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BioMed Research International
Volume 2014, Article ID 741018, 20 pages
http://dx.doi.org/10.1155/2014/741018
Review Article

Side Effects of Radiographic Contrast Media: Pathogenesis, Risk Factors, and Prevention

1Nephrology Unit, Department of “Health Sciences”, Campus “Salvatore Venuta”, “Magna Graecia” University, Loc. Germaneto, 88100 Catanzaro, Italy
2University of Vermont College of Medicine, Fletcher Allen Health Care, Burlington, VT, USA
3Nephrology Unit, Department of Medicine, Faculty of Medicine, Thammasat University, Rangsit Campus, Khlong Luang, Pathum Thani 12121, Thailand

Received 7 January 2014; Accepted 3 March 2014; Published 11 May 2014

Academic Editor: Vickram Ramkumar

Copyright © 2014 Michele Andreucci et al. 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

Radiocontrast media (RCM) are medical drugs used to improve the visibility of internal organs and structures in X-ray based imaging techniques. They may have side effects ranging from itching to a life-threatening emergency, known as contrast-induced nephropathy (CIN). We define CIN as acute renal failure occurring within 24–72 hrs of exposure to RCM that cannot be attributed to other causes. It usually occurs in patients with preexisting renal impairment and diabetes. The mechanisms underlying CIN include reduction in medullary blood flow leading to hypoxia and direct tubule cell damage and the formation of reactive oxygen species. Identification of patients at high risk for CIN is important. We have reviewed the risk factors and procedures for prevention, providing a long list of references enabling readers a deep evaluation of them both. The first rule to follow in patients at risk of CIN undergoing radiographic procedure is monitoring renal function by measuring serum creatinine and calculating the eGFR before and once daily for 5 days after the procedure. It is advised to discontinue potentially nephrotoxic medications, to choose radiocontrast media at lowest dosage, and to encourage oral or intravenous hydration. In high-risk patients N-acetylcysteine may also be given.