Contrast media in renal insufficiency - risk and prevention.

The use of iodinated contrast media (CM) continues to be a common cause of hospital-acquired acute renal failure (ARF) and its development increases t he in-hospital mortality significantly. Alterations in renal hemodynamics a nd direct tubular toxicity by contrast media are the primary factors believ ed to be responsible for contrast media-associated nephrotoxicity. We revie w recent insights into the pathogenesis of this complication and summarize prophylactic strategies focussing on hydration, vasoactive pharmacological agents, alternative contrast media and "prophylactic hemodialysis".