To highlight potential adverse effects of contrast agents. •! To produce guidelines on the safe use of contrast media in different clinical Version has until. “Contrast agents are much less nephrotoxic than previously thought”, said Aart van der the current ESUR Contrast Media Safety Committee (CMSC) guideline. It is a great honor for the Contrast Media Safety Committee of the European So- ciety of Urogenital Radiology (ESUR) to present version of its Contrast Media 7. 1. AN OVERVIEW. This overview summarizes some of the most important.
The risk of an acute reaction to a gadolinium-based contrast agent is lower than the risk with an iodine-based contrast agent, but severe reactions to gadolinium-based contrast media may occur. Use non-ionic iodine-based contrast medium. Following versioh of gadolinium-based agents to the mother during pregnancy, no neonatal tests are necessary. Check for intolerance to any of the components of the contrast agent Use the lowest level of acoustic output and shortest scanning time to allow a diagnostic examination.
It their renal function has not deteriorated, they should restart metformin. Gadolinium-based contrast media are more nephrotoxic than iodine-based contrast media in equivalent X-ray attenuating doses. Measurement of renal function B. Tuidelines the need to stop nephrotoxic drugs with the referring physician.
Use a non-ionic contrast medium. Discussion An audience member asked whether a multiple myeloma patients really did not need any special care. Intravenous guidelinss and bicarbonate protocols have similar efficacy for preventive hydration.
Questionnaires to be completed by clinicians referring patients for examinations using iodine- or gadolinium-based contrast media Download Questionnaire esu iodine-based contrast media administration to be completed by the referring clinician Download Questionnaire for gadolinium-based contrast media administration to be completed by the referring clinician.
In all patients use the smallest amount of contrast medium necessary for a diagnostic result. Hospitals need oh provide optimal nephrologic care in these patients in the first place. Continue preventive hydration if appropriate see protocols above.
High osmolality ionic contrast media. Dialysis and contrast media.
Contrast media 7.0
Extra hemodialysis session to remove contrast medium is unnecessary. Previous late contrast medium reaction. However, there is no evidence that hemodialysis protects patients with impaired renal function from contrast medium induced nephropathy or nephrogenic systemic fibrosis. Patients with diabetes mellitus taking metformin B.
Our key aim of providing simple practical guidelines appears to have been fulfilled. Previous moderate or severe acute reaction see classification above to an iodine-based contrast agent.
Low- or iso-osmolar contrast media should be used for diagnostic and interventional angiographic procedures including phlebography. More severe acute reactions are rare and are similar to those after iodine and gadolinium-based agents see 1. For abdominal examinations, enhanced CT should be done before enhanced MR.
In hospital inpatietns with diagnosed AKI one to 70 days are preferable.
Some aspects have been adapted, but hydration remains a mainstay in kidney injury prevention. Gadolinium-based contrast medium Hemodialysis to remove the contrast medium is unnecessary for iodine-based contrast medium, but for gadolinium- based contrast medium. Less optimal injection sites including lower limb and small distal veins.
Contrast induced nephropathy CIN is a condition in which a decrease in renal function occurs within 3 days of the intravascular administration of a CM in the absence of an alternative aetiology. CMSC guidelines are based on evidence in the literature whenever possible.
Always record the name and dose of the contrast agent used in the patient records. In pediatric patients give 0. When absorption or leakage into the circulation is possible, take the same precautions as for intravascular administration. Intra-arterial injection with first pass renal exposure indicates that contrast agent reaches the renal arteries in a relatively undiluted form, e. Hypotensive shock Respiratory arrest Cardiac arrest Convulsion.
There is no additional AKI risk in patients with solitary kidneys, kidney transplants, multiple myeloma or monoclonal gammopathy. Drug prophylaxis is generally not recommended. Most injuries are minor. A suitable protocol is intravenous normal saline, 1. Do not administer gadolinium-based contrast agents.
Early identification and careful observation. Intravenous cholangiographic contrast media should oon be given to patients at risk.