Primary prevention

Implementing an intervention before the ischemic or toxic injury occurs provides the best opportunity for preventing or attenuating the course of ATN.[5] If patients are prescribed nephrotoxic drugs, therapeutic blood drug levels should be monitored to avoid nephrotoxicity. In hospitalized patients, an optimal hemodynamic state should be maintained and renal hypoperfusion avoided. Monitored fluid repletion should always be performed as soon as ATN is suspected. The risk of postoperative kidney injury can be reduced by monitoring hemodynamic changes during surgery (especially in high-risk surgeries, such as vascular or cardiac), and optimizing intravascular volume, cardiac output, and oxygenation.[1]

Pretreatment for radiocontrast exposure:

A lower incidence of toxicity has been seen in patients receiving periprocedural intravenous isotonic saline; however, the protective effect remains controversial. Other studies suggest that the risk of acute kidney injury (AKI) following contrast administration could be overestimated.[21][22] Despite this, current guidelines from the American College of Radiology recommend administration of 100 mL/hour intravenous isotonic saline for 6 to 12 hours before and 4 to 12 hours after radiocontrast exposure.[23] The European Society of Cardiology guidelines on myocardial revascularization recommend intravenous isotonic saline 1-1.5 mL/kg/hour for 12 hours before and up to 24 hours after the procedure.[24] For outpatient or urgent procedures, administration of isotonic saline 1 to 3 hours before and 6 hours after could be beneficial. N-acetylcysteine has been widely used in daily practice. However, a recent study has shown no difference in the rate of contrast-associated AKI compared with placebo. Therefore, it is no longer recommended.[21][23][25]

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