Medims.muhc.mcgill.ca

Centre universitaire de santé McGill McGill University Health Center
Subject : Radiologic Exams Requiring Intravenous Contrast for Patients with Decreased Renal
Function

Manual : MUHC Medical Imaging
Policy No.
Effective Date : January 1, 2002

Originating Dept : MUHC Medical Imaging
New Policy ___
Page : _1_ of ___
Revised Policy ___


I. Purpose:
To identify and manage patients at risk for possible renal complications from radiological exams requiring intra-venous contrast. II. Persons / Areas
All radiology modalities using intra-venous contrast agents. Affected:

III. Policy:
Patients at risk for renal complications from exams with intra-venous contrast agents must have their renal function verified by means of a serum creatinine IV. Definitions and
1. A serum creatinine level is valid for a three-month period (90 days). References:
Male 65-120 µmol/L Female 65-104 µmol/L 3. Patients with serum creatinine levels greater than 150 µmol/L may require 4. Clinical indications that require serum creatinine include: - history of kidney disease as an adult, including tumour or transplant - family history of kidney failure - insulin dependent diabetes of two years or greater duration - non-insulin dependant diabetes mellitus of over 5 years duration if on - paraproteinemia syndromes or diseases (e.g. myeloma) - collagen vascular disease (e.g. scleroderma) - patients receiving certain medications such as metformin (Glucophage), non- steroidal anti-inflammatory drugs, nephrotoxic antibiotics such as aminoglycosides V. Procedures:
1. When making appointments for intravenous contrast-enhanced studies, patients will be asked if they are taking any hypoglycemic medication (e.g. Glucophage). Patients on such medication are to be booked for I.V. contrast exams between Monday and Wednesday only, in order to facilitate follow-up serum creatinine tests when required. 2. All patients scheduled to receive intravenous contrast will be screened by a pre-injection questionnaire. Patients identified as belonging to one of the above categories of clinical indications require serum creatinine results to be available before the examination. Patients currently taking hypoglycemic agents (e.g. Glucophage) must also be identified. 3. Patients on Glucophage are to stop taking the medication for 48 hours following IV contrast injection. After this time, patients at high clinical risk for renal failure must have their renal function checked prior to re-initiating the medication. Patients who notice no difference in their pattern of urine production during this time, and where the referring physician agrees that no surveillance is necessary, can subsequently resume their oral hypoglycemic agent after two days without having a serum creatinine test. 4. Creatinine levels, when available from the MUHC Laboratory Information System, will be printed on the flash-cards. This value must be appropriately recorded in each department (i.e. in the PBMP system at the MGH, or manually recorded on requisitions etc. at other sites). 5. Creatinine levels supplied by the patient or referring clinician must also be 6. When serum creatinine levels are above 150 µmol/L, the technologist will alert the radiologist so that a dialogue can be established with the patient's referring physician in order to decide on how, or whether, to proceed with the examination. Technologists will proceed as per these instructions. 7. In any instance, if a referring physician provides a written note indicating no evidence of renal failure, the exam may proceed. VI. Forms:

Additional References:
1. Waybill, Mary M. et al "Contrast Media-induced Nephrotoxicity: Identification of Patients at Risk and
Algorithms for Prevention" Journal of Vascular and Interventional Radiology Vol 12:3-9 2001 2. Katzberg, Richard W. "Urography into the 21st Century: New Contrast Media, Renal Handling, Imaging Characteristics, and Nephrotoxicity" 3. Davidson, Charles, J. et al "Randomized Trial of Contrast Media Utilization in High-Risk PTCA" 4. Jakobsen, Jarl A. et al "Angiography with Nonionic X-Ray Contrast Media in Severe Chronic Renal Failure: Renal Function and Contrast Retention" Nephron 1996 Vol 73

Source: http://www.medims.muhc.mcgill.ca/careinfo/pive/creatinine.pdf