Radiocontrast Nephropathy: Progress not Prevention

Radiocontrast Nephropathy (RCN) is a well-known complication after the intravascular administration of contrast medium occurring in approximately 15% of all cases. RCN can potentially be prevented by identifying subjects with major and minor risk factors and administering preventive strategies. Pharmacologically, volume expansion with intravenous isotonic saline, N-acetylcysteine, and the use of low-osmolar contrast are the most proven prophylactic approaches. However, the weight of evidence is beginning to build for more novel protective measures, such as the use of iso-osmolar contrast, sodium bicarbonate infusion, and periprocedural hemofiltration. This comprehensive review provides the interventional community a practical treatment paradigm for patients at risk for RCN.