Which of the following is a feature of contrast induced nephropathy?
Correct Answer: Increased creatinine
Description: Ref: Harrison's Principles of Internal Medicine, 18th edition, Page 2300 Table and 3241Explanation:"The most common clinical course of contrast nephropathy is characterized by a rise in serum creatinine beginning 24-48 hours following exposure, peaking within 3-5 days, and resolving within 1 week. " Ref: Harrison'sCONTRAST NEPHROPATHYRise in S. creatinine of atleast Img/dL within next 48 hours of contrast administration.Pathophysiologyo Hemodynamic changeso Renal tubular obstructiono Cell damage.o Immunological reactions to contrast agents.Risk Factorso Age >80 years.o Preexisting renal problems Great >2 mg/ dL.o DM.o Dehydration.o Solitary kidneyo Paraproteinemia.o Nephrotoxic drug usageo High contrast dose.Adequate prior HYDRATION may prevent this condition.Nonionic, low osmolar contrast media cause less renal cell damage.Sodium bicarbonate or N-acetylcysteine may decrease this.When eGFR < 45 mi/min/1.73m2 - iodinated contrast must be avoided.Risk of Anaphylaxiso With iodinated contrast 0.24%o With nonionic media- 0.04%.Premedication in high risk patientso Glucocorticoids.o H2 blockers (ranitidine)o H1 blockerantihistaminics.High risk patients - Anaphylaxiso Prior contrast allergy.o Food allergy to shellfisho Atopy (asthma or hay fever).NOTEMR contrast with gadolinium is less risky.But, when eGFR <30 ml/min. gadolinium should be avoided.
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