Contrast-induced nephropathy - Revision history

Rossdonaldson1: /* References */

2023-03-22T17:22:11Z

References

← Older revision		Revision as of 17:22, 22 March 2023
Line 73:		Line 73:

	[[Category:Renal]]		[[Category:Renal]]
			[[Category:Radiology]]

Rossdonaldson1: /* See Also */

2023-03-22T16:34:45Z

Rossdonaldson1: /* Prevention */

2023-03-22T16:28:33Z

Prevention

← Older revision		Revision as of 16:28, 22 March 2023
Line 55:		Line 55:
	==Disposition==		==Disposition==

	==Prevention==		==Prevention<ref>Tippins RB, Torres WE, Baumgartner BR, Baumgarten DA. Are screening serum creatinine levels necessary prior to outpatient CT examinations? Radiology. 2000 Aug;216(2):481-4.</ref><ref>ACR Manual on Contrast Media – Version 10, 2015. [http://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/Contrast%20Manual/2015_Contrast_Media.pdf PDF] Accessed 08/10/15</ref>==
			* ED patients do NOT require creatinine measurement prior to IV contrast if the study is immediately necessary to prevent life-threatening decompensation or delay in emergent treatment (e.g., trauma patients, dissection r/o)
			* [https://lacounty-my.sharepoint.com/personal/jshim_dhs_lacounty_gov/_layouts/15/onedrive.aspx?FolderCTID=0x01200042EAB0B5A27C63468CDB5666D0718199&id=%2Fpersonal%2Fjshim%5Fdhs%5Flacounty%5Fgov%2FDocuments%2FMicrosoft%20Teams%20Chat%20Files%2FUse%20of%20IV%2 DHS IV Contrast Expected Practices 10-2022]
			** '''Ok to give IV contrast if GFR>30'''
			** '''No need for GFR screening if age <60 with no pertinent history''' (AKI, CKD, HD with urine output, renal transplant, Metformin use)
			** If the GFR<30, ER physician should state in the CT order “Clinical History” or document in the chart that IV contrast is necessary and authorized.
			*** Alternately, the '''CT tech may call the physician to confirm IV contrast is necessary and authorized, and CT tech should document this communication in the chart.'''
			** Screening for MRI contrast is unnecessary unless using Eovist for liver mets study (all ED Emergent studies should use Dotarem or Gadavist)

	==See Also==		==See Also==

Rossdonaldson1: /* Healthy Patients */

2023-03-22T16:27:19Z

Healthy Patients

← Older revision		Revision as of 16:27, 22 March 2023
Line 7:		Line 7:

	===Healthy Patients===		===Healthy Patients===
	*~~CIN not~~ likely to occur in patients with a Cr<1.5 or a GFR >60ml/min<ref>Davenport MS. et al. Contrast material-induced nephrotoxicity and intravenous low-osmolality iodinated contrast material. Radiology. 2013 Apr;267(1):94-105</ref><ref>Sinert R, Brandler E, et al. Acad Emerg Med2012;19(11):1261</ref>		*Not likely to occur in patients with a Cr<1.5 or a GFR >60ml/min<ref>Davenport MS. et al. Contrast material-induced nephrotoxicity and intravenous low-osmolality iodinated contrast material. Radiology. 2013 Apr;267(1):94-105</ref><ref>Sinert R, Brandler E, et al. Acad Emerg Med2012;19(11):1261</ref>

	===Impaired Renal Function===		===Impaired Renal Function===

Rossdonaldson1: /* Management */

2023-03-22T16:26:52Z

Management

← Older revision		Revision as of 16:26, 22 March 2023
Line 47:		Line 47:
	===[[N-acetylcysteine]]===		===[[N-acetylcysteine]]===
	*'''Is not useful for preventing CIN'''<ref>ACT Investigators. Acetylcysteine for prevention of renal outcomes in patients undergoing coronary and peripheral vascular angiography: main results from the randomized Acetylcysteine for Contrast-induced nephropathy Trial (ACT). Circulation. 2011 Sep 13;124(11):1250-9 [http://circ.ahajournals.org/content/124/11/1250.full.pdf PDF]</ref><ref name="traub"></ref>		*'''Is not useful for preventing CIN'''<ref>ACT Investigators. Acetylcysteine for prevention of renal outcomes in patients undergoing coronary and peripheral vascular angiography: main results from the randomized Acetylcysteine for Contrast-induced nephropathy Trial (ACT). Circulation. 2011 Sep 13;124(11):1250-9 [http://circ.ahajournals.org/content/124/11/1250.full.pdf PDF]</ref><ref name="traub"></ref>

