Iodinated Contrast in Emergency Imaging, Kidney Radiology - 2020 Guideline UpdateNew guidance regarding iodinated contrast in contrast-enhanced emergency imaging of patients with an abnormal renal history.
Iodinated contrast is in the news. 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 56-year-old female presents to the hospital with acute stroke symptoms...
She only qualifies for emergent thrombectomy for which a pre-procedure emergent CT scan with angiogram is ordered.
Given that this requires the injection of iodinated contrast medium, the patient is queried about kidney problems.
The aphasic patient points to her purse where a medical card is found with the statement that she has a solitary kidney.
Upon further questioning, she shakes her head to receiving dialysis or having chronic kidney disease.
The nurse is concerned about contrast-induced acute kidney injury (CI-AKI) and asks if a creatinine level should be obtained and/or the standard kidney-protective IV hydration protocol with saline should be completed prior to contrast-enhanced imaging to prevent contrast-induced acute kidney injury (CI-AKI).
What does the 2020 consensus statement from the American College of Radiology and the National Kidney Foundation recommend with regards to preventing CI-AKI in patients with an abnormal renal history who require emergent, contrast-enhanced imaging?
A creatinine level should only be obtained prior to emergency contrast-enhanced imaging in patients with (1) a history of an estimated glomerular filtration rate < 45 mL/min/1.73 m2) and/or (2) a solitary kidney. Creatinine levels >3.0 mg/dL require CI-AKI pre-procedure prophylaxis.
CI-AKI prophylaxis with pre=procedure IV saline hydration prior to injection of iodinated contrast is indicated for all patients with a solitary kidney; waiting for a creatinine level is not necessary.
A creatinine level should only be obtained prior to emergency contrast-enhanced imaging in patients with a history of (1) dialysis-dependent renal disease and/or(2) those with a solitary kidney. Creatinine levels >5 mg/dL require pre-procedure CI-AKI prophylaxis even in the case of emergency imaging.
If preprocedural CI-AKI prophylaxis will delay time-sensitive, emergent imaging, then, regardless of the underlying kidney problem, the pre-procedure IV saline hydration may be skipped and only postprocedural prophylaxis may be given. A creatinine level can be drawn prior to the procedure but the procedure should not be delayed to wait for the results.
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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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