Медицинская литература. Новинки

 

 

 

 

 

 

Факторы риска и патофизиология контраст-индуцированной нефропатии после мультиспиральной компьютерной томографии с контрастным усилением

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Введение. Количество МСКТ с контрастным усилением растет повсеместно, а вместе с ней растет риск развития побочных проявлений внутрисосудистого введения рентгеноконтрастных диагностических средств, в частности острого повреждения почек (известного в литературе как “контраст-индуцированная нефропатия - КИН”). Литературные данные часто противоречивы. Необходим объективный анализ информации о частоте КИН и оценке групп риска ее развития. Цель исследования: изучение факторов, влияющих на развитие КИН, осмысление ее патофизиологии при выполнении МСКТ с контрастным усилением изображения, в том числе у пациентов с сахарным диабетом. Материал и методы. Проанализированы 62 научные англоязычные публикации, полный текст которых и их библиография доступны в поисковой системе PubMed (2013-2016 гг.). Факторы патофизиологии КИН разделены на подгруппы и подвергнуты критическому анализу для осмысления противопоказаний к использованию МСКТ с контрастным усилением в диагностическом процессе. Результаты. Возраст старше 65 лет, низкий базовый уровень расчетной скорости клубочковой фильтрации (рСКФ), сахарный диабет, низкий уровень сывороточного альбумина, гипертония предрасполагают пациентов к КИН чаще, чем измененный исходный уровень сывороточного креатинина (SCr). Внутривенное введение низкоосмолярных контрастных веществ не является фактором риска у пациентом с рСКФ ?45 мл/кг/1,73 м2. Уровень SCr может колебаться до уровней, больше или меньше, чем 25% от базового уровня даже без введения йодсодержащих контрастных веществ, и не может считаться надежным диагностическим тестом. Заключение. Введение в практику повседневной работы скрининга, основанного на изучении рСКФ (считая порогом риска развития КИН уровень ниже, чем 45 мл/мин/1,73 м2) приведет к сокращению неправильной идентификации риска КИН у большого числа взрослых стационарных больных с пороговым уровнем SCr >1,5 мг/дл.

Ключевые слова:
контраст-индуцированная нефропатия (КИН), МСКТ с контрастным усилением, сывороточный креатинин, расчетная скорость клубочковой фильтрации (рСКФ), побочное действие контрастных средств, почечная недостаточность, Contrast-induced nephropathy (CIN), contrast-enhanced MDCT, serum creatinine, estimated glomerular filtration rate (eGFR), adverse events, renal failure

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Risk Factors and Pathophysiology of Contrast- Induced Nephropathy after Contrast Enhanced Multidetector Computed Tomography

Introduction. The number of contrast enhanced MDCT is growing everywhere. The risk adverse events after intravascular injection of contrast media increased also. One of these adverse events is an acute renal injury (known in the literature as a “contrast-induced nephropathy, CIN”). Literature data are often contradictory. We need an objective analysis of information on the incidence of CIN and evaluation of risk groups for MDCT-CIN. The aim of the study: the evaluation of factors affecting the development of CIN, understanding of its pathophysiology, including patients with diabetes mellitus, at contrast-enhanced MDCT. Material and methods. 62 English-language scientific publications, the full text of which and bibliography is available for search in PubMed (2013-2016 years), were analyzed. Factors of pathophysiology of CIN were divided into groups and subgroups for critical analysis and understanding the contraindications to the use of contrast-enhanced MDCT in the diagnostic process. Results. Age older than 65 years, low baseline estimated glomerular filtration rate (eGFR), diabetes, low levels of serum albumin, hypertension predispose patients to CIN more often than the modified baseline serum creatinine. Intravenous injection of low osmolar CM is not a risk factor in patients with eGFR ?45 ml/kg/1.73 m2. SCr levels may vary to levels greater than or less than 25% of baseline even without administration of iodinated CM and may not be a reliable diagnostic test. Conclusion. The introduction into the everyday practice of screening CIN such test as the eGFR, considering the risk of CIN threshold level lower than 45 mL/min/1.73 m2, will reduce the risk of misidentification of CIN in a large number of adult inpatients with a threshold level of serum creatinine (SCr) > 1,5 mg/dl.

Keywords:
контраст-индуцированная нефропатия (КИН), МСКТ с контрастным усилением, сывороточный креатинин, расчетная скорость клубочковой фильтрации (рСКФ), побочное действие контрастных средств, почечная недостаточность, Contrast-induced nephropathy (CIN), contrast-enhanced MDCT, serum creatinine, estimated glomerular filtration rate (eGFR), adverse events, renal failure