~Teachingcenter的醫學筆記~

根據2012 KDIGO guideline對contrast-induced acute kidney injury(CI-AKI)的建議，下列何者為是？

A. 所有病人都可用靜脈注射方式hydration預防CI-AKI。

B. 安排須顯影劑注射的檢查之前要評估風險。

C. 可事後以洗腎方式治療CI-AKI。

D. 建議使用針劑的N-acetylcysteine 預防CI-AKI。

E. 可檢查前多喝水預防。

Ans: B. (但個人認為A和C也應該為正確，但”所有人”就不一定了，而若做完檢查就要洗腎，那會建議選用其他檢查或治療方法)

Kidney disease: Improving global outcomes (KDIGO)在2012年發表了對於acute kidney injury這個疾病諸多的建議

其中關於contrast-induced acute kidney injury(CI-AKI)的建議如下：

Contrast-induced AKI

1. In individuals who develop changes in kidney function after administration of intravascular contrast media, evaluate for CI-AKI as well as for other possible causes of AKI. (Not Graded) 即使懷疑是因顯影劑造成的腎功能異常，仍不能忽略其他可能造成急性腎損傷
2. Assess the risk for CI-AKI and, in particular, screen for pre-existing impairment of kidney function in all patients who are considered for a procedure that requires intravascular (i.v. or i.a.) administration of iodinated contrast medium. (Not Graded) 「所有的病人」在執行血管內注射顯影劑之前，都應該要有完整的評估，包含其初始腎功能和其他風險
3. Consider alternative imaging methods in patients at increased risk for CI-AKI. (Not Graded) 對於有急性腎損傷風險的病人，選用其他種檢查方式
4. Use the lowest possible dose of contrast medium in patients at risk for CI-AKI. (Not Graded) 對有風險的病人儘量減少顯影劑的劑量(但我認為應該是所有病人都應該如此)
5. We recommend using either iso-osmolar or low-osmolar iodinated contrast media, rather than high-osmolar iodinated contrast media in patients at increased risk of CI-AKI. (1B) 對有風險的病人使用等滲透壓或低滲透壓的顯影劑
6. We recommend i.v. volume expansion with either isotonic sodium chloride or sodium bicarbonate solutions, rather than no i.v. volume expansion, in patients at increased risk for CI-AKI. (1A) 對於有風險的病人，使用等張靜脈輸液(如生理食鹽水或碳酸氫鈉溶液)增加體液容積，而不是完全沒有增加體液容積
7. We recommend not using oral fluids alone in patients at increased risk of CI-AKI. (1C) 對於有風險的病人，不建議只使用增加引水的方式來預防檢查後的急性腎損傷
8. We suggest using oral NAC, together with i.v. isotonic crystalloids, in patients at increased risk of CI-AKI. (2D) 對於有風險的病人，可使用「口服」N-acetylcysteine和靜脈給予等張晶體容易
9. We suggest not using theophylline to prevent CI-AKI. (2C) 不建議使用theophylline來預防檢查後的急性腎損傷
10. We recommend not using fenoldopam to prevent CI-AKI. (1B) 不建議使用fenoldopam來預防檢查後的急性腎損傷
11. We suggest not using prophylactic intermittent hemodialysis (IHD) or hemofiltration (HF) for contrast-media removal in patients at increased risk for CI-AKI. (2C) 對於有風險的病人，不建議在檢查後使用預防性洗腎的方式來移除血中的顯影劑

Fenoldopam:

- selective D1 receptor agonist 
- arterial/arteriolar vasodilation (ie increases preload)
- promotes sodiumexcretion via specific dopamine receptors along the nephron.
- vasodilation increases blood flow to kidneys