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IMAGING IN RENAL IMPAIRMENT Contrast induced nephropathy (CIN) is the third most

IMAGING IN RENAL IMPAIRMENT Contrast induced nephropathy (CIN) is the third most common cause of acute kidney injury in hospitalized patients Defined as increase in serum creatinine of >/+0.5 mg/dl within 48hr of exposure to contrast or relative 25%

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IMAGING IN RENAL IMPAIRMENT Contrast induced nephropathy (CIN) is the third most

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  1. IMAGING IN RENAL IMPAIRMENT • Contrast induced nephropathy (CIN) is the third most • common cause of acute kidney injury in hospitalized • patients • Defined as increase in serum creatinine of >/+0.5 mg/dl • within 48hr of exposure to contrast or relative 25% • increase in serum creatinine from baseline • Clinical course is rise to serum creatinine within 24h of • contrast exposure, peak within 3-7 days and returns to • baseline within 14 days (25)

  2. CIN AND IMAGING • Risk factors– chromic kidney, Diabetes, class IV heart • failure, age, hypovolemia, hypotension • Higher volumes of contrast increases the likelihood of CIN • The risk of CIN is quite low even for patients at higher risk

  3. RECOMMENDATIONS FOR PREVENTION OF CIN • Evaluate the risk of CIN in all patients including CKD, diabetes, • heart failure • All patients should be encouraged to drink water liberally • before the procedure • High risk patients should receive intravenous volume • expansion with isotonic saline. Sodium bicarbonate • administration is debatable. IV fluids should be continued for • at least 6 hrs after contrast exposure. N-Acetylcysteine can be considered • in high risk patients

  4. SUMMARY • IMAGING IN PATIENTS AT RISK OF CIN • Creatinine prior to CT • Adequate fluid replacement prior and • following contrast administration • Dialysis not definitively shown to be of benefit • Creatinine 48-72 hours post CT http://www.appliedradiology.com/Issues/2010/09/Articles/AR_09-10_Katzberg/Contrast-induced-nephropathy-in-2010.aspx

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