Contrast Induced Nephropathy with Intravenous Iodinated Contrast Media in Routine Diagnostic Imaging: An Initial Experience in a Tertiary Care Hospital

Table 4

Recommended requisition form for contrast enhanced investigations in our department.

Name	Consent
Age	Baseline ( not more than 1 week old) serum creatinine (mg/dL) =; eGFR calculated (mL/min/1.73 m^2) =; If < 45 mL/min/1.73 m^2 defer CECT/IVP, take preventive measures
Sex	H/o contrast allergy, drug allergy, or allergic condition; if yes, defer Ix and preventive measures taken
Weight	(1) Preexisting renal disease	Y/N	Type of disease
Clinical indication for IVP/CECT	(2) Dehydration on history or clinical exam	Y/N
Ix required IVP/CECT study and ID	(3) H/o previous contrast (within 2 wks)	Y/N	IV or IA, type of CM
Any significant past or present medical illness	(4) H/o heart failure	Y/N	Past/present
	(5) H/o renal surgery	Y/N	Type of surgery
Hb/TLC/CRP	(6) H/o diabetes mellitus	Y/N	Recent fasting blood sugar level
	(7) H/o hypertension	Y/N	Blood pressure = mm of Hg
	(8) H/o nephrotoxic drug intake	Y/N	Type of drug
If one of the risk factors 1–4 or two of risk factors 5–8 or subnormal renal function (eGFR 46 to 90 mL/min/1.73 m^2) or if volume of administered IV contrast is equal to or more than 100 mL
Repeat S creatinine after 2-3 days of Ix, postprocedural S. Creatinine level =
Postprocedural S. Creatinine raised Yes/No % increase =
If increase > 25% or is by an absolute value of 0.5 mg/dL, CIN is diagnosed; Group allotted: CIN or No CIN
If CIN present, serum creatinine is repeated weekly and refer to nephrologist if there is clinical deterioration
If not, send back to referring clinician

Consent to be taken on separate form, Ix: investigation.