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Dtsch Med Wochenschr 2021; 146(22): 1489-1495
DOI: 10.1055/a-1640-4503
Review

Kontrastmittelgabe bei Niereninsuffizienz – praktische Handlungsempfehlungen

Contrast media use in kidney disease – clinical practice recommendations
Ulrich Pein
1   Universitätsklinik und Poliklinik für Innere Medizin II, Universitätsklinikum Halle (Saale)
,
Annekathrin Fritz
1   Universitätsklinik und Poliklinik für Innere Medizin II, Universitätsklinikum Halle (Saale)
,
Silke Markau
1   Universitätsklinik und Poliklinik für Innere Medizin II, Universitätsklinikum Halle (Saale)
,
Walter A. Wohlgemuth
2   Department für Strahlenmedizin, Universitätsklinik und Poliklinik für Radiologie, Universitätsklinikum Halle (Saale)
,
Matthias Girndt
1   Universitätsklinik und Poliklinik für Innere Medizin II, Universitätsklinikum Halle (Saale)
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Zusammenfassung

Noch immer sorgt die Kontrastmittelgabe bei Patienten mit Niereninsuffizienz für regelmäßige Diskussionen im klinischen Alltag. Sowohl Röntgen- als auch MR-Kontrastmittel werden überwiegend renal eliminiert und sind somit eng an die Nierenfunktion gekoppelt. Basis der Risikostratifizierung vor Kontrastmittelgabe ist die Bestimmung der eGFR. Patienten mit einer eGFR ≥ 30 ml/min benötigen eine individuelle Risikobeurteilung. Bei fortgeschrittener Niereninsuffizienz liegt das Hauptaugenmerk auf der Gewährleistung der Euvolämie. Evidenz für anderweitige Präventionsansätze findet sich aktuell nicht, weitere spezifische Maßnahmen zur Prävention einer Kontrastmittel-assoziierten Nierenschädigung sind bei heutigen Kontrastmitteln somit nicht angezeigt. Eine zeitliche Abstimmung von Kontrastmittelgabe und Dialysesitzung bei terminaler Niereninsuffizienz ist nur nach Kontrastmittel-gestützten MRT-Untersuchungen zu beachten. Eine Sonderrolle stellt nach wie vor die akute Nierenschädigung dar.

Abstract

Contrast media use in patients with renal disease regularly ensures discussions in everyday clinical practice. Both X-ray and MRI contrast media are predominantly eliminated by the kidneys and therefore closely linked to kidney function. Risk stratification prior to contrast media use in patients with pre-existing renal dysfunction should be based on eGFR-determination. Patients with an eGFR ≥ 30 ml/min require an individual risk assessment. In patients with advanced renal insufficiency ensuring euvolemia is crucial. Currently, there is no evidence for any other preventive approach. Therefore, no further specific procedures preventing contrast-associated kidney injury are recommended. Timing of contrast media injection and dialysis sessions in patients with end stage renal disease is necessary only after MRI contrast media use. Independently, acute kidney injury requires a patient individual decision.

Schlüsselwörter

Kontrastmittel - Niereninsuffizienz - Kontrastmittel-Nephropathie - Gadolinium - Iod-haltig

Key words

contrast media - kidney disease - contrast induced nephropathy - gadolinium - iodine


Publication History

Article published online:
05 November 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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