Kidney and contrast media: Common viewpoint of the French Nephrology societies (SFNDT, FIRN, CJN) and the French Radiological Society (SFR) following ESUR guidelines - 25/02/21
Highlights |
• | Priority should be given to performing relevant imaging examinations, using contrast media when indicated, and identifying at-risk patients requiring prior preparation. |
• | Patients at risk are those with impaired renal function: acute kidney injury, or chronic kidney disease with glomerular filtration rate inferior to 45 mL/min/1.73m2 (for intraarterial contrast media injection with renal first pass) or glomerular filtration rate inferior to 30 mL/min/1.73m2 (for all others situations). |
• | Decreased glomerular filtration rate (irrespective of the stage of kidney disease) is not per se a contra-indication to contrast media administration when really needed. |
• | For patients at risk of post-contrast acute kidney injury, intravenous hydration with NaCl 0.9% or sodium bicarbonate 1.4% is the best option. |
• | No drug has proven to be effective in preventing acute kidney injury due to administration of contrast medium. |
Abstract |
Contrast medium administration is classically considered to cause or worsen kidney failure, but recent data may moderate this assertion. The European Society of Urogenital Radiology recently published guidelines re-evaluating the precautions before administering contrast media. Kidney injury does not constitute a contra-indication to the administration of iodinated contrast medium, as long as the benefit–risk ratio justifies it. Intravenous hydration with 0.9% NaCl or 1.4% sodium bicarbonate is the only validated measure for the prevention of post-iodine contrast nephropathy. This is necessary for intravenous or intra-arterial administration of iodinated contrast agent without first renal pass when the glomerular filtration rate is less than 30mL/min/1.73m2, for intra-arterial administration of iodinated contrast agent with first renal passage when the glomerular filtration rate is less than 45mL/min/1.73m2, or in patients with acute renal failure. The use of iodinated contrast medium should allow the carrying out of relevant examinations based on an analysis of the benefit–risk ratio and the implementation of measures to prevent toxicity when necessary.
Le texte complet de cet article est disponible en PDF.Keywords : Contrast media, Kidney failure, Chronic kidney injury, Tomography, X-ray computed, Magnetic resonance imaging
Abbreviations : ACE, AKI, CM, CKD, eGFR, ESUR, GBCA, GFR, ICU, NAC, NSAIDs, NSF, PC, RAAS, RCT
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Vol 102 - N° 3
P. 131-139 - mars 2021 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.