Patient evaluation for contrast administration for computed tomography: Concern for contrast-associated acute kidney injury

CT: computed tomography; eGFR: estimated glomerular filtration rate.
* Refer to UpToDate topics or the American College of Radiology (ACR) Appropriateness Criteria for CT contrast recommendations based on a specific exam indication. Enteric (oral or rectal) contrast is not associated with kidney injury.
¶ Medical judgment should be used to determine whether baseline kidney function is likely stable. In general, eGFR within 30 days in an outpatient and two days in an inpatient is likely to reflect baseline kidney function if the medical condition and treatments have not been changing in the interim.
Δ Examples are patients with sepsis, myocardial infarction, or large volume hemorrhage.
◊ Imaging alternatives are CT without contrast, ultrasound, magnetic resonance imaging, or nuclear scintigraphy. Discuss with a radiologist whether any of these are likely to provide a diagnosis.
§ No standard regimen has been described. Examples are 100 cc/hour, beginning 6 to 12 hours before and continuing 4 to 12 hours after the exam in inpatients, and 500 cc bolus over 30 minutes to one hour before and during the exam in outpatients.