Contrast-induced nephropathy; A literature review

Context: Contrast–induced nephropathy (CIN) is a common cause of acute kidneydysfunction.Evidence Acquisitions: Directory of Open Access Journals, Google Scholar, PubMed, EBSCOand Web of Science have been searched. It is necessary to identify at risk patients at early stages to implement preventivestrategies to decrease the incidence of this nephropathy. However, mechanisms of CINhave not fully explained yet. It seems that mechanisms which mediated by nitric oxideand prostaglandin-induced vasodilatation have been played a crucial role in the CIN.Hemodynamic changes of renal blood flow, which causes hypoxia in the renal medullaand direct toxic effects of contrast media on renal cells, are thought to contribute to thepathogenesis of CIN. Contrast media is normally divided into iso-osmolar, low-osmolar,and high-osmolar. N-acetylcysteine is considered as one of the best choices to prevent CINin high-risk groups. The first aim to prevent CIN is identifying high-risk subjects and controllingassociate risk factors. As significant differences existed between contrasts agents due to theirphysicochemical properties, low-osmolar or iso-osmolar contrast media should be used toprevent CIN in at-risk patients. The volume of contrast media should be as low as possible.