Nephrotoxicity Due to Contrast Media

Key points

• Definition: 25% rise in creatinine within 3 days of intravascular contrast (occurs 2–5 days post-administration).
• Risk factors: known renal impairment (esp. diabetic nephropathy) · age > 70 · dehydration · cardiac failure · nephrotoxic drugs (NSAIDs).
• Prevention: IV 0.9% sodium chloride 1 mL/kg/h for 12 h pre- and post-procedure; isotonic sodium bicarbonate also supported.
• N-acetylcysteine: recent evidence (NEJM 2018) shows it is NOT effective.