J Pediatr Intensive Care 2014; 03(02): 045-052
DOI: 10.3233/PIC-14090
Review
Georg Thieme Verlag KG Stuttgart – New York

Contrast nephropathy in children

Priya S. Verghese
a   University of Minnesota Children's Hospital, Minneapolis, MN, USA
b   Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
› Institutsangaben

Verantwortlicher Herausgeber dieser Rubrik:
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Publikationsverlauf

15. Juli 2014

16. September 2014

Publikationsdatum:
28. Juli 2015 (online)

Abstract

Contrast-induced nephropathy (CIN) remains a common and potentially serious complication in at risk patients after exposure to contrast agents. Risk factors for CIN include chronic kidney disease, hypotension, diabetes mellitus, recent previous exposure to contrast and all of these are potentially additive. Therefore, careful pre-procedural risk stratification is important. In high-risk patients, contrast should be avoided if possible. If avoidance is not possible, the volume of contrast should be minimized and the type of contrast used should if possible be non-ionic iso-osmolar contrast. In view of the clinical importance of CIN, numerous potential risk-reduction strategies have been evaluated. Adequate intravenous volume expansion with isotonic crystalloid (1.0–1.5 mL/kg per hr) for 3–12 hr before the procedure and continued for 6–24 hr afterward can lessen the probability of CIN in patients at risk. But there are insufficient data on oral fluids as a preventive strategy. Nephrotoxic drugs should be withdrawn before contrast administration in patients at risk for CIN. No adjunctive medical or mechanical treatment has been proved to be efficacious in reducing risk for CIN including prophylactic hemodialysis and hemofiltration, N-acetylcysteine, fenoldopam, dopamine, calcium channel blockers, atrial natriuretic peptide, and L-arginine. The CIN Consensus Working Panel considered that, of the pharmacologic agents that have been evaluated, theophylline, 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins), ascorbic acid, and prostaglandin E deserve further evaluation.