PENCEGAHAN DAN PENATALAKSANAAN NEFROPATI RADIOKONTRAS

Maimun Syukri, Cut Srijuita

Abstract


Abstrak. Gagal ginjal karena pemberian kontras media  merupakan penyebab ketiga dari gagal ginjal yang didapat di rumah sakit. Penderita dengan fungsi ginjal normal jarang mengalami nefropati karena kontras. Pada penderita  dengan serum kreatinin lebih dari 1.5 mg/dl (132 µmol/l), pemberian  iodine harus hati-hati terhadap nefropati karena dari laporan pemberian kontras iodine mempunyai risiko sangat tinggi untuk terjadi nefropati kontras. Manifestasi dari nefro toksik yang berat bisa dimulai dari non oliguri dengan penurunan laju filtrasi glomerulus sampai dengan gangguan ginjal akut yang memerlukan dialisis. Faktor penyebab utama terjadinya  gangguan ginjal akut adalah pre-existing insufisiensi ginjal dan diabetes. Faktor risiko lain adalah penyakit kardiovaskuler, pemakaian diuretik, urikosuria, usia lanjut, multiple myoloma yang mengalami dehidrasi. Kontras media ionik dan non ionik keduanya mempunyai efek nefro toksik meskipun kontras non ionik efek nefro toksiknya lebih rendah dari kontras ionik. Rehidrasi adalah cara utama untuk pencegahan nefropati kontras, pencegahan lainnya dapat menggunakan acetyl cysteine dan anti oksidan.

Abstract. Renal failure associated with contrast administration has been reported  as the third most common cause of in-hospital renal failure. Patient with normal renal function rarely develop contrast-induced nephropathy. In patients with serum creatinine levels higher than 1.5 mg/dl (132 µmol/l), iodinated contras should be used with caution because the risk for contrast-induced nephropathy renal failure is increased. Nephrotoxicity ranges in severity from nonoliguric transient fall in glomerular  filtration rate to severe renal failure requiring dialysis. The major risk factor for developing acute kidney injury is the combination of pre-existing renal insufficiency and diabetes. Other risk factors include cardio-vascular disease, the use diuretic, advanced age, multiple myeloma in dehydrate patients, hypertension, uricosuria, and high dose of contrast. Both ionic  and nonionic contrast media can induce nephrotoxicity although nonionic contrast is significantly less nephrotoxic. Hydration is the mainstay of prevention, acetylcysteine, a thiol-containing antioxidant given in conjunction with hydration, has not proved consistently to be protective.


Keywords


Nefropati kontras; gangguan ginjal akut; faktor risiko; pencegahan Contrast-induced nephropathy; acute kidney injury; risk factors; prevention

References


Coffman T, Kidney function impairment caused by therapeutic agents.In: Greenberg A.Editor. Primer on kidney disease,5th ed.Philadelphia, Elseveir. 2009. P.288-289.

Mitchell AM, Jones AE. Incidence of contrast induced nephropaty after contrast enhanced computed tomography in the outpatient setting. Clin J Am Soc Nephrol. 2010;5:4-9.

McCullough PA, Contrast induced acute kidney injury. J Am Coll Cardiol. 2008;51:1419-1428.

Heyman S, Mayer B, Robert EC. Radiocontrast media-induced acute renal failure. In: Robert WS, editor.Dissease of the kidney & urinary tractus.8th ed.Philadelphia: Churchill Livingstone; 2007;45:1102-1117

Bartorelli AL,Marenzi G. Contrast induced nephropathy. J Interv Cardiol 2008;21:74-85.

Bandara R. Gangguan ginjal akut akibat media kontras. Dalam: Roesli MA, Gangguan Ginjal Akut. cetakan I. RSHS. Jakarta. 2008. hal 188-194.

Persson P,Hansell P, Liss P. Pathophysiology of contrast medium-induced nephropathy. Kidney Int . 2005;68:14-22

Ilan G, Shlomi M. Nephropathy induced by contrast media: pathogenesis, risk factors and preventive strategies. CMAJ. 2005;172:10-1503.

Solomon R, Rudnick MR, Saini S. CIN strategies: anticipate, manage, prevent. Imaging economics med imaging suppl. 2007:3-12

Rudnick MR, Kesstlheim A, Goldfarbs. Contrast induced nepropathy: How it develops, how to prevent it .Cleveland clin j med. 2006:73:75-85

Kawashima A, LeRoy AS. Plain radiography, excretion radiography, and contrast radiography. In: Davison AM editor. Oxforord Text Book of Clinical Nephrology. 3rd Ed.Oxford University Press. 2005:97-99

Magee C.Guidelines for the prevention of contrast induced nephropathy. Beaumont hospital.2009:3-5

Barrett BJ, Partrey PS. Preventing nepropathy induced by contrast medium. NEJM. 2006. 354: 379-386.

Schweiger M, Chambers C, Davidson C et al. Prevention of contrast induced nephropaty: recommendations for the high risk patient undergoing cardiovascular procedures. Catheterization and cardiovascular interventions. 2007;69:135-140

Andrew B, Margaret FH, Peter M, et al. Guidelines for the prevention of contrast induced nephropathy. Canadian association of radiologist. Approved: June 17.2011:12

Dunn S. Guidelines for contrast induced nephropathy (CIN) prevention in adults. UK health care. 2008:1-3

Moioli M, Toso A,Leonaini M. Sodium bicarbonate vesus saline for the prevention of contrast induced nephropathy in patients with rnal dysfunction undergoing coronary angiography or intervention. J Am Coll Cardiol. 2008;8:599-604

Steven D, Paul M. Prevention of contrast-induced nephropathy with volume expansion. Clin J Am Soc Nephrol.2008;3:273-280

Vermeulen.Guidelines for the prevention of contrast-induced nephropathy in adults.University of Wisconsin hospital and clinics. 2008:3


Refbacks




Creative Commons LicenseISSN: 1411-3848E-ISSN: 2579-6372
Copyright© 1987-2017 | ISSN: 1412-1026 | EISSN: 2550-0112 
Jurnal Kedokteran Syiah Kuala is licensed under a Creative Commons Attribution 4.0 International License.

 

Published by:
Fakultas Kedokteran, Universitas Syiah Kuala
 
Jl. Tgk. Tanoh Abee, Kopelma Darussalam,
Banda Aceh, 23111, Indonesia.
Phone: +626517551843 
Email: jks@unsyiah.ac.id


Online Submissions & Guidelines | Editorial Policies | Contact | Statistics | Indexing | Citations