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Acute myocardial infarction in renal insufficiency II: Contrast induced nephropathy, modern continuous elimination methods, importance of troponin evaluation


Authors: S. Janoušek
Authors‘ workplace: Interní kardiologická klinika ;  FN Brno, pracoviště Bohunice ;  doc. MUDr. Stanislav Janoušek, CSc.
Published in: Kardiol Rev Int Med 2007, 9(2): 90-98
Category: Editorial

Overview

The serious complication of modern interventional treatment of acute myocardial infarction (AMI) with impaired renal function is so called contrast-induced nephropathy that is connected with significantly higher morbidity and mortality. That risk is increased with stage of renal insuficiency (RI) and is also significantly higher in diabetics. Therefore its prevention is important approach to reduction mortality and rate of cardiovascular complication. The basic approach is beside risk stratification the elimination of potentially nephrotoxic drugs and the use of nonionic low- or iso-osmolality radiocontrast media with minimalization of their dosis The very important is adequate hydration and monitoring of renal function and diuresis after interventional procedure. The application of N-acetylcystein-is promising preventive pharmacotherapy. The modern continuous elimination methods are of great benefit for patients with AMI and severe renal failure, because that could be performed bedside in the intensive care department. The higher serum concentration of troponins frequently observed in patients with RI without AMI can cause some problems in diagnostics. It is very considerable that also non-coronary increase of serum troponin concentration in RI is significant negative prognostic factor

Key words:
acute myocardial infarction, renal insufficiency, contrast induced nephropathy, prevention, modern continuous elimination methods, troponin


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