조영제 유발 신독성
Contrast-Induced Nephropathy
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초록
조영제 신독성은 원내 급성 신부전 원인 중 세 번째로 많은 원인 질환을 차지한다. 조영제를 이용한 검사와 시술뒤 발생하는 조영제 유발 급성 신부전의 발생 빈도는 환자의 위험인자에 따라 0-24%까지 다양하게 보고되고 있으며 대체로 가역적으로 회복되는 것으로 알려져 있기는 하지만 재원 일수의 증가와 동반 합병증 발생 증가 및 사망률증가로 이어질 수 있어 적극적인 예방과 치료가 요구된다. 조영제 신독성을 막기 위한 치료로써 일반적으로는 충분한 수액 공급을 시행하면서 전해질 불균형을 막기 위해노력하는 것으로 회복을 도울 수 있다고 보고되나, 진행을 막는 확실한 치료법이나 예방법이 밝혀지지 않아 일부에서는 투석이 필요한 경우도 있기 때문에 초기에 발생을 막기위한 예방법 개발에 보다 많은 연구가 필요한 시점이다. 이에 앞서 발표된 문헌을 중심으로 조영제 유발 신부전의 기전과 치료에 대해 기술해 보고자 한다.
Abstract
Radiocontrast-induced nephropathy (CIN) is the third most common cause of acute renal failure among inpatients. The numberof patients undergoing examinations using radiocontrast is increasing, and the population at risk for CIN is growing; this populationincludes older individuals and those with underlying diabetes mellitus, chronic kidney disease, hypertensive nephropathy, and concomitantuse of nephrotoxic drugs. However, little progress in CIN treatment has been made. CIN remains a substantial medicalproblem because of its association with prolonged hospitalization, the potential need for renal replacement therapy, and increasedmortality. The exact pathogenesis of CIN has not been fully elucidated―and multiple factors including tubular renal vasoconstriction,direct renal tubular toxicity, increased oxidative stress, and cellular apoptosis―may contribute to the proximal tubulardamage that occurs in patients with CIN. Despite the exploration of numerous prophylactic regimens and treatments, definite therapeuticand preventive strategies for CIN have not been established. This article reviews recent studies involving the risk factors forCIN as well as its pathophysiology and prevention.
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