🧪Patient Lab Values
📚 Clinical Guidelines
Kidney Function (CI-AKI)
- eGFR ≥45: Safe (Standard Protocol)
- eGFR 30-44: Caution (Hydrate & Consult)
- eGFR <30: High Risk (Avoid Contrast)
Metformin Guidelines
If eGFR < 30 or AKI suspected, withhold for 48h post-contrast. Restart only after renal function re-evaluation.
Clinical Safety Guidelines
Understanding eGFR & Contrast Risk
Estimated Glomerular Filtration Rate (eGFR) is the primary marker for kidney function. Iodinated contrast media (ICM) can potentially cause Post-Contrast Acute Kidney Injury (PC-AKI), formerly known as Contrast-Induced Nephropathy (CIN), in patients with severe renal impairment.
Key Threshold: eGFR < 30 mL/min/1.73m² is generally considered high risk. Caution is advised for eGFR 30-45.
RANZCR vs ESUR Guidelines
- RANZCR (Australia/NZ): Emphasizes individual risk assessment. Recommends hydration for high-risk patients. eGFR < 30 is the critical cutoff.
- ESUR (Europe): Similar thresholds. Defines PC-AKI as an increase in serum creatinine ≥ 0.3 mg/dl or ≥ 50% within 48-72 hours.
Metformin & Contrast
Metformin itself is not nephrotoxic, but if PC-AKI occurs, metformin accumulation can lead to lactic acidosis, a rare but serious complication.
Management Protocol:
- eGFR > 30: Generally safe to continue Metformin.
- eGFR < 30 or Acute Kidney Injury: Metformin should be withheld for 48 hours post-contrast and restarted only after renal function is re-evaluated.
*Always follow your specific institutional protocols as policies may vary.