Wie gefährlich ist die Kontrastmittelexposition für die Nieren? Strategien der Nephroprotektion

Zusammenfassung

Seit Einführung der kontrastmittelverstärkten Bildgebung vor mehr als 90 Jahren hat diese sowohl in diagnostischer als auch in therapeutisch-interventioneller Hinsicht einen beispiellosen Siegeszug hingelegt. Gleichzeitig wurde die Kontrastmittelexposition seit Ende der 1970er-Jahre zunehmend für akutes Nierenversagen – insbesondere von hospitalisierten Patienten – verantwortlich gemacht. In der Folge gab es eine Vielzahl von Untersuchungen zur Toxizität unterschiedlicher Kontrastmittel sowie zur Nephroprotektion mit verschiedenen Methoden und Substanzen. Neue Untersuchungen lassen sowohl die Toxizität für die Nieren als auch die bislang eingesetzten Methoden zur Nephroprotektion in einem anderen Licht erscheinen, sodass sich eine deutliche Trendwende in der Anwendung von Kontrastmitteln abzeichnet. Der folgende Artikel fasst prägnant die letzten Entwicklungen auf beiden Gebieten zusammen und gibt Empfehlungen für die Praxis im Umgang mit kontrastmittelverstärkter Bildgebung – insbesondere für nierenkranke Patienten mit bereits reduzierter glomerulärer Filtrationsrate.

Abstract

Contrast enhanced imaging was introduced over 90 years ago and has led to unprecedented triumphs in diagnostics testing, as well as in therapeutic and interventional procedures. At the same time, contrast agent exposure has been increasingly blamed for acute renal failure, particularly in hospitalised patients, and since the late 1970s. As a result, there has been a large number of studies on the toxicity of different contrast agents and on nephroprotection with various methods and substances. New studies have provided information on both the toxicity to the kidneys and the methods and substances used for nephroprotection, so that there have been clear changes in the use of contrast agents. The following article summarises recent developments in both areas and provides recommendations for the practice of using contrast-enhanced imaging, especially for kidney patients with already reduced glomerular filtration rate.

Schlüsselwörter

Gefäßintervention - interdisziplinär - Risiko-Nutzen-Relation - Kontrastmittel - akutes Nierenversagen - Nephroprotektion

Key words

vascular intervention - interdisciplinary - risk-benefit ratio - contrast media - acute kidney failure - nephroprotection

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