冠状动脉造影中肝脏功能和肾功能异常.ppt

Cardiorenal Risk Major Causes of Acute Renal Failure in Cardiac Patients Frequency of Radiocontrast Nephropathy The incidence depends on how it is defined Radiocontrast Nephropathy (RCN) DEFINITION New onset or exacerbation of renal dysfunction after contrast administration absent other causes:  increase by 25% or absolute ? of 0.5 mg/dL Prediction of RCN and Dialysis after PCI Predictors of ARF after PCI Circulation. 2002;105:2259, April 22, 2002 Online Predictors of Death Circulation. 2002;105:2259, April 22, 2002 Online Outcomes Mortality of Acute In-Hospital Renal Failure Survival of those Requiring Dialysis after PCI Long-Term Impact of RCNRCN defined as 0.5 mg/dl rise in Cr Renal Complications and CostsMulticenter Study of Perioperative Ischemia Group OUTCOMES OF THOSE REQUIRING DIALYSIS FOLLOWING PCIGruberg, Mehran, Dangas, et al. American College of Cardiology. 2000;Poster:1129–1175. Anaheim, CA. Pathogenesis of Contrast Nephropathy Toxicity of Contrast to Cells Direct cellular toxicity (ionic concentration dependent) Tubular sluffing Thick ascending limb ? Tamm- Horsfall protein Renal Ischemic Effects of Contrast **Intrarenal vasoconstriction (endothelin, histamine, ? NO)** Ischemic tubular injury Additive Insults to Injury Atheroembolism Systemic Hypotension-induced ? renal blood flow BLOOD FLOW AND INTERSTITIAL OXYGEN CONTENT REGIONAL DISTRIBUTION IN RENAL CORTEX AND MEDULLA Aortic DebrisKeeley EC, Grines CL. Scraping of aortic debris by coronary guiding catheters: a prospective evaluation of 1,000 cases J Am Coll Cardiol. 1998 Dec;32(7):1861-5. Model PREVIOUS ATTEMPTS AT PREVENTING RCN EITHER NO BENEFIT OR CAUSE HARM dopamine1 mannitol2 furosemide2 atrial natriuretic peptide1 mixed endothelin antagonists3 calcium channel blockers4 Immediate hemodialysis post contrast SOME BENEFIT saline2 non-ionic contrast media5 Continuous Veno-Venous Hemofiltration—pre and post contrast6 N-Acetylcysteine Fenoldopam Iodinated contrast choice