Abstract：
:Contrast-induced nephropathy (CIN) is regarded as acute tubular necrosis resulting from the cytotoxicity of contrast media and the medullary hypoxia linking to the interplay of vasoconstriction and vasodilatation. Saline infusion may prevent CIN by inhibiting renin release and thus production of angiotensin II (ANG II), a vasoconstrictor, from angiotensin I (ANG I). Yet the use of angiotensin converting enzyme inhibitor (ACEI) yields conflicting results in the prevention of CIN. We hypothesise that ACEI will be useful for CIN prevention when the saline infusion is insufficient, useless when the saline infusion is sufficient, and counterproductive when the saline infusion is excessive, respectively. When the production of ANG I and thus ANG II is insufficiently inhibited by insufficient saline infusion, ACEI may help prevent CIN by conferring extra inhibition on the production of ANG II from ANG I. The counterproductive effect may result from ACEI blocking the generation of angiotensin 1-7, a potent vasodilator, from angiotensin 1-9 whose precursor, ANG I, is excessively diminished by excessive saline infusion. Clinical data suggest that normal saline infusion at a rate of 1 ml/kg/h for 12 h, 1 ml/kg/h for 6 h, and 2 ml/kg/h for 6 h before and after contrast injection provide sufficient, insufficient, and excessive hydration in the prevention of CIN, respectively. The mainstream guideline is to stop ACEI and provide sufficient hydration for CIN prevention. Alternatively one may continue to have ACEI but the use of normal saline infusion must be limited to 1 ml/kg/h for 6 h before and after contrast injection.
journal_name
Med Hypothesesjournal_title
Medical hypothesesauthors
Wong PC,Guo J,Zhang Adoi
10.1016/j.mehy.2015.09.020subject
Has Abstractpub_date
2015-12-01 00:00:00pages
874-7issue
6eissn
0306-9877issn
1532-2777pii
S0306-9877(15)00363-1journal_volume
85pub_type
杂志文章abstract：:Melasma is an acquired disorder of pigmentation that presents with asymptomatic symmetric darkening of the face. The pathogenesis of this condition is multifactorial and influenced by several factors including female sex hormones, genetic predisposition and ultraviolet light exposure. The management of melasma is usua...
journal_title：Medical hypotheses
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doi：10.1016/j.mehy.2008.07.044
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pub_type： 杂志文章
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pub_type： 杂志文章
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更新日期：2011-12-01 00:00:00
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journal_title：Medical hypotheses
pub_type： 杂志文章
doi：10.1016/j.mehy.2013.10.030
更新日期：2014-01-01 00:00:00
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pub_type： 杂志文章
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pub_type： 杂志文章
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pub_type： 杂志文章
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journal_title：Medical hypotheses
pub_type： 杂志文章,评审
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journal_title：Medical hypotheses
pub_type： 信件
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pub_type： 杂志文章
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journal_title：Medical hypotheses
pub_type： 杂志文章,评审
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journal_title：Medical hypotheses
pub_type： 杂志文章,评审
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journal_title：Medical hypotheses
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更新日期：2019-02-01 00:00:00
