Resumen
Contexto: la lesión renal aguda inducida por contraste se ha convertido en un tema de gran interés en la comunidad médica a nivel mundial, siendo la tercera causa de lesión renal aguda adquirida en el hospital.
Objetivo: el presente artículo presenta una revisión de la literatura con el fin de actualizar los conceptos de esta patología en el personal de la salud que está en contacto con la población pediátrica y que es sometida a procedimientos con medios de contraste.
Metodología: en esta revisión narrativa de la literatura, presentamos la definición, los factores de riesgo, el enfoque clínico y las medidas preventivas de la nefropatía inducida por contraste en pediatría.
Resultados: se define que hay un deterioro en la función renal aguda después de la administración del medio de contraste en donde se excluyen otras posibles etiologías y se establece una verdadera relación causal con la sustancia. Los factores de riesgo son múltiples, sin embargo, factores estrictamente relacionados en los niños no han sido establecidos en su totalidad. El abordaje de los pacientes que van a ser sometidos a estudios con medios de contraste inicia desde una historia clínica, un examen físico y unas medidas de laboratorio que permiten evaluar el estado basal de cada paciente para instaurar medidas preventivas. Por su parte, las estrategias de prevención de esta condición son múltiples, sin embargo, no existen guías basadas en la evidencia acerca de esta condición en el paciente pediátrico.
Conclusiones: el artículo presenta una revisión de la literatura sobre lesión renal aguda para actualizar los conceptos de esta patología en el personal de la salud que está en contacto con la población pediátrica que se somete a procedimientos con medios de contraste.
Citas
Verghese P. Contrast nephropathy in children. J Pediatr Intensive Care. 2014;3(2):45-52. https://doi.org/10.3233/pic-14090
Sartori P, Rizzo F, Taborda N, Anaya V, Caraballo A, Saleme A, et al. Medios de contraste en imágenes. Rev Argent Radiol. 2013;77(1):49-62.
Cantais A, Hammouda H, Mory O, Patural H, Stephan J, Gulyaeva L, et al. Incidence of contrast-induced acute kidney injury in a pediatric setting: a cohort study. Pediatr Nephrol. 2016;31(8):1355-62. https://doi.org/10.1007/s00467-016-3313-9
Davenport MS, Cohan RH, Khalatbari S, Ellis JH. The challenges in assessing contrast-induced nephropathy: where are we now? AJR Am J Roentgenol. 2014;202(4):784-9. https://doi.org/10.2214/AJR.13.11369
Davenport MS, Perazella MA, Yee J, Dillman JR, Fine D, McDonald RJ, et al. Use of Intravenous Iodinated Contrast Media in Patients with Kidney Disease: Consensus Statements from the American College of Radiology and the National Kidney Foundation. Kidney Med. 2020;22;2(1):85-93. https://doi.org/10.1016/j.xkme.2020.01.001
American College of Radiology. Manual on contrast media. Version 10.3. Vancouver, Estados Unidos: American College of Radiology, 2018. Disponible en: https://www.acr.org/Clinical-Resources/Contrast-Manual
Windpessl M, Kronbichler A. Contrast-Associated Acute Kidney Injury (CA-AKI) in Children: Special Considerations. Child Kidney Dis. 2019;23:77-85. https://doi.org/10.3339/jkspn.2019.23.2.77
