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Contrast AKI Prevention — RACP Adult Medicine MCQ

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HardNephrologyContrast AKI PreventionRACP Adult Medicine

A 65-year-old with diabetes and eGFR 38 mL/min/1.73 m2 requires intra-arterial coronary angiography. Which renal-protection plan has the strongest practical basis?

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Correct answer: A — Assess volume status, use the minimum necessary contrast and provide isotonic IV fluid when not contraindicated

The best answer is “Assess volume status, use the minimum necessary contrast and provide isotonic IV fluid when not contraindicated”. Risk reduction centres on avoiding hypovolaemia and hypotension, limiting contrast dose and using isotonic IV hydration in at-risk patients who can tolerate it. N-acetylcysteine and routine bicarbonate have not shown consistent superiority, and prophylactic dialysis is not indicated. Medication decisions are individualised, but withholding one drug does not replace the core procedural and volume measures.

Reference: Kidney Health Australia: CKD Management in Primary Care, 5th edition: https://kidney.org.au/health-professionals/ckd-management-handbook/