Контраст-индуцированное острое почечное повреждение: современное состояние вопроса

Понятие “контраст-индуцированное острое почечное повреждение” (КИ-ОПП) представляет собой подъем уровня креатинина плазмы крови, зафиксированный в течение 48 ч после введения контрастного препарата. Данное состояние является третьей по частоте причиной хронической почечной недостаточности, возникающей в стационаре. Несмотря на довольно частую встречаемость данного явления, до конца не ясно, действительно ли все подобные случаи можно объяснить исключительно широким распространением процедур с введением контрастного препарата, ведь снижение функции почек зачастую встречается и у стационарных пациентов, которым не вводили контрастный препарат. Так как схемы лечения КИ-ОПП не существует, многие группы ученых предпринимали попытки разработать схему профилактики. Однако такие мероприятия сопряжены с рядом сложностей: возможные последствия для пациентов, логистические трудности в лечебном учреждении, экономические затраты. Эффективность данных мероприятий также однозначно не доказана. В частности, в ходе крупного исследования AMACING было показано, что гидратация не снижает вероятность развития КИ-ОПП, но существенно увеличивает расходы на лечение пациента и может вызвать специфические осложнения. Кроме того, много литературных данных свидетельствует в пользу того, что методика гидратации эффективна для предотвращения снижения функции почек лишь у пациентов, которые подверглись внутриартериальному введению контрастного препарата. Таким образом, необходимость медикаментозной профилактики КИ-ОПП в настоящее время подвергается сомнению; исследования в этой области активно продолжаются.

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