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→Contrast-induced nephropathy: Reformatted
==Contrast-induced nephropathy==
Decreased renal function and several other conditions increase the risk of contrast-induced nephropathy, which is a potentially lethal renal injury to the kidney following intravenous radiocontrast.<ref name="RudnickFeldman2008">{{cite journal|last1=Rudnick|first1=M.|last2=Feldman|first2=H.|title=Contrast-Induced Nephropathy: What Are the True Clinical Consequences?|journal=Clinical Journal of the American Society of Nephrology|volume=3|issue=1|year=2008|pages=263–272|issn=1555-9041|doi=10.2215/CJN.03690907}}</ref>
The main alternatives in people with a risk of contrast-induced nephropathy are:
*''Adjustment'' of the radiocontrast dose
*Using '''no intravenous contrast''' for the investigation.
*Switching to '''another modality''' such as [[ultrasonography]] or [[MRI]]
*'''Treating or mitigating risk factors'''
:*'''Hydration''' by drinking or intravenous volume expander, either before or after contract administration, decreases the risk of contrast-induced nephropathy.<ref name="YangHiremath2013">{{cite journal|last1=Yang|first1=Xiaoming|last2=Hiremath|first2=Swapnil|last3=Akbari|first3=Ayub|last4=Shabana|first4=Wael|last5=Fergusson|first5=Dean A.|last6=Knoll|first6=Greg A.|title=Prevention of Contrast-Induced Acute Kidney Injury: Is Simple Oral Hydration Similar To Intravenous? A Systematic Review of the Evidence|journal=PLoS ONE|volume=8|issue=3|year=2013|pages=e60009|issn=1932-6203|doi=10.1371/journal.pone.0060009}}</ref>
===Risk factors===
The Roxana Mehran score predictor applies the following ten variables:<ref name=Modi2017>{{cite web|url=https://www.ncbi.nlm.nih.gov/books/NBK448066/|title=Contrast-Induced Nephropathy|website=StatPearls Publishing|year=2017|author=Kalgi Modi, Scott C. Dulebohn}} [http://creativecommons.org/licenses/by/4.0/ CC-BY-4.0]</ref>
A risk score of less than 6 carries a risk of 7.5% to score more than 16 carries up to 57% risk.<ref name=Modi2017/>
===AlternativesAdjustment of dose===In people Steps to take for potentially performing the CT scan with risk factors, the main alternatives an adjusted radiocontrast dose are:*'''AdjustmentHow much contrast can be given?''' of the contrast dose. Evidence suggests that contrast doses should be limited to a ratio of grams of iodine to glomerular filtration rate (I<sub>gram</sub> / GFR<sub>ml/min</sub>) of a maximum of 1.<ref name="KeaneyHannon2013">{{cite journal|last1=Keaney|first1=J. J.|last2=Hannon|first2=C. M.|last3=Murray|first3=P. T.|title=Contrast-induced acute kidney injury: how much contrast is safe?|journal=Nephrology Dialysis Transplantation|volume=28|issue=6|year=2013|pages=1376–1383|issn=0931-0509|doi=10.1093/ndt/gfs602}}</ref> The local practice at NU Hospital Group has a I<sub>gram</sub>/GFR ratio of maximum 0.7 in patients with GFR ≥45 ml/min. It recommends a ratio of maximum 0.5 if GFR is lower, or in the presence of risk factors.
{|class="wikitable" align="center"
|+ Volume for various I<sub>gram</sub> / GFR<sub>ml/min</sub> ratios
| 350 mg/ml || 2.9 ml *GFR<sub>ml/min</sub> || 2 ml *GFR<sub>ml/min</sub> || 1.4 ml *GFR<sub>ml/min</sub>
|}
*Using ''no intravenous 'How much contrastis needed?''' for the investigation.*Switching to '''another modality''' such as [[ultrasonography]] or [[MRI]]*'''Treating or mitigating risk factors'''. :*'''Hydration''' by drinking or intravenous volume expander, either before or after contract administration, decreases the risk of contrast-induced nephropathy.<ref name="YangHiremath2013">{{cite journal|last1=Yang|first1=Xiaoming|last2=Hiremath|first2=Swapnil|last3=Akbari|first3=Ayub|last4=Shabana|first4=Wael|last5=Fergusson|first5=Dean A.|last6=Knoll|first6=Greg A.|title=Prevention of Contrast-Induced Acute Kidney Injury: Is Simple Oral Hydration Similar To Intravenous? A Systematic Review of the Evidence|journal=PLoS ONE|volume=8|issue=3|year=2013|pages=e60009|issn=1932-6203|doi=10.1371/journal.pone.0060009}}</ref>
==Phases==
