Tubulopathies

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Nécrose tubulaire aiguë

Définition

• Persistance d'une insuffisance rénale > 48-72h, définition arbitraire
• Entité clinique dont la distinction avec l'insuffisance rénale aiguë d'origine prérénale est discutée

Etiologie

• Contrast agents are thought to cause acute tubular necrosis through renal vasoconstriction and direct cytotoxicity; however, the mechanisms are not completely understood. Risk factors for CIN include advanced age, diabetic nephropathy, multiple myeloma, concomitant use of nephrotoxins (for example, aminoglycoside antibiotics, NSAIDs), severity of CKD, reduced renal perfusion (due to poor cardiac function or volume depletion), higher dose of contrast, high osmolar contrast (rarely used in industrialized contrast), repeated doses of contrast, and intra-arterial administration. Intravenous isotonic fluids (1-1.5 mL/kg/h 3 to 4 hours before the procedure and continued for 6 to 12 hours) are the mainstay in preventing CIN and perform better than hypotonic fluids.