Contrast Induced Nephropathy

This month, JC will be looking at the often frustrating issue of contrast induced nephropathy (CIN) in ED patients requiring enhanced CT’s. A Pub-Med, Trip database or Big Brother (aka Google) search of the topic will demonstrate wide assertions from ‘credible’ EM blogsites that assert there is “no such thing” to a recent EM RCT  in PE workups that found CIN rates of over 20%! To ramble on, the Canadian RAD guidelines suggest a 300-500 cc pre-hydration fluid bolus for those with a GFR of less than 45 ml/min whereas, a very large recently published RCT in Lancet found no difference pre-hydrating patients with low GFR’s. If you are a mouse nephrologist, there is even a study that suggested vitamin C as being renal-protective. What do we make of all of this disparate data? Is there a reasonable approach that can be tailored to our patient population, risk tolerance and friendships with our CT techs and radiologists? Please take a look at the aforementioned links above. The articles that are being presented are among the most highly cited so take a look and come share your thoughts.

Hinson JS et al, Risk of Acute Kidney Injury After Intravenous Contrast Media Administration.  Ann Emerg Med. 2017 May,69(5):577-586 | Article Appraisal

McDonald JS et al, Risk of intravenous contrast material-mediated acute kidney injury: a propensity score-matched study stratified by baseline-estimated glomerular filtration rate.  Radiology. 2014 Apr;27 1 (1):65-73 | Article Appraisal

 McDonald JS et al, Frequency of acute kidney injury following intravenous contrast medium administration:  a systematic review and meta-analysis.  Radiology. 2013 Apr;267(1): 119-28 | Article Appraisal