Figure 1.

Presumed renoprotective effects of Mesna in tubule lumen. Radiocontrast agents (RCA) are filtered into the primary urine. In the tubule lumen, RCAs are concentrated 100-fold by water reabsorption. High RCA concentration stimulates the production of reactive oxygen (ROS) in the tubule cells leading to epithelial cell necrosis and tubule obstruction. By hydration, RCAs are less concentrated and tubule obstruction can be washed out. While N-acetylcysteine acts mainly from the basal side, Mesna can prevent ROS production in the tubule cells from both apical and basal sides. Finally Mesna may prevent contrast-agent-induced nephrotoxicity by glutathione regeneration. Graphic: G.Hintze.