N-acetylcysteine in kidney disease

Acute kidney injury (AKI) is a frequent complication of contrast administration (contrast-induced nephropathy) and cardiac surgery and is associated with increased short-term and long-term morbidity and mortality. Acute kidney injury is becoming a growing problem in modern cardiovascular medicine, in parallel with the increase in application of radiological procedures utilizing iodinated contrast media for both diagnostic and therapeutic purposes, and with the increasing number of elderly patients with comorbidities undergoing cardiac surgery. Due to the lack of any effective treatment, prevention of this complication is the key strategy. As oxidative stress seems to play an important role in both contrast-induced nephropathy and postcardiac surgery AKI etiologies, the potential prophylactic effect of the antioxidant agent N-acetylcysteine (NAC) has been largely investigated in recent years in patients at risk. In this chapter, we review the clinical impact of contrast-induced nephropathy and postcardiac surgery AKI and the clinical and investigational evidence for the potential role of NAC in the prevention of these two conditions.