Advances in the pathogenesis and prevention of contrast-induced nephropathy

Abstract With the increasing application of medical imaging contrast materials, contrast-induced nephropathy has become one of the leading causes of iatrogenic renal insufficiency. Due to the individual differences, the incidence of contrast-induced nephropathy varies among patients with different pre-existing conditions. In mechanism, renal medullary hypoxia and direct toxicity of contrast agents have been extensively studied, while there are relatively few reports on the mechanisms of oxidative stress, apoptosis, immune/inflammation and epigenetic regulation in contrast-induced nephropathy. To date, there is no effective therapy for contrast-induced nephropathy, and thus risk predication and effective preventive strategies are keys to reduce the occurrence of contrast-induced nephropathy. Recently, the proper use of contrast medium, personalized hydration, and high-dose statins have been found to reduce the occurrence of contrast-induced nephropathy, while antioxidants have not shown significant therapeutic benefits in this type of patients. Additionally, the role of remote ischemia preconditioning and vasodilators in the prevention of contrast-induced nephropathy warrants further study. This review aims to discuss the incidence, pathogenesis, risk prediction, and preventive strategies for contrast-induced nephropathy.