Zusammenfassung.
Das durch Röntgenkontrastmittelgabe initiierte Nierenversagen, die sogenannte Kontrastmittelnephropathie
(KMN), stellt - insbesondere bei Patienten mit eingeschränkter Nierenfunktion - nach
wie vor ein erhebliches medizinisches Problem dar, dessen Auftreten mit einer deutlich
erhöhten Krankenhausmortalität verbunden ist. Die Genese der KMN ist nach wie vor
nicht eindeutig geklärt. Neben hämodynamischen Veränderungen durch die Kontrastmittel
spielen tubulotoxische Schäden eine Rolle. Die vorliegende Übersicht beschreibt die
zur Zeit bekannten pathophysiologischen Vorgänge bei der KMN und die möglichen Präventivmaßnahmen
mit besonderem Augenmerk auf die klinisch relevanten Themen der Hydratation, der prophylaktischen
Gabe vasoaktiver Substanzen, den Einsatz alternativer Kontrastmittel und die Entfernung
von Röntgenkontrastmitteln (KM) mittels Hämodialyse.
Contrast media in renal insufficiency - risk and prevention.
The use of iodinated contrast media (CM) continues to be a common cause of hospital-acquired
acute renal failure (ARF) and its development increases the in-hospital mortality
significantly. Alterations in renal hemodynamics and direct tubular toxicity by contrast
media are the primary factors believed to be responsible for contrast media-associated
nephrotoxicity. We review recent insights into the pathogenesis of this complication
and summarize prophylactic strategies focussing on hydration, vasoactive pharmacological
agents, alternative contrast media and “prophylactic hemodialysis”.
Schlüsselwörter:
Kontrastmittelnephropathie - Hämodialyse - Atrialer Natriuretischer Faktor - Hydratation
- Theophyllin - Dopamin
Key words:
Contrast media nephropathy - Theophylline - Hemodialysis - Natriuretic peptide - Hydration
- Dopamine
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Priv. Doz. Dr. Christiane M. Erley
Universität Tübingen Abteilung Innere Medizin III
Otfried-Müller-Straße 10
72076 Tübingen
Phone: 07071-29-83469
Fax: 07071-29-2716
Email: christiane.erley@med.uni-tuebingen.de
