Lesão renal aguda induzida por contrastes radiológicos: revisão sistemática das medidas preventivas

Abstract

ACUTE RENAL INJURY INDUCED CONTRAST RADIOLOGICAL: SYSTEMATIC REVIEW OF PREVENTIVE MEASURES. Theoretical basis: The Acute Kidney Injury (AKI) has high rates of morbidity and mortality. The use of radiological contrast (RCs) applied on imaging studies for diagnostic purposes and therapy is one of the risk factors for nephrotoxicity when associated with preexisting comorbidities such as diabetes mellitus (DM), systemic arterial hypertension (SAH), Chronic Kidney Disease (CKD), Heart Failure (HF). The incidence of hospitalizations associated with increased morbidity and mortality for Nephrotoxicity Induced Contrast (NIC) and the non-standardization of preventive measures is the object of this systematic review. Objective: To compare the main preventive measures applied in radiological contrast-induced AKI: hydration and / or N-acetylcysteine (NAC). Methods: A systematic literature review by leading global database: Pubmed. Data for this revision were extracted from clinical trials published from 2009 to 2014. Results: 19 trials in which the definition of CIN was characterized by changes in serum baseline creatinine (sCR) with a 25% increase were studied and for absolute values> 0.5 mg / dl in 48-72 hours after use of the RC. The minimum age of the patients was 18anos and a maximum of 80 years. Examinations of cardiovascular image, such as percutaneous coronary intervention (PCI) were performed in most studies. The sCR value was above> 1.1mg / dl and GFR <60ml / min before carrying out tests. The incidence of CIN was linear in all studies and hydration showed benefit compared to the use of NAC (N acetylcysteine) using RCs osmolar and isosmolar. Discussion: The incidence of CIN is increasing, especially in patients with associated risk factors. In an attempt to minimize induced CRs beyond the control of the dose and choice of contrast, preventive measures such as saline hydration pre and post LRA procedure is recommended as an effective strategy, superior to the use of NAC, which showed benefit only a small group of diabetic patients. Conclusions: The use of saline hydration as a preventative treatment for CIN is superior to the use of NAC which still shows inconsistent results in scientific papers.