Clinical Pearl Blog: Contrast-Induced Nephropathy

Gerard Kiernan, MD, FAAFP, FHMClinical Pearls, Emergency Medicine, Family Medicine, Internal Medicine, Nurse Practitioner, Nursing RN/PN, Urgent Care

Pearls in the prevention of contrast-induced nephropathy CIN AKI

Test your clinical knowledge with this clinical pearl of the month review question.

Clinical Scenario

A 78-year-old man with type 2 diabetes and chronic kidney disease presents with substernal chest discomfort that radiates to the left arm and neck, present intermittently over a period of a day, with symptoms made worse by exertion.

His EKG shows lateral S-T depression and T-wave inversion.

His troponin-I levels are elevated.

Initial treatment with nitroglycerine relieves his pain, he is placed on heparin intravenously, and he receives oral aspirin and clopidogrel.

His weight is 200 lb., and his creatinine is 2.7 mg/dL, corresponding to an estimated creatinine clearance of 29 mL/minute.

His home medications include lisinopril 10mg PO daily and atorvastatin 20 mg PO daily.

He no longer smokes, having quit eight years prior.

The decision is made to proceed with cardiac catheterization for NSTEMI.


Which of the following measures is most likely to lessen this patient's risk of contrast-associated acute kidney injury?

Answer Options:

Isotonic saline, administered both before and after the procedure.

Mannitol intravenously, before and after the procedure.

Acetylcysteine orally, before and after the procedure.

Intravenous isotonic sodium bicarbonate, before and after the procedure.

See the Answer:

About the Author:

Gerard Kiernan, MD, FAAFP, FHM is a Dartmouth-Hitchcock Clinic hospitalist in Keene, NH. He attended the University of Rochester School of Medicine and Dentistry, followed by a Family Medicine residency at the University of Wisconsin, Madison, where he was a chief resident. Dr. Kiernan is a Lean Six Sigma Greenbelt and has led hospital medicine quality improvement efforts. He is a fellow of both the American Academy of Family Physicians and the Society of Hospital Medicine. He has achieved the Recognition of Focused Practice in Hospital Medicine offered through the AAFP and ABIM via their joint examination pathway.

About Clinical Pearl of the Month:

Med-Challenger's Clinical Pearl Blog Series is a recurring segment of Med-Challenger's popular Medical Education Blog. Med-Challenger provides online medical education products and services to physicians, nurses, and other medical specialists as well as medical training programs and healthcare groups world-wide via its web-based medical education library and world-class assessment platform at

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