Patzer L. Nephrotoxicity as a cause of acute kidney injury in children. Pediatr Nephrol. 2008; 23(12):2159-73. https://doi.org/10.1007/s00467-007-0721-x
Hwang YJ, Hyun MC, Choi BS, Chun SY, Cho MH. Acute kidney injury after using contrast during cardiac catheterization in children with heart disease. J Korean Med Sci. 2014 ag.;29(8):1102-7. https://doi.org/10.3346/jkms.2014.29.8.1102
López I, Carolina M, Fernanda R. Incidencia de la Nefropatía Inducida por Medio de Contraste luego de una Tomografía Computarizada en pediatría. X Congreso Latinoamericano de Nefrología Pediátrica, ALANEPE. Cartagena 2014. Disponible en: https://www.hgm.gov.co/loader.php?lServicio=Tools2&lTipo=descargas&lFuncion=descargar&idFile=780
Bello-Caicedo Y. Frecuencia de nefrotoxicidad y su severidad en niños de unidad de cuidados intensivos e intermedios pediátricos, expuestos a medio de contraste intravenoso, para realización de tomografía computarizada. Bogotá, Universidad Nacional de Colombia, 2013. Disponible en: https://repositorio.unal.edu.co/handle/unal/20647
Bansal S, Patel RN. Pathophysiology of Contrast-Induced Acute Kidney Injury. Interv Cardiol Clin. 2020;9(3):293-8. https://doi.org/10.1016/j.iccl.2020.03.001
Heyman SN, Rosen S, Rosenberger C. Renal parenchymal hypoxia, hypoxia adaptation and the pathogenesis of radiocontrast nephropathy. Clin J Am Soc Nephrol. 2008;3:288-96. https://doi.org/10.2215/CJN.02600607
Tumlin J, Stacul F, Adam A, Becker CR, Davidson C, Lameire N, et al. Pathophysiology of contrast-induced nephropathy. Am J Cardiol. 2006 sept. 18;98(6A):14K-20K. https://doi.org/10.1016/j.amjcard.2006.01.020
Shams E, Mayrovitz HN. Contrast-Induced Nephropathy: A Review of Mechanisms and Risks. Cureus. 2021 my. 4;13(5):e14842. https://doi.org/10.7759/cureus.14842
McCullough PA, Adam A, Becker CR, Davidson C, Lameire N, Stacul F, et al. CIN Consensus Working Panel. Risk prediction of contrast-induced nephropathy. Am J Cardiol. 2006;98(6):27-36. https://doi.org/10.1016/j.amjcard.2006.01.022
Xu X, Nie S, Zhang A, Jianhua M, Liu HP, Xia H, et al. A New Criterion for Pediatric AKI Based on the Reference Change Value of Serum Creatinine. J Am Soc Nephrol. 2018 sept.;29(9):2432-42. https://doi.org/10.1681/ASN.2018010090
Brasch RC. Contrast media toxicity in children. Pediatr Radiol. 2008 my.;38(supl. 2):S281-4. https://doi.org/10.1007/s00247-008-0773-5
KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney International Supplements. Kidney Int Suppl. 2012;2(1):1-141. https://doi.org/10.1038/kisup.2012.1
Bolignano D, Lacquaniti A, Coppolino G, Donato V, Campo S, Fazio MR, et al. Neutrophil gelatinase-associated lipocalin (NGAL) and progression of chronic kidney disease. Clin J Am Soc Nephrol. 2009 febr.;4(2):337-44. https://doi.org/10.2215/CJN.03530708
Hirsch R, Dent C, Pfriem H, Allen J, Beekman RH, Ma Q, et al. NGAL is an early predictive biomarker of contrast-induced nephropathy in children. Pediatr Nephrol. 2007;22:2089-95. https://doi.org/10.1007/s00467-007-0601-4
Tkaczyk M, Tomczyk D, Jander A, Goreczny S, Moszura T, Dryzek P, et al. Glomerular filtration decrease after diagnostic cardiac catheterisation in children with congenital cardiac malformation - the role of serum creatinine, cystatin C, neutrophil gelatinase and urine output monitoring. Postepy Kardiol Interwencyjnej. 2018;14:67-74. https://doi.org/10.5114/aic.2018.74357
