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.
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