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The cell damage may be aggravated by factors such as tissue hypoperfusion and hypoxia, by properties of contrast media, such as ionic strength, high osmolarity, and/or viscosity, and by clinically unfavourable conditions, such as preexisting renal impairment particularly secondary to diabetic nephropathy, salt depletion and dehydration, congestive heart failure, and concurrent use of nephrotoxic d
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