(1) Fujita Health University Second Hospital, Nagoya, Japan
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Contrast-induced acute kidney injury (CIAKI), defined as a serum creatinine (Cr) level of ≥ 25% or ≥ 0.5mg/dL from baseline, is a major complication associated with the administration of iodinated contrast media, and often irreversible declines in the kidney function. CIAKI is the major leading cause of acute kidney injury in hospitalized patients and substantially increases the morbidity and mortality. Although numerous studies have addressed the characteristics of patients at risk, neither precipitating factors regarding procedures or reno-protective agents, reliable biomarkers nor prophylactic strategies for CIAKI have yet been established. Assessing patients at risk and providing the early detection of CIAKI is of utmost clinical relevance. Several papers have been published with respect to plasmatic and urinary biomarkers from this point of view, with the utility of an increased urinary neutrophil gelatinase-associated lipocalin (NGAL) level in the early phase as a powerful independent predictor. As no specific treatment for CIAKI has been established, the management of such patients is focused on the clinical importance of prevention with hydration as the only secured protective agent to date. This review summarizes recent evidence and provides a future perspective for clinicians, concerning the pathophysiology of CIAKI, identification of populations at risk, predictive factors, and treatment based on prophylactic strategies.
The recent studies and reports indicated the utility of the urinary NGAL level as a biomarker of early phase of CIAKI. For the purpose of the prevention of contrast -induced renal impairment, the clinicians should mind the established reno-protective strategies of small volume of contrast media and adequate transfusion, with the usage of a novel biomarker.