Creatinine Recommendation for Contrast

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