造影剂肾病的诊治进展

造影剂肾病已成为当前医院内发生肾功能衰竭的第三位常见原因，并且发病率和死亡率逐年增加。虽然造影剂肾病在普通人群中发病风险并不高，但在具有高危因素的人群中，比如原有肾功能不全、糖尿病和行急诊经皮冠脉介入治疗等，造影剂肾病的发病风险明显增高。造影剂肾病的主要发病机制是肾髓质缺血，另外，氧自由基损害、免疫因素、肾小管阻塞等也有重要作用。尿中性粒细胞明胶酶载脂蛋白和肾损伤分子1是诊断造影剂早期肾损伤敏感且特异性较高的指标。水化治疗可预防造影剂肾病的发生。本文将对造影剂肾病的发病机制、危险因素、临床过程以及预防、治疗措施进行综述。

Progress in Diagnosis and Treatment of Contrast Nephropathy

Abstract:Contrast nephropathy has become the third most common cause of renal failure in hospitals,and the morbidity and mortality are increasing year by year.Although the risk of renal failure in the general population is not high, in the population with high risk factors,such as original renal insufficiency,diabetes and emergency percutaneous coronary intervention,the risk of contrast agent nephropathy was significantly increased.The main pathogenesis of contrast agent nephropathy is renal medullary ischemia,in addition,oxygen free radical damage, immune factors.Tubular obstruction also has an important role.Urinary neutrophil gelatinase apolipoprotein and renal injury molecule 1 are sensitive and specific indicators for the early diagnosis of contrast-induced renal injury.Hydration therapy can prevent the occurrence of contrast agent nephropathy.This article will review the pathogenesis of contrast agent nephropathy,risk factors,clinical course, as well as prevention and treatment measures.