Nefropatía inducida por contraste en pacientes con cardiopatía isquémica
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2018
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Medicina
Resumen
La nefropatía inducida por contraste es una complicación aguda o subaguda, considerada enfermedad iatrogénica, producida luego de la administración de contraste intravenoso, para su diagnóstico se requiere el aumento de 0,5 mg/dl o del 25% posterior a la administración de contraste en comparación a la medición de creatinina sérica pre procedimiento. El desarrollo de NIC aumenta la morbimortalidad, días de hospitalización y subsecuentemente gastos para el paciente que la desarrolla. Los factores de riesgos dependen de aquellos propios de pacientes y aquellos externos a él, factores de riesgo intrínsecos son edad mayor a 70 años, DMII, nefropatía previa, insuficiencia cardiaca congestiva con fracción de eyección disminuida y valvulopatía; los factores de riesgo extrínsecos son tipo de procedimiento, duración del procedimiento, cantidad y tipo de contraste administrado. La cardiología intervencionista ha sido protagonista de un gran avance en el diagnóstico y tratamiento de patologías cardiacas, en especial para el síndrome coronario, por medio de un catéter que es introducido por un vaso periférico de gran calibre se llega al corazón en el cual se administra un contraste intravenoso que resulta radiopaco para al angiografía y permite observar la anatomía del corazón y el recorrido de los vasos coronarios, en los actuales momentos es posible introducir el mismo catéter a las arterias coronarias y en caso de existir un estrechamiento se puede proceder a la dilatación con balón o incluso la colocación de un stent que permeabilizará el flujo coronario, el contraste es utilizado tanto para los procedimientos diagnósticos como terapéuticos.
Contrast-induced nephropathy is an acute or subacute complication, it is considered an iatrogenic disease. It is produced after intravenous contrast administration, for its diagnosis is required an increase of 0,5 mg/dl or 25% after the administration of contrast compared to pre-procedure creatinine level. The development of contrast-induced nephropathy increases morbimortality, hospitalization days and subsequent payments for the affected patients. The risk factors depend of those unique of each patient and factors not related to them, XIII intrinsic risk factors are age over 70, diabetes mellitus type II, previous nephropathy, congestive heart failure with low ejection fraction and valvular disease; extrinsic risk factors are type of procedure, duration of the procedure, amount and type of contrast. The interventionist cardiologist have been protagonist of a breakthrough in diagnosis and treatment of heart disease, especially for coronary syndrome, by means of a catheter that it is introduced by a great caliber peripheric vessel that travels to the heart cavity where it’s possible to provide an intravenous contrast that results radiopaque for the angiography and that allows us to watch the heart anatomy and coronary vessels, it is currently possible to introduce the same catheter into coronary arteries and in the case of a preexisting narrowing, we can proceed to the dilatation with ball or even a stent placement that will allow the coronary blood flow, the contrast is used both for diagnosis and treatment.
Contrast-induced nephropathy is an acute or subacute complication, it is considered an iatrogenic disease. It is produced after intravenous contrast administration, for its diagnosis is required an increase of 0,5 mg/dl or 25% after the administration of contrast compared to pre-procedure creatinine level. The development of contrast-induced nephropathy increases morbimortality, hospitalization days and subsequent payments for the affected patients. The risk factors depend of those unique of each patient and factors not related to them, XIII intrinsic risk factors are age over 70, diabetes mellitus type II, previous nephropathy, congestive heart failure with low ejection fraction and valvular disease; extrinsic risk factors are type of procedure, duration of the procedure, amount and type of contrast. The interventionist cardiologist have been protagonist of a breakthrough in diagnosis and treatment of heart disease, especially for coronary syndrome, by means of a catheter that it is introduced by a great caliber peripheric vessel that travels to the heart cavity where it’s possible to provide an intravenous contrast that results radiopaque for the angiography and that allows us to watch the heart anatomy and coronary vessels, it is currently possible to introduce the same catheter into coronary arteries and in the case of a preexisting narrowing, we can proceed to the dilatation with ball or even a stent placement that will allow the coronary blood flow, the contrast is used both for diagnosis and treatment.
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Nefropatía, Cardiopatía isquémica, Complicaciones, Factores de riesgo, Indicadores de morbimortalidad, Cantón Guayaquil, Ecuador, Hospital de Especialidades Dr. Teodoro Maldonado Carbo, Enfermedad iatrogénica, Medios de contraste