Spasojevic-Dimitrijeva B, Kotur-Stevuljevic J, Dukic M, Paripovic D, Milosevski-Lomic G, Spasojevic-Kalimanovska V, et al. Serum Neutrophil Gelatinase-Associated Lipocalin and Urinary Kidney Injury Molecule-1 as Potential Biomarkers of Subclinical Nephrotoxicity After Gadolinium-Based and Iodinated-Based Contrast Media Exposure in Pediatric Patients with Normal Kidney Function. Med Sci Monit. 2017;23:4299-305. https://doi.org/10.12659/MSM.903255
Benzer M, Alpay H, Baykan Ö, Erdem A, Demir IH. Serum NGAL, cystatin C and urinary NAG measurements for early diagnosis of contrast-induced nephropathy in children. Ren Fail. 2016;38(1):27-34. https://doi.org/10.3109/0886022X.2015.1106846
Zappitelli M, Greenberg JH, Coca SG, Krawczeski CD, Li S, Thiessen-Philbrook HR, et al. Association of definition of acute kidney injury by cystatin C rise with biomarkers and clinical outcomes in children undergoing cardiac surgery. JAMA Pediatr. 2015 jun.;169(6):583-91. https://doi.org/10.1001/jamapediatrics.2015.54
Murphy SW, Barrett BJ, Parfrey P. Contrast nephropathy. JASN. 2000;11(1):177-82. https://doi.org/10.1681/ASN.V111177
Owen RJ, Hiremath S, Myers A. Canadian Association of Radiologists Consensus Guidelines for the Prevention of Contrast-Induced Nephropathy: Update 2012. Can Assoc Radiol J. 2014;65(2):96-105. https://doi.org/10.1016/j.carj.2012.11.002
Weisbord SD, Gallagher M, Jneid H, Garcia S, Cass A, Thwin SS, et al. Outcomes after Angiography with Sodium Bicarbonate and Acetylcysteine. N Engl J Med. 2018;378:603-14. https://doi.org/10.1056/NEJMoa1710933
Barrett BJ, Carlisle EJ. Metaanalysis of the relative nephrotoxicity of high- and low-osmolality iodinated contrast media. Radiology. 1993 jul.;188(1):171-8. https://doi.org/10.1148/radiology.188.1.8511292
McDonald JS, McDonald RJ, Williamson EE, Kallmes DF. Is Intravenous Administration of Iodixanol Associated with Increased Risk of Acute Kidney Injury, Dialysis, or Mortality? A Propensity Score-adjusted Study. Radiology. 2017 nov.;285(2):414-24. https://doi.org/10.1148/radiol.2017161573
Kronbichler A, Shin JI, Windpessl M. What is left to prevent contrast-induced acute kidney injury? No difference between low and iso-osmolar contrast media. Int J Cardiol. 2018;273:94-5. https://doi.org/10.1016/j.ijcard.2018.09.050
Zo'o M, Hoermann M, Balassy C, Brunelle F, Azoulay R, Pariente D, et al. Renal safety in pediatric imaging: randomized, doubleblind phase IV clinical trial of iobitridol 300 versus iodixanol 270 in multidetector CT. Pediatr Radiol. 2011;41:1393-400. https://doi.org/10.1007/s00247-011-2164-6
Trout AT, Dillman JR, Ellis JH, Cohan RH, Strouse PJ. Patterns of intravenous contrast material use and corticosteroid premedication in children--a survey of Society of Chairs of Radiology in Children's Hospitals (SCORCH) member institutions. Pediatr Radiol. 2011 oct.;41(10):1272-83. https://doi.org/10.1007/s00247-011-2112-5
Modi K, Padala SA, Gupta M. Contrast-Induced Nephropathy. 2021 ag. 2. En: StatPearls [Internet]. Treasure Island (Florida, Estados Unidos): StatPearls Publishing; 2022.
