Creatinine screening prior to IV contrast

Background

It may be possible to reduce the use of creatinine screening in ED patients requiring IV contrast for CT or other radiographic evaluation
Data is sparse, however, and any guidelines should be utilized with that in mind, and in the context of local policies.

ED patients do NOT require creatinine measurement prior to IV contrast:

If the study is immediately necessary to prevent life-threatening decompensation or delay in emergent treatment (e.g. trauma patients)
If they do not meet any of the following criteria[1][2]:
- Age >60
- History of kidney disease
  - Kidney transplant
  - Dialysis
  - Single kidney
  - Renal cancer
  - Kidney surgery
- Family history of kidney failure
- Diabetes
- Hypertension
- Collagen vascular disease (e.g. SLE, scleroderma, rheumatoid arthritis)
- Paraproteinemia (e.g. multiple myeloma)
- Recent use of nephrotoxic medication (eg, metformin, aminoglycosides)

Tippins RB, Torres WE, Baumgartner BR, Baumgarten DA. Are screening serum creatinine levels necessary prior to outpatient CT examinations? Radiology. 2000 Aug;216(2):481-4.
ACR Manual on Contrast Media – Version 10, 2015. PDF Accessed 08/10/15

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