Can selective inhibitors of cyclic guanosine monophosphate (cGMP)-specific phosphadiesterase type 5 (PDE 5) offer protection against contrast induced nephropathy?

Parenchymal hypoxia within the renal outer medulla plays an important role in the pathogenesis of contrast induced nephropathy (CIN). Nitric oxide (NO) is crucial for medullary oxygenation by enhancing regional blood flow. Augmenting the effect of NO in the renal medulla by the use of selective inhibitors of cyclic guanosine monophosphate (cGMP)-specific phosphadiesterase type 5 (PDE 5) such as sildenafil (Viagra^TM), vardenafil (Levitra^TM) or tadalafil (Cialis^TM) could reduce the severity of the hypoxic insult induced by the contrast medium and reduce the risk of CIN. Prophylactic administration of one of these drugs particularly the long acting one tadalafil before and after the administration of CM could offer a simple and rational approach to reduce the risk of this complication. This hypothesis deserves serious investigation to determine its clinical efficacy.