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.
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Measurement of renal function.
Contrast media 7.0
Renal adverse reactions to iodine-based contrast media. Renal adverse reactions to gadolinium-based contrast agents. Patients with diabetes mellitus taking metformin. Dialysis and contrast medium administration. Can iodine- and gadolinium-based contrast agents safely be given on the same day for routine ,edia How long should there be between two iodine-based contrast media injections for routine examinations?
How long should there be between two gadolinium-based contrast agent injections for routine examinations? Intra-arterial injection with first pass renal exposure indicates that contrast agent reaches the renal arteries in a relatively undiluted form, e.
Intra-arterial injection with second pass renal exposure indicates that contrast agent reaches the renal arteries after dilution either in the pulmonary or peripheral circulation, e. No pharmacological prophylaxis with statins, renal vasodilators, receptor antagonists of endogenous vasoactive mediators or cytoprotective drugs has been shown guieelines offer consistent protection against PC-AKI.
Measure eGFR within 48 hours and restart metformin if renal function has not changed significantly.
No special precautions are necessary when diabetic patients on metformin are given gadolinium-based contrast agents as the risk of PC-AKI is very low. Guidelibes iodine- and gadolinium-based contrast agents can be removed by hemodialysis or peritoneal dialysis. However, there is no evidence that hemodialysis protects patients with impaired renal function from post contrast acute kidney injury or nephrogenic systemic fibrosis.
Patients on continuous ambulatory peritoneal dialysis.
European Society of Urogenital Radiology
Efficient practice may involve giving iodine- and gadolinium-based contrast agents for enhanced CT and MR on the same day. To reduce any potential for nephrotoxicity the following are recommended: Gadolinium-based contrast agents attenuate X-rays well and may be misinterpreted mwdia CT when they have been excreted into the urinary tract. For abdominal examinations, enhanced CT should be done before enhanced MR.
For chest and brain examinations, either CT or MR may be done first. General adverse reactions B. Renal adverse reactions C. Measurement of renal function B. Renal adverse reactions to iodine-based contrast media B. Time of referral Conhrast.
Before the examination B. Time of examination B. After verrsion examination B. Multiple myeloma patients B. Renal adverse reactions to gadolinium-based contrast agents B. Patients with diabetes mellitus taking metformin B.
Iodine-based contrast media B. Gadolinium-based guidelinfs agents B. Dialysis and contrast medium administration B. All equations x 1. In children, the revised Schwartz formula is recommended to calculate eGFR.
Neither serum nor plasma creatinine is an ideal indicator of renal function and may miss decreased renal function. Powered By T3 Framework. Known or suspected acute renal failure.
Intra-arterial contrast medium administration with first guidelins renal exposure. Large doses of contrast medium given intra-arterially with first pass renal exposure. Multiple contrast medium injections within hours.
At-risk patients see above. Consider an alternative imaging method not using iodine-based contrast media. Intravenous saline and bicarbonate protocols have similar efficacy for preventive hydration.
ESUR Guidelines :
For intravenous contrast medium and intra-arterial contrast medium administration with second pass renal exposure hydrate the patient either a with intravenous sodium bicarbonate 1.
For intra-arterial contrast medium administration with first pass renal exposure hydrate the patient either with a intravenous meria bicarbonate 1. Oral hydration is not recommended as the sole method of preventive hydration. Use preventive hydration before contrast medium administration see ‘Elective examination’ for protocols.
Use low- or iso-osmolar contrast media. Use the lowest dose of contrast medium consistent with eaur diagnostic result. Continue preventive hydration if appropriate see protocols above.
ESUR Update 2018
Determine eGFR 48 hours after contrast medium ln. Iodine-based contrast medium Correlation of time of the contrast medium injection with the hemodialysis session is unnecessary. Extra hemodialysis session to remove contrast medium is unnecessary. Gadolinium-based contrast agent Correlation of time of the contrast agent injection with the hemodialysis session is recommended.
Extra hemodialysis session to remove contrast agent as soon as possible after it has been administered is recommended.
Iodine-based contrast medium Hemodialysis to remove the contrast medium is unnecessary. Gadolinium-based contrast agent The need for hemodialysis should be discussed with the referring physician.