Radiocontrast-induced nephropathy.

Significant renal insufficiency defined as a stable SCr > 1.5 mg/dl is the single most important risk factor for RCIN. Based on the outcome data summarized, the occurrence of RCIN should be avoided, since significant deterioration of renal function occurs in one of every four patients. Clearly volume depletion should be corrected before administering RCM. In high-risk patients a hydration protocol should be initiated before the procedure and continued for at least 2 h after the procedure. At least one large cooperative study has reported a significant reduction in RCIN when LORCM are compared to HORCM. Limiting the total volume of RCM used for an individual study also reduces the incidence of RCIN. While indications for invasive studies with RCM continue to expand, especially for elderly and other high-risk groups, using the above recommendations as guidelines should minimize the risk of RCIN while still providing the critical information needed to develop a clinical management plan.