Contrast-induced nephropathy and oxidative stress: mechanistic insights for better interventional approaches

Abstract

Contrast-induced nephropathy (CIN) or contrast-induced acute kidney injury (CI-AKI) is an iatrogenic acute kidney injury observed after intravascular administration of contrast media for intravascular diagnostic procedures or therapeutic angiographic intervention. High risk patients including those with chronic kidney disease (CKD), diabetes mellitus with impaired renal function, congestive heart failure, intraarterial intervention, higher volume of contrast, volume depletion, old age, multiple myeloma, hypertension, and hyperuricemia had increased prevalence of CIN. Although CIN is reversible by itself, some patients suffer this condition without renal recovery leading to CKD or even end-stage renal disease which required long term renal replacement therapy. In addition, both CIN and CKD have been associated with increasing of mortality. Three pathophysiological mechanisms have been proposed including direct tubular toxicity, intrarenal vasoconstriction, and excessive production of reactive oxygen species (ROS), all of which lead to impaired renal function. Reports from basic and clinical studies showing potential preventive strategies for CIN pathophysiology including low- or iso-osmolar contrast media are summarized and discussed. In addition, reports on pharmacological interventions to reduce ROS and attenuate CIN are summarized, highlighting potential for use in clinical practice. Understanding this contributory mechanism could pave ways to improve therapeutic strategies in combating CIN.

Effect of statins on post-contrast acute kidney injury: a multicenter retrospective observational study

“…The pathophysiology of PC-AKI is not exactly understood, and several studies trying to fill gaps in knowledge are underway [ 16 – 19 ]. Three basic mechanisms have been proposed that act together on PC-AKI: reactive oxygen species formation, tubular cell toxicity, and medullary hypoxia with renal vasoconstriction [ 16 , 17 , 20 , 21 ].…”

“…The pathophysiology of PC-AKI is not exactly understood, and several studies trying to fill gaps in knowledge are underway [ 16 – 19 ]. Three basic mechanisms have been proposed that act together on PC-AKI: reactive oxygen species formation, tubular cell toxicity, and medullary hypoxia with renal vasoconstriction [ 16 , 17 , 20 , 21 ]. Statins, known for their lipid-lowering effects, also have other non-lipid modifiable effects, named pleiotropic effects [ 22 ], of which the most important effects are reducing oxidative stress [ 23 – 26 ] and anti-inflammatory [ 27 ].…”

Role of TRPA1 in Tissue Damage and Kidney Disease

“…Inflammation and oxidative stresses play important roles in these conditions of CKD [ 8 ]. Moreover, patients with CKD typically suffer from chronic inflammation [ 9 ], and the dysfunction of the antioxidative systems worsens with the degree of renal function [ 10 ]. The treatment of inflammation and oxidative stresses is very important in CKD-associated complications.…”

The Effect and Underlying Mechanism of Statins in the Prevention of Post-Contrast Acute Kidney Injury: A Multicenter Retrospective Observational Study

“…The pathophysiology of PC-AKI is not exactly understood, and there are many laboratory studies in further exploration [17][18][19][20]. Three basic mechanisms appear to simultaneously occur for PC-AKI development: renal vasoconstriction and medullary hypoxia, tubular cell toxicity and reactive oxygen species formation [17,18,21,22].…”

“…The pathophysiology of PC-AKI is not exactly understood, and there are many laboratory studies in further exploration [17][18][19][20]. Three basic mechanisms appear to simultaneously occur for PC-AKI development: renal vasoconstriction and medullary hypoxia, tubular cell toxicity and reactive oxygen species formation [17,18,21,22]. Statins, as a class of cholesterol-lowering drugs, also have numerous non-lipid modifiable effects, named pleiotropic effects [23], of which the most important positive effects are anti-inflammatory [24] and reducing oxidative stress [25][26][27][28].…”