Biomedical subjects
Publications and source records attributed to Michael R Rudnick.
No current treatment can reverse or ameliorate contrast-induced nephropathy once it occurs, but prophylaxis is possible. Many preventive measures have failed to show benefits in well-designed, prospective, randomized, double-blinded trials. This review will focus only on the prophylactic strategies that have possible or proven value.
The authors retrospectively reviewed the use of ultrahigh-pressure angioplasty balloons at atmospheric pressures at or above the manufacturer recommended burst pressure (30 atm) for the treatment of resistant hemodialysis-related venous stenosis at their institution. In seven of 87 procedures, high-pressure angioplasty (up to 27 atm) was unsuccessful. By coupling new balloon technology with aggressive inflation pressures, 100% technical success was achieved in the treatment of stenoses that were resistant to high-pressure angioplasty in these seven procedures. This approach could potentially offer cost savings compared with the costs of other previously described treatment methods for resistant lesions, such as atherectomy devices and cutting balloons.
Experimental studies suggest that the pathogenesis of contrast media nephrotopathy is due to a combination of renal ischemia and direct tubular epithelial cell toxicity. Clinical studies to date have demonstrated a reduction in clinical contrast nephropathy with the introduction of low-osmolar and, more recently, iso-osmolar contrast media. Numerous experimental studies have examined the role of osmolality per se in the pathogenesis of contrast nephropathy, with conflicting results. Whether iso-osmolar contrast media are the least nephrotoxic iodinated contrast media needs to be determined with large prospective randomized clinical trials.