Abstract

ORTEGA MARTINEZ, Rommer Alex  and  SILVESTRE ARZE, Ricardo. FALLO RENAL AGUDO INDUCIDO POR MEDIOS DE CONTRASTE RADIOLÓGICO: REVISIÓN BIBLIOGRAFICA A PARTIR DE UN CASO. Gac Med Bol [online]. 2006, vol.29, n.2, pp.53-60. ISSN 1012-2966.

The exposure to xRay contrast media is followed hy a usually reversible acule renal failure, short time after. We present a 72 year old patient with coronary heart disease, type II diabetes mellitus, diabetic nephropathy, diabetic macrovascular disease and bleeding hemorroids, admitted for coronary angiogram before surgery for hemorroids. Serum creatinine on admision 4 mg/dl, raising to 7.1 two days after exposure and coming down to 35 mg/dl three weeks later. The risk of nephroloxicity is higher with ionic hyperosmolar agents and lower with those recently introduced iso osmolar and non ionic, especially in high risk patients as the one described. The mechanism of nephrotoxicity incluyes renal vasoconstriction and medular hypoxemia induced by changes in nitric oxide, endothelin andior adenosine and a direct toxic effect. Exposure to xRay contrast media is the third cause of in hospital acute renal failure and has a mortality of 14%. The incidence is higher in patients with multiple riskfactors or a risk factor of great severity as in our patient. Mortality in patients admitted to the Intensive Care Unit is higher when develop acute renal failure resulting from exposure to xRay contrast media and proporcional to APACHE score, reaching 62% in those with a score > than 12 against those without acute renal failure and a score < 3 in whom mortality is only 4%. Prevention includes the administration of small doses of contrast media, avoiding repeated studies in less than 72 hours; avoiding fluid depletion and the administration of non steroid anti inflalory agents in the previous days or the day of the study; hydration with normal satine or sodium bicarbonato the day before, the day of the study and one day later; giving N-acetyl cisteine one day before and the day of the study and using if possible the most recent non ionic iso osmolar agents. In patients with normal renal func-tion, serum creatine less than 1,5 mg/dl and a glomerular filtration rate higher than 60 ml/min, the risk is small and it is not necessary to take any especial precaution. In elderly patients, diabetics and especially in patients with a serum creatinne higher than 1.5 mg/dl or a glomerular filtration rate lower than 60 ml/min as our patient, the risk is very high and even higher when the renal function is lower.

Keywords : Acute renal failure; xRay contrast media.

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