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Contrast-associated AKI — ABIM Board MCQ

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HardNephrologyContrast-associated AKIABIM Board

A patient with eGFR 24 mL/min/1.73 m2 needs urgent contrast-enhanced coronary angiography. There is no pulmonary edema and contrast volume can be minimized. Which preventive strategy is appropriate?

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Correct answer: E — Administer periprocedural isotonic intravenous hydration

The best answer is “Administer periprocedural isotonic intravenous hydration”. For a high-risk patient undergoing necessary iodinated contrast exposure, isotonic volume expansion when tolerated, low contrast dose and avoidance of nephrotoxins are core preventive measures. Prophylactic dialysis does not prevent contrast-associated AKI, and forced diuresis can worsen volume depletion. Gadolinium is not a risk-free substitute in advanced CKD.

Reference: KDIGO Acute Kidney Injury Guideline: https://kdigo.org/guidelines/acute-kidney-injury/