[New aspects of contrast nephropathy in cardiology].

Advances in imaging techniques for diagnostic purposes and for guiding percutaneous coronary interventions and the demographic changes in the population mean that increasing numbers of patients are undergoing studies with iodine contrast agents. When no recognized risk factors are present and renal function is normal, exposure to such agents does not require any special caution. However, elderly patients and patients with diabetes, hypertension, heart disease, and kidney disease, that is, those who stand to benefit most from the aforementioned interventional techniques, are also those at greatest risk of contrast nephropathy. Magnetic resonance imaging techniques, initially considered the best diagnostic alternative in patients at high risk of contrast nephropathy, are not a substitute for invasive techniques when endovascular treatment is needed. Furthermore, the use of gadolinium as a paramagnetic contrast for magnetic resonance imaging is contraindicated in patients with creatinine clearance below 30 mL/min due to the risk of developing nephrogenic systemic fibrosis or nephrogenic fibrosing dermopathy (NSF/NFD), as recently recognized by the Food and Drug Administration.1 The 2 fundamental criteria proposed by the Spanish Society of Nephrology to define the appearance of contrast nephropathy are an absolute increase in plasma creatinine of 0.5 mg/dL with respect to baseline or a relative increase of 25% of iodine contrast 24-48 hours after administration,2 in absence of other documented causes for renal failure (atheroemboli, aortic dissection, etc). Table 1 shows the recommendations for recognizing the onset of contrast nephropathy. New Aspects of Contrast Nephropathy in Cardiology