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BioMed Research International
Volume 2014, Article ID 510385, 6 pages
http://dx.doi.org/10.1155/2014/510385
Review Article

Mechanisms of Contrast-Induced Nephropathy Reduction for Saline (NaCl) and Sodium Bicarbonate (NaHCO3)

MD Scientific, LLC, 1214 Wareham Court, Charlotte, NC 28207, USA

Received 19 October 2013; Revised 28 February 2014; Accepted 19 March 2014; Published 15 April 2014

Academic Editor: Michele Andreucci

Copyright © 2014 W. Patrick Burgess and Phillip J. Walker. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Nephropathy following contrast media (CM) exposure is reduced by administration before, during, and after the contrast procedure of either isotonic sodium chloride solution (Saline) or isotonic sodium bicarbonate solution (IsoBicarb). The reasons for this reduction are not well established for either sodium salt; probable mechanisms are discussed in this paper. For Saline, the mechanism for the decrease in CIN is likely related primarily to the increased tubular flow rates produced by volume expansion and therefore a decreased concentration of the filtered CM during transit through the kidney tubules. Furthermore, increased tubular flow rates produce a slight increase in tubular pH resulting from a fixed acid excretion in an increased tubular volume. The mechanism for the decreased CIN associated with sodium bicarbonate includes the same mechanisms listed for Saline in addition to a renal pH effect. Increased filtered bicarbonate anion raises both tubular pH and tubular bicarbonate anion levels toward blood physiologic levels, thus providing increased buffer for reactive oxygen species (ROS) formed in the tubules as a result of exposure to CM in renal tubular fluid.