually in
contrast after 24-48 hours, 3-5 days to reach peak performance for
some patients with urine test abnormal, urinary osmolality, nag,
urinary sodium excretion in urine and the majority of patients in
contrast 7 ~ 10 days later, renal function back to the original level.
Therefore, if in contrast after 1 week without kidney function
checked and urine examination, diagnosis or CIN is extremely easy.
About 2% of the patients with CIN demonstrated to oliguria-AKI,
oliguria duration and SCr level depends on the patient's renal
function level, based on approximately 30% of the patients left the
different degrees of renal insufficiency, less than 1% of patients in
need of renal replacement therapy.


      Figure contrast induced AKI pathophysiological hypotheses

Contrast-induced nephropathy prevention

At present, to a certain extent can prevent AKI measures include: ①
adequate hydration during the perioperative period, ② to minimize
the amount of contrast, ③ using isotonic (such as iodine fixa
alcohol) or low contrast agent (such as iopamidol), etc. In addition,
prevention of hemodialysis may be useful.

The following measures may increase the risk of occurrence of AKI:
the use of dopamine, mannitol, furosemide, atrial natriuretic
peptides, endothelin receptor antagonist (mixed), calcium antagonists,
comparison, etc.

Adequate hydration during the perioperative period

In AKI preventive measures, adequate hydration during the
perioperative period. Non-restrictive effect of oral rehydration than
intravenous rehydration, often using intravenous hydration. Study
shows and intravenous hydration hydration when compared to oral serum
creatinine values more than mg/dl of 0.5 patients significantly
elevated (34.6% on 3.7%).

Inpatient intravenous hydration should be 3 ~ 12 hours before start,
maintained until after 6 ~ 24 hours [1.0 ~ 1.5 ml/(kg · h)],
outpatients preoperative hydration should start, for 3 hours until 6
hours after the operation.

Miller (Mueller), discovery, and use 0.9% sodium chloride, NaCl 0.45%
patients hydration, angiography and 48 hours after elevated levels of
serum creatinine > 0.5 mg/dl of patients (2.0% on 0.7%, P = 0.04),
as a result, the current use of hydration 0.9% sodium chloride.

At present, about 0.9% sodium chloride sodium bicarbonate and
preventive effect on the pros and cons of AKI no consolidated
conclusions, but most studies have shown that lowering the incidence
of AKI, sodium bicarbonate may be preferable over 0.9% sodium
chloride.

In addition, adequate hydration shall be combined with individual
treatment, etc.



Keywords:
?Oliguria, sodium bicarbonate, checking, hydration, patients

				
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