Contrast-induced nephropathy:searching for new solutions to prevent its development

Abstract

Contrast-induced nephropathy (CIN) is the main cause of acute kidney injury and worsens the prognosis of chronic kidney disease. To evaluate the clinical risk score of CIN development, various medical calculators are proposed. The main criterion for assessing the possible development of CIN is the initial glomerular filtration rate presented by estimated glomerular filtration rate. Toxic effect of contrast substances is realized through the properties of the molecule of contrast itself (tubular cell damage) and induced ischemia with oxidative stress and vasoconstriction. Existing methods for preventing the development of CIN are based on reducing the toxic effect of a contrast agent and preventing hypoxic kidney shock. The drugs currently proposed are acetylcysteine, statins, and some other approaches as well as hemodialysis. However, the evidence base is the most informative for hydration, which should be used before the introduction of a contrast agent, along with the minimization of the dose of contrast. Nevertheless, no final solution has been found to prevent the development of CIN. We have proposed the use of edaravone, which has an evidence base for ischemic stroke, to prevent the development of CIN. Three patients with chronic kidney disease stage 3b were given 30 mg edaravone twice a day before contrast media infusion and during two days after contrast administration. In two patients, CIN was avoided. The proposed approach requires future research to evaluate its effectiveness.