25 percent, measured 2 to 5 days after the procedure) occurred less frequently among patients who received iloprost compared to placebo (8 versus 22 percent respectively). - Severe hypotension required withdrawal of Iloprost in three patients. Although Iloprost may be effective in the prevention of contrast nephropathy, confirmation of these results in larger definitive trials is necessary before its use can be recommended. Fetzoldopanz - A prospective randomized trial (CONTRAST) assessed the effectiveness of fenoldopam in 315 patients (one-half diabetic) undergoing a cardiovascular procedure who had chronic renal .failure with an estimated creatinine clearance below 60 mllmin (mean 29 m1/min with a mean serum creatinine of 1.8 mg/dL ). - All patients also received one-half normal saline as mentioned above, and contrast nephropathy was defined as an increase in serum creatinine of ?..25 percent above baseline in the first four days. - There was no reduction in the incidence of contrast nephropathy in the fenoldopam group (34 versus 30 percent with placebo). It has been proposed that direct intrarenal administration may be more beneficial. Endothelia: receptor antagonist - A nonselective endothelin receptor antagonist was tested in a multicenter, double-blind randomized trial of high-risk patients undergoing coronary angiography. Compared with those assigned to placebo, a significantly higher percentage of patients who received active therapy sustained contrast nephropathy (56 versus 29 percent); this observation raises the possibility that endothelin may actually provide an intrinsic protective effect rather than contributing to the development of acute renal failure. Alternatively, selective endothelin receptor antagonists may be required to demonstrate prophylactic value in this setting. Summary And Recommendations Optimal therapy to prevent contrast-induced acute renal failure remains unceain. Patients with near-normal renal function are at little risk and,few precautions are necessary other than avoidance of volume depletion. We recommend the following preventive measures for patients at increased risk of contrast nephropathy, which is defined a serum creatinine 1.5 mg/d1. (132 tnicromol/L) or an estimated glomerular filtration rate">