	===Other Measures===		===Other Measures===
	*Low osmolar contrast agents		*Low osmolar contrast agents
	*[[Bicarbonate]] infusion		*[[Bicarbonate]] infusion
	*[[Hypertonic saline]]		*[[Hypertonic saline]]

			==Disposition==

			==Prevention==

	==See Also==		==See Also==

Elcatracho: /* Hydration */

2021-01-24T15:29:10Z

Hydration

← Older revision		Revision as of 15:29, 24 January 2021
Line 43:		Line 43:
	*Isotonic hydration with [[normal saline]] 1-1.5L (15ml/kg) prior to the contrast load in patients with impaired renal function may lessen the chances of developing CIN <ref>Mueller C. et al. Prevention of contrast media-associated nephropathy: randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty. Arch Intern Med. 2002;162(3):329</ref><ref>Bertrand Dussol. et al. A randomized trial of saline hydration to prevent contrast nephropathy in chronic renal failure patients. Nephrol. Dial. Transplant. 2006. 21 (8): 2120-2126</ref><ref name="traub">Traub SJ, et al. N-acetylcysteine plus intravenous fluids versus intravenous fluids alone to prevent contrast-induced nephropathy in emergency computed tomography. Ann Emerg Med 2013;62(5):511-20 [http://www.annemergmed.com/article/S0196-0644(13)00350-8/pdf PDF]</ref>		*Isotonic hydration with [[normal saline]] 1-1.5L (15ml/kg) prior to the contrast load in patients with impaired renal function may lessen the chances of developing CIN <ref>Mueller C. et al. Prevention of contrast media-associated nephropathy: randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty. Arch Intern Med. 2002;162(3):329</ref><ref>Bertrand Dussol. et al. A randomized trial of saline hydration to prevent contrast nephropathy in chronic renal failure patients. Nephrol. Dial. Transplant. 2006. 21 (8): 2120-2126</ref><ref name="traub">Traub SJ, et al. N-acetylcysteine plus intravenous fluids versus intravenous fluids alone to prevent contrast-induced nephropathy in emergency computed tomography. Ann Emerg Med 2013;62(5):511-20 [http://www.annemergmed.com/article/S0196-0644(13)00350-8/pdf PDF]</ref>
	*If suspect the development or confirm the diagnosis continue adequate hydration to maintain urine output of 0.7cc-1cc/kg		*If suspect the development or confirm the diagnosis continue adequate hydration to maintain urine output of 0.7cc-1cc/kg
	*Early research suggests a potential benefit for forced [[furosemide]] diuresis (300ml/h) while continuing intravenous hydration fluids (0.5mg/kg) but should be performed in consult with radiologist and nephrologist<ref>Marenzi G. et al. Prevention of contrast nephropathy by furosemide with matched hydration: the MYTHOS (Induced Diuresis With Matched Hydration Compared to Standard Hydration for Contrast Induced Nephropathy Prevention) trial. JACC Cardiovasc Interv. 2012 Jan;5(1):90-7</ref>		*Early research suggests a potential benefit for forced [[furosemide]] diuresis (300ml/h) while continuing [[IVF\|intravenous hydration fluids]] (0.5mg/kg) but should be performed in consult with radiologist and nephrologist<ref>Marenzi G. et al. Prevention of contrast nephropathy by furosemide with matched hydration: the MYTHOS (Induced Diuresis With Matched Hydration Compared to Standard Hydration for Contrast Induced Nephropathy Prevention) trial. JACC Cardiovasc Interv. 2012 Jan;5(1):90-7</ref>

	===[[N-acetylcysteine]]===		===[[N-acetylcysteine]]===

Elcatracho: /* Risk Factors */

2021-01-24T15:28:25Z

Risk Factors

← Older revision		Revision as of 15:28, 24 January 2021
Line 21:		Line 21:
	*Age > 70		*Age > 70
	*[[Hypertension]]		*[[Hypertension]]
	*Hyperuricemia		*[[Uremia\|Hyperuricemia]]
	*[[Diuretics]]		*[[Diuretics]]

