University of Wisconsin Hospital and Clinics Guidelines for the Prevention of Contrast-Induced Nephropathy in Adults

These clinical guidelines were designed to assist clinicians by providing a framework for the identification, evaluation and treatment options available to reduce the risk of contrast-induced kidney failure in high risk populations. They were developed by reviewing and incorporating the most current evidenced-based literature available. These guidelines are not intended to replace a clinician’s judgment or to establish a protocol. The intravascular administration of contrast media can lead to acute kidney injury. Contrast agents induce kidney injury and reduce kidney function by altering hemodynamics and by direct toxic effects on kidney cells. Even small changes in kidney function have been associated with increased morbidity and mortality, making prevention of contrast-induced nephropathy (CIN) of paramount importance. Clinical trials have defined CIN as an increase in serum creatinine by 25 % or 0.5 mg/dL within 2-5 days after contrast. The mechanism by which contrast induced kidney injury occurs is not well understood. Preliminary evidence in animals suggest two theories.1 • Vasoconstriction – In animal studies the infusion of contrast media resulted in a transient increase in perfusion, followed by an abrupt, sharp and prolonged decrease in blood flow. In some studies completed on humans, the reduction in blood flow with contrast media did no