Impaired renal function in acute myocardial infarction.

Impaired renal function is a risk factor for cardiovascular disease and an adverse prognostic factor in patients with established cardiovascular disease. In addition, with current widespread use of invasive procedures in the treatment of acute myocardial infarction, contrast-induced nephropathy is a growing problem in this patient population. In acute myocardial infarction, impaired renal function may result from underlying kidney disease, acute renal failure, and the effect of drugs and contrast agents used during diagnostic procedures or treatment. These various causes may coexist, resulting in significantly worse outcomes. Prompt recognition of the degree of renal function impairment and institution of appropriate preventive and therapeutic measures are among major goals of in-hospital management of these patients. A commonly used method to evaluate renal function is the determination of glomerular filtration rate. Appropriate nephroprotective treatment should be used in patients at risk of contrast-induced nephropathy. The most commonly used methods include the use of iso-osmotic contrast agents and appropriate hydration in the periprocedural period. Studies are currently under way to evaluate nephroprotective properties of other drugs such as N-acetylcysteine, sodium chloride and sodium bicarbonate solutions, mannitol, and statins. Results of some studies suggest that these measures may effectively reduce the number of renal function deterioration events in patients with acute myocardial infarction. Regardless of the cause, impaired renal function in acute myocardial infarction is a significant adverse prognostic factor. Thus, despite some inconsistent views regarding the optimal management strategy, intensive diagnostic, preventive, and therapeutic measures are clearly necessary in patients with acute myocardial infarction and impaired renal function.