Cytotoxic Effects of Contrast Media on Renal Tubular Cells. Pathogenesis of Contrast-induced Acute Kidney Injury and Prevention

Abstract

The continued growth in radiographic procedures for diagnostic or therapeutic purposes is leading to an increasing number of cases of contrast-induced Acute Kidney Injury (CI-AKI) secondary to Iodinated RadioContrast Agents (IRCA). In this review, following a brief description of IRCA and CI-AKI, the pathogenesis of CI-AKI is discussed in detail, particularly focusing on the direct toxic effects by IRCA on endothelial cells, red blood cells and mainly on renal tubular epithelial cells. In vitro studies of the effects of different IRCA on various signalling pathways known to play a role in cellular survival, growth and proliferation are reported, demonstrating that IRCA cause several and significant changes in a variety of cell signalling molecules that play important roles in cellular homeostasis. Factors favouring toxic effects by IRCA on renal tubular epithelial cells and protection of tubular cells against IRCA toxicity (by e.g. asialoerythropoietin, human serum albumin–Thioredoxin, extracellular volume expansion) are discussed. Measures to prevent IRCA nephrotoxicity by antioxidants and recent studies demonstrating reversal of IRCA toxicity on human renal proximal tubular cells by white grape juice extract conclude the review.