kidney injury from IV contrast?

31 Oct

MAYBE NOT…

Nice review in October’s EM News by Dr. James Roberts

Click through for the whole read, but here are some PEARLS:

 

No specific treatment once contrast nephropathy happens.   Same plan as any cause of acute kidney necrosis: fluid/electrolyte balance.

 

typical definition of contrast nephropathy: increased serum creatinine of 0.5mg/dL, or >25% increase above baseline in 2-3 days

…”clinical significance of these minor elevations is likely minimal”

 

in one study: 773 patients got contrast CT, no one needed dialysis

 

in people with previously normal kidneys (Cr < 1.5 mg/dL, or GFR>60 ml/min):  incidence of AKI in contrast and non-contrast exposed patients were similar

 

results are conflicting RE: AKI protective pre-treatments (e.g. N-acetylcysteine, bicarb, saline hydration).  IV fluid is probably the most available and intuitive method to try (before, during, & after).

 

pathogenesis unclear, some type of acute tubular necrosis (ATN)?  

 

BOTTOM LINE:

“It would appear reasonable to eschew the use of contrast material for CT scans whenever possible, but the use of IV contrast material is not as detrimental to kidney function as previously thought.”

 

References: EMN article; picture

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