Медицинская литература. Новинки

 

 

 

 

 

 

Контраст-индуцированное острое почечное повреждение: современное состояние вопроса

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Понятие “контраст-индуцированное острое почечное повреждение” (КИ-ОПП) представляет собой подъем уровня креатинина плазмы крови, зафиксированный в течение 48 ч после введения контрастного препарата. Данное состояние является третьей по частоте причиной хронической почечной недостаточности, возникающей в стационаре. Несмотря на довольно частую встречаемость данного явления, до конца не ясно, действительно ли все подобные случаи можно объяснить исключительно широким распространением процедур с введением контрастного препарата, ведь снижение функции почек зачастую встречается и у стационарных пациентов, которым не вводили контрастный препарат. Так как схемы лечения КИ-ОПП не существует, многие группы ученых предпринимали попытки разработать схему профилактики. Однако такие мероприятия сопряжены с рядом сложностей: возможные последствия для пациентов, логистические трудности в лечебном учреждении, экономические затраты. Эффективность данных мероприятий также однозначно не доказана. В частности, в ходе крупного исследования AMACING было показано, что гидратация не снижает вероятность развития КИ-ОПП, но существенно увеличивает расходы на лечение пациента и может вызвать специфические осложнения. Кроме того, много литературных данных свидетельствует в пользу того, что методика гидратации эффективна для предотвращения снижения функции почек лишь у пациентов, которые подверглись внутриартериальному введению контрастного препарата. Таким образом, необходимость медикаментозной профилактики КИ-ОПП в настоящее время подвергается сомнению; исследования в этой области активно продолжаются.

Ключевые слова:
йодсодержащий контрастный препарат, компьютерная томография, острое почечное повреждение, профилактика, почки, iodine-containing contrast agent, computed tomography, acute renal injury, prevention, kidneys

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Contrast-induced acute renal injury: the modern state of issue

The concept of “contrast-induced acute renal injury” (CI-AKI) is an increase in the level of plasma creatinine, recorded within 48 hours after contrast drug administration. This condition is the third most common cause of chronic renal failure occurring in a hospital. Despite the rather frequent occurrence of this phenomenon, it is not completely clear whether all such cases can really be explained by the exceptionally wide spread of procedures with contrast agent administration, because a decrease in kidney function is often found in inpatient patients. Since there is no treatment for CI-AKI, many groups of scientists have attempted to develop a prevention regimen. However, such measures are fraught with a number of difficulties: possible consequences for patients, logistical difficulties in a medical institution, costs of funds. The effectiveness of these measures has also not been unequivocally proven. In particular, in the course of a large AMACING study, it was shown that hydration does not reduce the likelihood of developing CI-AKI, but significantly increases the patient''s treatment costs and can cause specific complications. In addition, there is a lot of literature evidence in favor of the fact that the hydration technique is effective for preventing a decrease in kidney function only in patients who have undergone intra-arterial administration of a contrast agent. Thus, the need for drug prevention of CI-AKI is currently being questioned, research in this area is actively continuing.

Keywords:
йодсодержащий контрастный препарат, компьютерная томография, острое почечное повреждение, профилактика, почки, iodine-containing contrast agent, computed tomography, acute renal injury, prevention, kidneys