조영제 콩팥병증에서 중탄산염나트륨 수액요법과 N-acetylcysteine의 역할
Role of Intravenous Sodium Bicarbonate and Oral N-acetylcysteine in Radiocontrast-Induced Nephropathy
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초록
조영제 콩팥병증의 예방을 위해서는 고 위험 군에서 조영제를 사용하는 시술은 반드시 필요한 경우로 제한하고 탈수 환자에서는 반드시 조영제를 사용하기 전 충분한 수액을 공급하고 이뇨제나 콩팥의 혈류를 변화시킬 수 있는 약제인 비스테로이드성 소염제 등의 투약을 중단해야 된다. 그러나 이것만으로 조영제 콩팥병증 예방은 부족하다. 따라서 염화나트륨 혹은 중탄산염나트륨 수액 요법과 oral NAC 병합 치료를 표준 요법으로 제시할 수 있을 것으로 생각되지만 어떤 수액요법이 더 효과적지를 규명하기 위해서는 후속적인 다기관 무작위 대조시험이 필요할 것으로 생각된다.
Abstract
Radiocontrast nephropathy (RCN) is one of the most common etiologies of hospital-acquired acute kidney injury (AKI), accounting for more than 10% of cases. There have been conflicting reports on the use of intravenous administration of sodium bicarbonate and oral N-acetylcysteine (NAC) for prevention of RCN. In this issue of the Journal, Koo et al compare the efficacy of sodium bicarbonate hydration with sodium chloride solution. They concluded that the efficacy of sodium bicarbonate hydration in the prevention of RCN seemed comparable to that of sodium chloride hydration. Oral NAC is safe and inexpensive. Therefore, we can propose that sodium bicarbonate or sodium chloride hydration with oral NAC in the prevention of RCN is probably effective, especially in CKD patients undergoing coronary procedure. However, additional large, multicenter, randomized, controlled trials will be required to define the true role of sodium bicarbonate and NAC in preventing RCN. (Korean J Med 2011;80:534-536)
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