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Contrast-Induced Nephropathy — RACP Adult Medicine MCQ

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ModerateNephrologyContrast-Induced NephropathyRACP Adult Medicine

A 65-year-old man with CKD stage 3b (eGFR 38 mL/min/1.73 m²) requires a contrast-enhanced CT for investigation of possible malignancy. What is the single most important measure to prevent contrast-induced nephropathy?

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Correct answer: D — IV normal saline hydration (pre- and post-procedure)

IV isotonic saline hydration (1–1.5 mL/kg/hr for 12 hours pre- and 12 hours post-procedure, or at minimum 3 mL/kg for 1 hour pre-procedure) is the most important preventive measure for contrast-induced nephropathy. N-acetylcysteine has NOT been shown to provide additional benefit in recent large RCTs (PRESERVE trial). Metformin should be withheld for 48 hours and renal function rechecked, but this prevents lactic acidosis, not CIN.

Reference: KHA-CARI – 2020 – Contrast Nephropathy Guidelines; KDIGO – 2012 – AKI Guidelines