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Hilla University College Journal For Medical Science

Document Type

Review

Keywords

Contrast-Associated Nephropathy (CAN), Renal hemodynamics, Reactive oxygen species, Acute kidney injury, Contrast media

Abstract

Acute renal failure can be attributed to Contrast-Associated Nephropathy (CAN), which remains a threat due to population variation and the increasing use of contrast media in various techniques. Thus, this review aims to discuss the pathophysiology, factors and risk factors for CAN, measures for prevention, and approaches to its management. The pathophysiology of CAN is extensive and encompasses various factors. Vasoconstriction and medullary hypoxia in the renovascular bed area are crucial in the pathogenesis of CAN. Several contrast media can provoke the formation of free radicals and reactive oxygen species (ROS), leading to oxidative stress, an inflammatory response, and enhancing renal injury. Hypotoxicity to tubular cells and osmotic stress contribute to the damage caused by contrast agents. Further, metabolic changes such as alterations in nitric oxide synthesis pathways and imbalances in antioxidant enzymes also contribute to the cause of CAN. It is noted that when the concentration of contrast media is high and the glomerular filtration rate is low, the condition is often seen in patients with compromised kidneys. The factors that predispose a patient to CAN are compromised renal function, diabetes mellitus, the patient’s age, lack of adequate hydration, and the administration of a high volume of contrast media. Possible measures involve managing these risks, promoting adequate hydration, and avoiding unnecessary translational imaging whenever possible. Early diagnosis and management of CAN components are crucial to decrease the risk of worsening renal dysfunction and other severe complications. This may involve prescribing suitable medications such as intravenous fluids, diuretics, and other nephroprotective drugs. Further research and enhanced understanding of the mechanisms will advance the improvement of prevention and treatment of this challenging condition. Collaborative care efforts among healthcare practitioners should enhance decision-making to reduce the high risk associated with this severe condition.

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