Background. Altered renal vasodilatation and oxidative stress are important mechanisms of contrast-induced nephropathy (CIN). The aim of the present study was to assess the effect of nebivolol, a beta blocker, on prevention of CIN. We hypothesized that nebivolol may prevent CIN due to its renal vasodilatation and antioxidant effects.

Background. The aim of the present study was to assess the influence of diabetic and pre-diabetic state on the development of contrast-induced nephropathy (CIN) in chronic kidney disease patients undergoing coronary angiography.

Iodinated contrast medium is commonly used in diagnostic or interventional procedures in uroradiology. Procedures requiring the intravascular administration of iodinated contrast medium are becoming a great source of an iatrogenic disease known as contrast induced nephropathy. Identifying patients at high risk is the first step to minimize the overall risk of contrast induced nephropathy. This review describes conflicting and new risk factors for contrast induced nephropathy. A MEDLINE/PubMed search from 1966 to 2006 was performed. All articles related to the use of contrast medium and the risk factors for contrast induced nephropathy were reviewed. The classic risk factors for contrast induced nephropathy are preexisting renal failure, diabetes mellitus, advanced age, nephrotoxic agent administration, hypovolemia, use of a large amount of contrast medium or an ionic hyperosmolar contrast medium and congestive heart failure. Metabolic syndrome, prediabetes and hyperuricemia have been identified as new risk factors for contrast induced nephropathy. The use of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers, renal transplantation, diabetes mellitus with normal renal function, low osmolar contrast medium in patients at high risk for contrast induced nephropathy, multiple myeloma, female gender and cirrhosis have been classified as conflicting risk factors for contrast induced nephropathy. Patients at risk for contrast induced nephropathy should be identified before urological procedures requiring contrast administration. In addition to the classic risk factors for contrast induced nephropathy, determining the metabolic syndrome, hyperuricemia and prediabetes as well as the use of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers before performing procedures using contrast medium seems to be a useful guide to assess the risk of contrast induced nephropathy.

Background/Aims: The aim of the present study was to assess the influence of chronic angiotensin-converting enzyme (ACE) inhibitor administration on the development of contrast-induced nephropathy (CIN) in patients undergoing coronary angiography. Methods: A total of 230 patients with renal insufficiency and age ≧65 years were divided into two groups according to prior use of ACE inhibitors (ACE inhibitor group, n = 109; control group, n = 121). CIN was defined as an increase of ≧25% in creatinine over the baseline value within 48 h of angiography. Results: CIN occurred in 17 patients (15.6%) in the ACE inhibitor group and 7 patients (5.8%) in the control group (p = 0.015). Serum creatinine level increased from 1.34 ± 0.20 to 1.53 ± 0.27 mg/dl in the ACE inhibitor group and from 1.33 ± 0.18 to 1.45 ± 0.19 mg/dl in the control group (p < 0.001). Chronic ACE inhibitor administration was a risk indicator of CIN [odds ratio 3.37; 95% confidence interval 1.14–9.94; p = 0.028]. Multi-vessel coronary involvement (p = 0.001), hypoalbuminemia (p = 0.005), diabetes mellitus (p = 0.006), GFR ≤40 ml/min (p = 0.010), and congestive heart failure (p = 0.024) were other risk indicators of CIN. Conclusion: Chronic ACE inhibitor administration is a risk for developing CIN in elderly patients with renal insufficiency.

An increasing number of diagnostic imaging and interventional procedures require the use of radiographic contrast agents which has led to a parallel increase in the incidence of contrast-induced nephropathy (CIN). CIN is a serious clinical problem associated with increased morbidity and mortality, particularly in patients with chronic renal failure (see the Case Report). A key step to minimize CIN is to identify patients at risk of CIN. The aim of the present review was to summarize the knowledge about the risk factors of CIN, including the review of ultimate clinical research and developments.