Med. Pro Praxi 2007; 4(10): 410-415

Poškození ledvin kontrastní látkou

MUDr. Lukáš Svoboda
Nefrologické pracoviště Nemocnice Na Homolce, Praha

Poškození ledvin jodovou kontrastní látkou je nejvýznamnějším a nejčastějším nežádoucím účinkem kontrastních látek. Riziko poškození se významně zvyšuje u rizikových nemocných, zejména u pacientů s preexistujícím snížením ledvinných funkcí. Závisí ovšem také na objemu, cestě podání a chemické struktuře látky. U pacientů se zvýšeným rizikem vzniku CIN podstupujících vyšetření kontrastní látkou, představují vysokoosmolární látky vyšší riziko vzniku CIN než nízkoosmolární látky. Současné poznatky u pacientů se zvýšeným rizikem vzniku CIN naznačují, že u intraarteriálního podání představují nejnižší riziko neionické isoosmolární kontrastní látky. K prevenci poškození je nutná dostatečná prehydratace pacienta kombinovaným zvýšeným perorálním příjmem tekutin a doplňující infuzní terapií ideálně 6–24 hodin před vyšetřením a 6–24 hodin po aplikaci látky. Použití N-acetylcysteinu ve vyšší dávce se zdá být přínosné, ale chybí široké zhodnocení. Odstranění kontrastní látky mimotělními eliminačními metodikami má úzká kritéria, preferována je hemofiltrace. Diskutovány jsou 3 recentní metodické návody k prevenci vzniku kontrastní nefropatie.

Keywords: kontrastní látka, akutní ledvinné poškození, kontrastní nefropatie, hydratace, N-acetylcystein, hemodialýza

Published: December 18, 2007  Show citation

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Svoboda L. Poškození ledvin kontrastní látkou. Med. praxi. 2007;4(10):410-415.
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