Figure 2 Determinants of renal contrast medium enrichment

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Figure 2 Determinants of renal contrast medium enrichment Figure 2 | Determinants of renal contrast medium enrichment. a | Contrast media (CM) are not reabsorbed so they become concentrated en route through the tubules. Conversely, interstitial osmolality drives tubular water reabsorption. The effects of these osmotic forces on CM concentration and viscosity were modelled by in vitro dialysis of CM solutions57. At the ambient osmolality of 290 mosmol/kg H2O, the concentration of CMs with high osmolality (that is low-osmolar CMs when compared to iso-osmolar CMs, see also Table 1) decreased owing to water inflow. With increasing ambient osmolalities, water is progressively extracted from the solutions and fluid viscosity increases. At 1,000 mosmol/kg H2O, the concentration of low-osmolar CM is slightly elevated whereas that of iso-osmolar CM is about twice as high as that of their original solutions. Owing to the exponential concentration–viscosity relationship, the viscosity of the iso-osmolar CM solution markedly exceeds that of the original solution as it was higher than the maximum value that the viscometer could measure in this experimental setting (150 mm2/s )57. b | In vivo, all contrast agents induce osmodiuresis to the degree of their osmolality. Consequently, in a rat model, tubular CM enrichment is higher, and urine viscosity much higher, following iso-osmolar versus low-osmolar CM administration84. These differences in the magnitude of tubular CM concentration and viscosity are inversely related to the hydration status. Fähling, M. et al. (2017) Understanding and preventing contrast-induced acute kidney injury Nat. Rev. Nephrol. doi:10.1038/nrneph.2016.196