Case Of The Injured Kidneys

Question 1

Side effects of iodinated contrast?

Answer 1

Warmth/flushing
Headache
Nausea
Itching/rash
Metallic taste

Question 2

Allergy to contrast?

Answer 2

Urticaria
Bronchospam
Laryngeal oedema
Hypotension
Generalised anaphylaxis

Question 3

Who are at risk of contrast reaction?

Answer 3

Asthma- x6

Question 4

How to deal with anaphylaxis?

Answer 4

Oxygen and IV fluids
Large bore cannula
Antihistamines- chlorphenamine 10mg
Hydrocortisone-200mg
Adrenaline I’m -

Question 5

What is nephrotoxicity?

Answer 5

25% increase in serum creatinine 48-72 hours after contrast injection

Question 6

Risk of nephrotoxicity if?

Answer 6

Renal impairment
Diabetes
Metformin therapy

Question 7

Mechanism of nephrotoxicity of contrast media?

Answer 7

1. Contrast media causes cytotoxicity which leads to endothelial and tubular injury. This results in vasoconstriction and so reduced medullary reducing glomerular filtration rate and reduced medullary ischaemia
2. Contrast media causes increased viscosity loading to reduced tubular flow and reduced medullary perfusion and so less glomerular filtration rate and reduced medullary ischaemia

Question 8

Preventing contrast induced AKI?

Answer 8

Stop metformin 48 hours post contrast injection

Pre/post hydration - to maintain renal perfusion

Question 9

Hypertension symptoms?

Answer 9

Headache, blurred vision, dizziness, sob, palpitations, epistaxis

Question 10

Treatment for hypertensive emergency?

Answer 10

IV therapy- labetalol, GTN, sodium nitroprusside, esmolol