The Internet Book of Critical Care Podcast IBCC Episode 35 - Contrast Induced Nephropathy
May 2, 2019
Join critical care physician Josh Farkas as he unpacks the myth of contrast-induced nephropathy. He traces its origins, revealing that many conclusions were drawn from weak evidence and small creatinine fluctuations. Farkas highlights studies showing no true link between contrast use and kidney injury, emphasizing the importance of administering necessary scans. Bringing attention to other nephrotoxins often overlooked, he provides practical advice for clinicians on avoiding unnecessary precautions. A refreshing take on a misunderstood topic!
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Origins Of The Myth
- Contrast nephropathy originated from small case reports decades ago using high‑osmolar dye that we no longer use.
- The diagnosis then expanded arbitrarily when small creatinine bumps were labeled as contrast injury.
Creatinine Is A Noisy Marker
- Creatinine fluctuates spontaneously and small rises (e.g., 0.3 mg/dL) often reflect random variation.
- Labeling transient bumps as 'contrast nephropathy' can create a disease from noise.
Bumps Don't Equal Injury
- Small creatinine increases after contrast did not correlate with renal injury biomarkers in studies.
- Those bumps likely reflect hydration or fluid shifts rather than true tubular damage.