How to Prevent Contrast-Induced Nephropathy in Clinical Practice

After the description of the Contrast-Induced Nephropathy (CIN), its epidemiology and its pathogenesis, the risk factors for the development of CIN are discussed in depth, the main ones being pre-existing renal impairment, particularly secondary to diabetic nephropathy, salt depletion and dehydration, congestive heart failure, age greater than 70 years and concurrent use of nephrotoxic drugs. Then the measures to prevent CIN are suggested, beginning with the main rules in prevention: monitoring renal function, discontinuation of potentially nephrotoxic drugs, use of either iodixanol, an iso-osmolar contrast medium or iopamidol, a low-osmolar contrast medium at the lowest dosage possible. The main procedure for prevention of CIN is an adequate hydration of the patient with either isotonic sodium chloride or sodium bicarbonate solutions. The antioxidant N-acetylcysteine may be added orally or intravenously. Other antioxidants, such as vitamin C (ascorbic acid) and vitamin E (aor γ-tocopherol), compounds with antioxidant properties (e.g. Mesna), and β1-adrenergic receptor antagonists (e.g. Nebivolol) require further studies before deciding their use in clinical practice to prevent CIN.