Contrast-associated AKI risk — ESENeph MCQ

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HardAcute Kidney Injury, Electrolytes and Acid-BaseContrast-associated AKI riskESENeph

A 73-year-old woman with CKD G4 is due for CT angiography for suspected critical limb ischaemia. eGFR is 24 mL/min/1.73 m², ACR 45 mg/mmol and she takes ramipril, metformin and furosemide. She is clinically euvolaemic and the scan is judged necessary. What is the most appropriate investigation or preparation?

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Correct answer: E — Minimise contrast and provide individualised hydration

When contrast imaging is clinically necessary in high-risk CKD, the priority is risk reduction with appropriate hydration, low contrast dose and review of nephrotoxic or haemodynamically active drugs. CKD alone is not an automatic reason to cancel important vascular imaging. Prophylactic haemodialysis after contrast does not prevent contrast-associated AKI. The pearl is that contrast decisions should balance renal risk against the risk of missing limb-threatening disease. The competing options do not fit the renal phenotype, temporal relationship, treatment threshold or safety constraint described. Management still requires confirmation of current medicines, renal trajectory and relevant contraindications, followed by timely biochemical and clinical reassessment. Escalate urgently if life-threatening electrolyte disturbance, respiratory compromise, shock, neurological deterioration or a dialysis indication develops.

Reference: NICE NG148; ESUR Contrast Media Safety Guidance: https://www.nice.org.uk/guidance/ng148/chapter/recommendations