Jurado-Román A, Hernández-Hernández F, García-Tejada J, Granda-Nistal C, Molina J, Velázquez M, et al. Role of Hydration in Contrast-Induced Nephropathy in Patients Who Underwent Primary Percutaneous Coronary Intervention. Am J Cardiol. 2015;115:1174-9. https://doi.org/10.1016/j.amjcard.2015.02.004
Liu Y, Li H, Chen S, Chen J, Tan N, Zhou Y, et al. Excessively High Hydration Volume May Not Be Associated with Decreased Risk of Contrast-Induced Acute Kidney Injury After Percutaneous Coronary Intervention in Patients with Renal Insufficiency. J Am Heart Assoc. 2016;5:1-14. https://doi.org/10.1161/JAHA.115.003171
Stevens MA, McCullough PA, Tobin KJ, Speck JP, Westveer DC, Guido-Allen DA, et al. A prospective randomized trial of prevention measures in patients at high risk for contrast nephropathy: results of the P.R.I.N.C.E. Study. Prevention of Radiocontrast Induced. Nephropathy Clinical Evaluation. J Am Coll Cardiol. 1999;33:403-11. https://doi.org/10.1016/S0735-1097(98)00574-9
Mattathil S, Ghumman S, Weinerman J, Prasad A. Use of the RenalGuard system to prevent contrast-induced AKI: A metaanalysis. J Interv Cardiol. 2017;30:480-7. https://doi.org/10.1111/joic.12417
Katoh H, Nozue T, Horie K, Sozu T, Inoue N, Michishita I. RenalGuard system to prevent contrast-induced acute kidney injury in Japanese patients with renal dysfunction; RESPECT KIDNEY study. Cardiovasc Interv Ther. 2019 abr.;34(2):105-12. https://doi.org/10.1007/s12928-018-0527-8
Tepel M, van der Giet M, Schwarzfeld C, Laufer U, Liermann D, Zidek W. Prevention of radiographic-contrast-agent-induced reductions in renal function by acetylcysteine. N Engl J Med. 2000.20;343(3):180-4. https://doi.org/10.1056/NEJM200007203430304
Asif A, Epstein M. Prevention of radiocontrast-induced nephropathy. Am J Kidney Dis. 2004 jul.;44(1):12-24. https://doi.org/10.1053/j.ajkd.2004.04.001
ACT Investigators. Acetylcysteine for prevention of renal outcomes in patients undergoing coronary and peripheral vascular angiography: main results from the randomized Acetylcysteine for Contrast-induced nephropathy Trial (ACT). Circulation. 2011 sept. 13;124(11):1250-9. https://doi.org/10.1161/CIRCULATIONAHA.111.038943
Toso A, Leoncini M, Maioli M, Tropeano F, Bellandi F. Pharmacologic Prophylaxis for Contrast-Induced Acute Kidney Injury. Interv Cardiol Clin. 2014 jul.;3(3):405-19. https://doi.org/10.1016/j.iccl.2014.03.010
Assadi F. Acetazolamide for prevention of contrast-induced nephropathy:a new use for an old drug. Pediatr Cardiol. 2006;27:238-42. https://doi.org/10.1007/s00246-005-1132-z
Bayram A, Ulgey A, Baykan A, Narin N, Narin F, Esmaoglu A, et al. The effects of dexmedetomidine on early-stage renal functions in pediatric patients undergoing cardiac angiography using nonionic contrast media: a double-blind, randomized clinical trial. Paediatr Anaesth. 2014;24:426-32. https://doi.org/10.1111/pan.12348
Phan H, Nahata MC. Clinical uses of dexmedetomidine in pediatric patients. Paediatr Drugs. 2008;10(1):49-69. https://doi.org/10.2165/00148581-200810010-00006
Tang C, Hu Y, Gao J, Jiang J, Shi S, Wang J, et al. Dexmedetomidine pretreatment attenuates myocardial ischemia reperfusion induced acute kidney injury and endoplasmic reticulum stress in human and rat. Life Sci. 2020 sept. 15;257:118004. https://doi.org/10.1016/j.lfs.2020.118004
Yu X, Chi X, Wu S, Jin Y, Yao H, Wang Y, et al. Dexmedetomidine Pretreatment Attenuates Kidney Injury and Oxidative Stress during Orthotopic Autologous Liver Transplantation in Rats. Oxid Med Cell Longev. 2016;2016:4675817. https://doi.org/10.1155/2016/4675817
Sha J, Zhang H, Zhao Y, Feng X, Hu X, Wang C, et al. Dexmedetomidine attenuates lipopolysaccharide-induced liver oxidative stress and cell apoptosis in rats by increasing GSK-3?/MKP-1/Nrf2 pathway activity via the ?2 adrenergic receptor. Toxicol Appl Pharmacol. 2019 febr. 1;364:144-52. https://doi.org/10.1016/j.taap.2018.12.017
Wieruszewski PM, Wittwer ED. It's All in the Details: Dexmedetomidine and Acute Kidney Injury After Cardiac Surgery. J Cardiothorac Vasc Anesth. 2020 sept.;34(9):2549. https://doi.org/10.1053/j.jvca.2020.04.018
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