Contrast medium-associated nephropathy. Recognition and management.

The single most important risk factor for the development of CAN is significant renal insufficiency, which correlates with a stable sCr greater than 1.5 mg/dL. Based on the outcome data summarized, avoidance of CAN should be our goal, as it causes significant deterioration of renal function in one of every four patients afflicted. Clearly, volume depletion should be eliminated before administering radiographic CM. In addition, high-risk patients should have a hydration protocol initiated before the procedure and continued for at least 2 hours postprocedure. At least one large cooperative study has reported a significant reduction in CAN when LOICM was compared with HOICM. Limiting the total volume of radiographic CM used for an individual study also seems to reduce the incidence of CAN. Although indications for invasive studies with radiographic RCM continue to expand, especially for elderly and other high-risk groups, using these suggestions as guidelines should minimize the risk of CAN while still obtaining the critical information needed to develop a clinical management plan.