Journal Club 4.26.05 M. Danish Neyaz, D.O

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2. Contrast Induced Nephropathy - Background. Radiocontrast DyeIonic AcidEarlier form of dye.High Osmolarities (1500 to 1800 mosmol/kg).Non-Ionic AcidCurrent type of dye.IsoOsmotic (approximately 290 mosmol/kg)UpToDate v13.1: Radiocontrast media-induced acute renal failure . 3. Contrast I

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Journal Club 4.26.05 M. Danish Neyaz, D.O

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1. 1 Journal Club 4.26.05 M. Danish Neyaz, D.O Prevention of Contrast-Induced Nephropathy With Sodium Bicarbonate.

2. 2 Contrast Induced Nephropathy - Background Radiocontrast Dye Ionic Acid Earlier form of dye. High Osmolarities (1500 to 1800 mosmol/kg). Non-Ionic Acid Current type of dye. IsoOsmotic (approximately 290 mosmol/kg) UpToDate v13.1: Radiocontrast media-induced acute renal failure

3. 3 Contrast Induced Nephropathy - Background Dye Volume Diagnostic Cath: 100mL Interventional Cath: 250 – 300 mL Spiral CT Chest: 100 – 150 mL Cox et al. Preventing Contrast Nephropathy: What Is the Best Strategy? A Review of the Literature . The Journal of Clinical Pharmacology, 2004; 44:327-337

4. 4 Contrast Induced Nephropathy - Background Risk Factors related to Contrast Induced Nephropathy (CIN) Age > 55 Renal Insufficiency DM Volume Depletion Liver Failure Recent Contrast Exposure Proteinuria Multiple Myeloma Schrier et al., Renal and Electrolyte Disorders p.430

5. 5 Contrast Induced Nephropathy - Background CIN Predisposing Factors Renal Medullary Hypoxia (1) Altered Renal Hemodynamics Reactive Oxygen Species (2) Prostaglandins/Endothelin/NO synthesis/inhibition 1. Heyman et al., Pathophysiology of Radiocontrast Nephropathy: A Role for Medullary Hypoxia. Investigative Radiology. 34(11):685, November 1999. 2. Bakris et al., Radiocontrast medium-induced declines in renal function: a role for oxygen free radicals. Am J. Physiol. 1990 258:F115-120

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