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
  • -Dehydration
  • -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 > 60No Significant RiskNo action needed, use LOCM
GFR 59-45Low RiskUse Visipaque or other LOCM with oral hydration of 250 ml before and after.
GFR 44-30Moderate RiskConsider 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 < 30High RiskNo Contrast