ClaireLewis at 16:14, 16 October 2019

2019-10-16T16:14:37Z

← Older revision		Revision as of 16:14, 16 October 2019
Line 1:		Line 1:
	''This page only applies to contrast agents usually used for CT scans. MRIs with contrast use gadolinium, which can cause [[nephrogenic systemic fibrosis]] in patients with renal dysfunction.''		''This page only applies to contrast agents usually used for CT scans. MRIs with contrast use gadolinium, which can cause [[nephrogenic systemic fibrosis]] in patients with renal dysfunction.''
	==Background==		==Background==
	*Often defined as creatinine rise of more than 0.5mg/dL or ≥25% above baseline<ref>Goldfarb, S. et al. Contrast-Induced Acute Kidney Injury: Specialty-Specific Protocols for Interventional Radiology, Diagnostic Computed Tomography Radiology, and Interventional Cardiology. Mayo Clin Proc. Feb 2009; 84(2): 170–179 [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2664588/ Text]</ref>		*Often defined as [[AKI\|creatinine rise]] of more than 0.5mg/dL or ≥25% above baseline<ref>Goldfarb, S. et al. Contrast-Induced Acute Kidney Injury: Specialty-Specific Protocols for Interventional Radiology, Diagnostic Computed Tomography Radiology, and Interventional Cardiology. Mayo Clin Proc. Feb 2009; 84(2): 170–179 [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2664588/ Text]</ref>
	*Vasoconstriction leading to ischemia in the deeper portion of the outer medulla		*Vasoconstriction leading to ischemia in the deeper portion of the outer medulla
	*Toxic to kidney tubular cells, inducing vacuolization, change in mitochondrial function, and apoptosis		*Toxic to kidney tubular cells, inducing vacuolization, change in mitochondrial function, and apoptosis
Line 15:		Line 15:
	*Renal disease		*Renal disease
	*Recent contrast study within 72 hrs		*Recent contrast study within 72 hrs
	*Hypotension		*[[Hypotension]]
	*Dehydration		*[[Dehydration]]
	*[[DM]]		*[[DM]]
	*[[Multiple myeloma]]		*[[Multiple myeloma]]
	*Age > 70		*Age > 70
	*~~hypertension~~		*[[Hypertension]]
	*Hyperuricemia		*Hyperuricemia
	*Diuretics		*[[Diuretics]]

	==Clinical Features==		==Clinical Features==
Line 41:		Line 41:

	===Hydration===		===Hydration===
	*Isotonic hydration with ~~Normal Saline~~ 1-1.5L (15ml/kg) prior to the contrast load in patients with impaired renal function may lessen the chances of developing CIN <ref>Mueller C. et al. Prevention of contrast media-associated nephropathy: randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty. Arch Intern Med. 2002;162(3):329</ref><ref>Bertrand Dussol. et al. A randomized trial of saline hydration to prevent contrast nephropathy in chronic renal failure patients. Nephrol. Dial. Transplant. 2006. 21 (8): 2120-2126</ref><ref name="traub">Traub SJ, et al. N-acetylcysteine plus intravenous fluids versus intravenous fluids alone to prevent contrast-induced nephropathy in emergency computed tomography. Ann Emerg Med 2013;62(5):511-20 [http://www.annemergmed.com/article/S0196-0644(13)00350-8/pdf PDF]</ref>		*Isotonic hydration with [[normal saline]] 1-1.5L (15ml/kg) prior to the contrast load in patients with impaired renal function may lessen the chances of developing CIN <ref>Mueller C. et al. Prevention of contrast media-associated nephropathy: randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty. Arch Intern Med. 2002;162(3):329</ref><ref>Bertrand Dussol. et al. A randomized trial of saline hydration to prevent contrast nephropathy in chronic renal failure patients. Nephrol. Dial. Transplant. 2006. 21 (8): 2120-2126</ref><ref name="traub">Traub SJ, et al. N-acetylcysteine plus intravenous fluids versus intravenous fluids alone to prevent contrast-induced nephropathy in emergency computed tomography. Ann Emerg Med 2013;62(5):511-20 [http://www.annemergmed.com/article/S0196-0644(13)00350-8/pdf PDF]</ref>
	*If suspect the development or confirm the diagnosis continue adequate hydration to maintain urine output of 0.7cc-1cc/kg		*If suspect the development or confirm the diagnosis continue adequate hydration to maintain urine output of 0.7cc-1cc/kg
	*Early research suggests a potential benefit for forced furosemide diuresis (300ml/h) while continuing intravenous hydration fluids (0.5mg/kg) but should be performed in consult with radiologist and nephrologist<ref>Marenzi G. et al. Prevention of contrast nephropathy by furosemide with matched hydration: the MYTHOS (Induced Diuresis With Matched Hydration Compared to Standard Hydration for Contrast Induced Nephropathy Prevention) trial. JACC Cardiovasc Interv. 2012 Jan;5(1):90-7</ref>		*Early research suggests a potential benefit for forced [[furosemide]] diuresis (300ml/h) while continuing intravenous hydration fluids (0.5mg/kg) but should be performed in consult with radiologist and nephrologist<ref>Marenzi G. et al. Prevention of contrast nephropathy by furosemide with matched hydration: the MYTHOS (Induced Diuresis With Matched Hydration Compared to Standard Hydration for Contrast Induced Nephropathy Prevention) trial. JACC Cardiovasc Interv. 2012 Jan;5(1):90-7</ref>

