Pathophysiology of renal tissue damage by iodinated contrast media

• Published in: Clinical and experimental pharmacology & physiology Vol. 38; no. 5; pp. 292 - 299
• Main Author: Sendeski, Mauricio M
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.05.2011
• Subjects: Animals; Blood Vessels - drug effects; Blood Vessels - physiology; cell culture; contrast media; Contrast Media - adverse effects; Humans; Iodine Compounds - adverse effects; Kidney - drug effects; Kidney - pathology; Kidney Diseases - chemically induced; Kidney Diseases - pathology; Kidney Tubules - drug effects; Kidney Tubules - pathology; Kidney Tubules - physiology; Models, Biological; nephrotoxicity; pathophysiology; tubular epithelium; vessel
• ISSN: 0305-1870; 1440-1681
• DOI: 10.1111/j.1440-1681.2011.05503.x

Summary 1. The present review focuses on the cytotoxic effects of iodinated contrast media (CM) that are shared by all types of CM. 2. Although the clinical nephrotoxicity of CM has been progressively improved, all currently available CM still possess a level of cytotoxicity, which is probably caused by iodine. 3. The toxicity caused by specific CM properties, such as osmolarity, viscosity and ionic strength, can be differentiated from the cytotoxicity common to all CM in studies using cell culture, isolated blood vessels and isolated tubules. 4. The cytotoxicity induced by CM leads to apoptosis and cell death of endothelial and tubular cells and may be initiated by cell membrane damage, together with oxidative stress. 5. Cell damage may be aggravated by factors such as tissue hypoperfusion and hypoxia, properties of individual CM, such as ionic strength, high osmolarity and/or viscosity, and clinically unfavourable conditions. 6. Clinically detectable renal failure may result from the summation of all these factors.