Emergence Teleradiology Creatinine Recommendation
Serum creatinine results performed for all patients over age of 60 years or with any of following risk factors. *, **, ***, ****
- -Current antibiotic therapy
- -Known atherosclerotic disease
- -Current chemotherapy or know nephrotoxic medications
- -Collagen vascular disease
- -Diabetes Mellitus
- -Diuretic therapy
- -Daily NSAID usage
- -Debilitated state such as AIDS or advanced Malignancy
- -Liver Disease
- -Muscular dystrophy
- -Paraproteinemia syndrome, Multiple Myeloma
- -Renal disease or transplant
- -Renal failure
- -Known renal insufficiency
* Can use a serum creatinine level performed in the last 30 days.
** In clinical studies all Low Osmolar Contrast Media (LOCM) have been found to have little difference in incidence of adverse events.
*** Sample LOCM include Omnipaque, Optiray, Isovue, Ultravist, and Visipaque.
**** GFR calculated for all patients with a serum creatinine drawn based on above recommendation.
RISK FACTORS FOR CONTRAST INDUCED NEPHROPATHY
- Preexisting renal insufficiency, diabetes mellitus, dehydration, cardiovascular disease, diuretic usage, multiple myeloma, hypertension, hyperuricemia, and multiple iodinated contrast medium doses in a short time interval (<24 hours)
- Two studies have shown that CIN may occur after two closely spaced doses of contrast regardless of dosage. Therefore Emergence recommends not administering contrast twice in a 24 hour period unless the medical emergency for the exam outweighs the risk of CIN.
Reference: ACR Manual on Contrast Media – Version 9, 2013
|GFR > 60||No Significant Risk||No action needed, use LOCM|
|GFR 59-45||Low Risk||Use Visipaque or other LOCM with oral hydration of 250 ml before and after.|
|GFR 44-30||Moderate Risk||Consider no contrast, if need contrast then hydrate 500 ml NS before and additional 500 after exam IV, Visipaque, may limit contrast at radiologist discretion|
|GFR < 30||High Risk||No Contrast|