Iodinated Contrast in Emergency Imaging, Kidney Radiology - 2020 Guideline Update, Part 2New guidance regarding iodinated contrast in contrast-enhanced emergency imaging of patients with an abnormal renal history.
This is part two of our Guideline Knowledge Check regarding emergency kidney imaging. A just released 2020 National Radiology / Kidney Consensus statement provides new guidance regarding contrast-enhanced emergency imaging of patients with an abnormal renal history. What does this consensus statement recommend?
Today’s Guideline Knowledge Check question comes from the desk of Med-Challenger Emergency Medicine Editor-in-Chief, Andrea Eberly, MD, FAAEM.
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Try this patient case question and find out if you’re following the most current guideline.
A 78-year-old male presents to the hospital after a 30-minute episode of left-sided weakness, which caused him to fall.
He did not sustain any trauma and is now asymptomatic. He has a history of hypertension, poorly controlled congestive heart failure, and atrial fibrillation.
He states that he has some type of kidney problem, but is not receiving dialysis.
His neurological exam is intact, and an initial, unenhanced CT scan is read as normal.
Due to the high risk of stroke after TIA in patients with atrial fibrillation, the patient is admitted and an elective magnetic resonance angiogram (MRA) is ordered.
According to the 2020 consensus statement from the American College of Radiology and the National Kidney Foundation, how should this patient’s risk for contrast-induced acute kidney injury (CI-AKI) be assessed and managed in the context of a contrast-enhanced imaging study?
A screening estimated glomerular filtration rate (eGFR) should be obtained in all patients over 75-years-old who have hypertension or diabetes, regardless of kidney history.
Prophylaxis with IV saline hydration is indicated in all patients with an estimated glomerular filtration rate (eGFR) of less than 30 mL/mi/1.73 m2.
In patients with compromised kidney function who are not receiving dialysis, a 15% dose reduction of contrast medium decreases the risk of CI-AKI without compromising imaging quality.
Poorly controlled congestive heart failure is a contraindication to giving CI-AKI prophylaxis with IV saline, regardless of the patient’s kidney function.
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About Guideline Knowledge Checks:
With each update of national clinical practice guidelines, some recommendations change and many remain unchanged. Med-Challenger Guideline Knowledge Checks help you know both what is new and what has stayed the same in the most recent guidelines pertinent to each medical specialty.
About the Author:
Andrea Eberly, MD, FAAEM graduated from the David Geffen Medical School of Los Angeles (UCLA) and completed her residency in Emergency Medicine at the University Medical Center, Tucson, Arizona. After working as an attending physician in Tucson, she followed a recruiting call to the island of Guam, where she served in various roles, including as the director of the emergency department, the EMS Medical Director of Guam, and the Director of the 911 Call System. She has maintained her emergency medicine board certification through three cycles of American Board of Emergency Medicine Board Exams (last in 2014), all three with the help of Med-Challenger.
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