Pathogenesis of Acute Renal Failure Induced by Iodinated Radiographic Contrast Media

The use of iodinated radiographic contrast media, to improve the visibility of internal organs and structures in X-ray based imaging techniques, can cause Acute Renal Failure, commonly called Contrast-induced Nephropathy (CIN). The pathogenetic mechanisms responsible for contrast media nephrotoxicity have not been completely elucidated; knowing them, however, is very important to prevent CIN. All pathogenetic factors that have been suggested by many authors are discussed in this review, including haemodynamic changes, formation of reactive oxygen species (ROS), role of Nitric Oxide (NO), the role of adenosine and endothelin and cytotoxicity of contrast media, and the intracellular Ca2+ overload. Clinical conditions favouring the occurrence of CIN are also mentioned, including dehydration, salt depletion, reduction of ‘effective' circulating blood volume, pre-existing chronic renal failure, and diabetes mellitus.