	===N-acetylcysteine===		===[[N-acetylcysteine]]===
	*'''Is not useful for preventing CIN'''<ref>ACT Investigators. Acetylcysteine for prevention of renal outcomes in patients undergoing coronary and peripheral vascular angiography: main results from the randomized Acetylcysteine for Contrast-induced nephropathy Trial (ACT). Circulation. 2011 Sep 13;124(11):1250-9 [http://circ.ahajournals.org/content/124/11/1250.full.pdf PDF]</ref><ref name="traub"></ref>		*'''Is not useful for preventing CIN'''<ref>ACT Investigators. Acetylcysteine for prevention of renal outcomes in patients undergoing coronary and peripheral vascular angiography: main results from the randomized Acetylcysteine for Contrast-induced nephropathy Trial (ACT). Circulation. 2011 Sep 13;124(11):1250-9 [http://circ.ahajournals.org/content/124/11/1250.full.pdf PDF]</ref><ref name="traub"></ref>
	===Other Measures===		===Other Measures===
	*Low osmolar contrast agents		*Low osmolar contrast agents
	*Bicarbonate infusion		*[[Bicarbonate]] infusion
	*Hypertonic saline		*[[Hypertonic saline]]

	==See Also==		==See Also==

Rossdonaldson1 at 05:26, 30 October 2017

2017-10-30T05:26:24Z

← Older revision		Revision as of 05:26, 30 October 2017
Line 1:		Line 1:
			''This page only applies to contrast agents usually used for CT scans. MRIs with contrast use gadolinium, which can cause [[nephrogenic systemic fibrosis]] in patients with renal dysfunction.''
	==Background==		==Background==
	*Often defined as creatinine rise of more than 0.5mg/dL or ≥25% above baseline<ref>Goldfarb, S. et al. Contrast-Induced Acute Kidney Injury: Specialty-Specific Protocols for Interventional Radiology, Diagnostic Computed Tomography Radiology, and Interventional Cardiology. Mayo Clin Proc. Feb 2009; 84(2): 170–179 [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2664588/ Text]</ref>		*Often defined as creatinine rise of more than 0.5mg/dL or ≥25% above baseline<ref>Goldfarb, S. et al. Contrast-Induced Acute Kidney Injury: Specialty-Specific Protocols for Interventional Radiology, Diagnostic Computed Tomography Radiology, and Interventional Cardiology. Mayo Clin Proc. Feb 2009; 84(2): 170–179 [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2664588/ Text]</ref>
Line 4:		Line 5:
	*Toxic to kidney tubular cells, inducing vacuolization, change in mitochondrial function, and apoptosis		*Toxic to kidney tubular cells, inducing vacuolization, change in mitochondrial function, and apoptosis
	*Less likely to occur with low and iso-osmolar contrast agents		*Less likely to occur with low and iso-osmolar contrast agents
	* The above only applies to contrast agents usually used for CT scans. MRIs with contrast use gadolinium, which can cause [[nephrogenic systemic fibrosis]] in patients with renal dysfunction.

	===Healthy Patients===		===Healthy Patients===

Rossdonaldson1: /* Background */

2017-10-30T05:25:08Z

Background

← Older revision		Revision as of 05:25, 30 October 2017
Line 4:		Line 4:
	*Toxic to kidney tubular cells, inducing vacuolization, change in mitochondrial function, and apoptosis		*Toxic to kidney tubular cells, inducing vacuolization, change in mitochondrial function, and apoptosis
	*Less likely to occur with low and iso-osmolar contrast agents		*Less likely to occur with low and iso-osmolar contrast agents
	* The above only applies to contrast agents usually used for CT scans. MRIs with contrast use gadolinium, which can cause [~~https://wikem.org/wiki/Nephrogenic_systemic_fibrosis~~ nephrogenic systemic fibrosis] in patients with renal dysfunction.		* The above only applies to contrast agents usually used for CT scans. MRIs with contrast use gadolinium, which can cause [[nephrogenic systemic fibrosis]] in patients with renal dysfunction.

	===Healthy Patients===		===Healthy Patients===

← Older revision		Revision as of 16:34, 22 March 2023
Line 65:		Line 65:

	==See Also==		==See Also==
	*[[Creatinine screening prior to IV contrast]]
	*[[MRI contraindications]]		*[[MRI contraindications]]
	*[[CT contrast media extravasation‎]]		*[[CT contrast media extravasation‎]]