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In this episode, we review the high-yield topic of Contrast-Induced Nephropathy from the Renal section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets Linkedin: https://www.linkedin.com/company/medbullets
This short episode sees the podcast team having a chat about relatively recent statements from RCEM/RCR and what impact that also has for us. Let us know your thoughts.
This episode sees Vicky and Damian chatting to a Nephrologist about the topic of Contrast Induced Nephropathy, sometimes called CI-AKI. We hope you enjoy.
In this conversation, Daniel Belkin and Mitch Belkin speak with Joel Topf, MD, about contrast-associated nephropathy. We discuss Acute Kidney Injury (AKI), the value of creatinine as a marker for AKI, how to evaluate volume status, the evidence around contrast-induced/contrast-associated nephropathy, recommendations on fluids to prevent AKI in patients with Chronic Kidney Disease, and comparing venous and arterial contrast with respect to the risk of AKI.Who is Joel Topf?Dr. Topf is a clinical nephrologist in Detroit, who is a partner and medical director at St Clair Nephrology and an assistant professor at Oakland University William Beaumont School of Medicine. He is the co-creator of NephMadness and NephJC. He hosts multiple podcasts, blogs at pbfluids.com, and tweets @Kidney_boy. References: Joel Topf's Blog Twitter: @Kidney_BoyJoel Topf - Grand Rounds Presentation on Contrast NephropathyThe PRESERVE trialN-Acetylcysteine and Contrast-Induced Nephropathy in Primary AngioplastyPrevention of Contrast-Induced Nephropathy With Sodium BicarbonateCraig Brater 1998 - NEJM review on DiureticsChlorthalidone for Hypertension in Advanced Chronic Kidney DiseaseEffect of Salt Substitution on Cardiovascular Events and Death______________________Follow us @ExMedPod and subscribe to our Youtube channel.Daniel Belkin, MD, and Mitch Belkin, MD, are brothers and resident physicians. The External Medicine Podcast is a podcast exploring nontraditional medical ideas and innovation.
So for decades people have talked about Contrast Induced Nephropathy…or Contrast Induced Acute Kidney Injury, depending on the decade and location of discussion. The theory being that diuresis, increased urine viscosity and changes in vasoconstriction and vasodilation leads to a worsening of renal function following iv contrast administration. It seems to come from the 1950’s where some patients were seen to develop acute kidney injuries following iv contrast. Now times have changed and treatments and contrasts evolved but the discussion around contrast induced nephropathy continues. At times these discussion can mean that some patients wait for scans in the Emergency Department whilst waiting for blood tests to come back first. But is this the right thing to do? In this episode we take a look at the origins of contrast induced nephropathy, consider some recent publications on the topic and see how this translates to practice and applications of the most recent guidelines. Reading around the topic has been hugely informative for us and we hope will be of benefit to you too! Enjoy Simon & Rob
Unsolved Mysteries: Contrast Induced Nephropathy by UC Department of Emergency Medicine
Joel TopfJennie LinMatt SparksSwapnil HiremathShow Notes: IgA Nephropathy ScoreLevi Strauss: https://www.biography.com/fashion-designer/levi-straussLevey MDRD study: https://www.ncbi.nlm.nih.gov/pubmed/10075613ADPKD Total Kidney Volume: https://www.nejm.org/doi/10.1056/NEJMoa054341Halt PKD: https://www.nejm.org/doi/full/10.1056/nejmoa1402685Tempo 3:4 Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1205511Description description of IgA nephropathy by Berger and Hiunglais: https://www.ncbi.nlm.nih.gov/pubmed/4180586The reprint in JASN in 2000 with commentary as part of the Milestones in Nephrology series: https://jasn.asnjournals.org/content/jnephrol/11/10/1957.full.pdf JASN supplies an English translation from the original French.Nice reference from JASN backing up Matt’s assertion that preeclampsia and not IgA nephropathy is the most common glomerular disease in the world: https://jasn.asnjournals.org/content/18/8/2281Description of the Singapore Army screening recruits from the Oxford Textbook of Clinical Nephrology: https://books.google.com/books?id=fVItBQAAQBAJ&lpg=PA485&ots=JRoOnUnleT&dq=singapore%20kidney%20biopsy%20army&pg=PA485#v=onepage&q&f=falseDescription of the Japanese glomerulonephritis screening program: https://cjasn.asnjournals.org/content/2/6/1360Swapnil’s studies on autopsy studies:Finland: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC501386/Japan: https://www.ncbi.nlm.nih.gov/pubmed/12753320/Nephrology Secrets, either one of the best or the best nephrology textbooks ever: https://www.amazon.com/Nephrology-Secrets-Book-Edgar-Lerma-ebook/dp/B079TSYNQW/ref=sr_1_1TESTING Trial on NephJC: http://www.nephjc.com/news/2017/8/28/testingStop-Iga Trial on NephJC: http://www.nephjc.com/iga-nephropathyTesting Trial two: Therapeutic Evaluation of Steroids in IgA Nephropathy Global Study Low Dose Study: https://clinicaltrials.gov/ct2/show/NCT01560052MEST Score versus MEST-C in NephJC: http://www.nephjc.com/news/2016/10/16/do-crescents-matter-for-iga-nephropathyNice discussion of the statistical tests during the Tweet Chat by people who know their stats (I.e. not Joel): https://twitter.com/NephJC/status/1133546750814367746Tweet-length description of IDI: https://twitter.com/kiwiskiNZ/status/1133595698929098752Assessing the performance of prediction models: a framework for traditional and novel measures. https://www.ncbi.nlm.nih.gov/pubmed/20010215/Net Reclassification Indices for Evaluating Risk-Prediction Instruments: A Critical Review https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3918180/Predicting Progression in CKD: Perspectives and Precautions https://www.ajkd.org/article/S0272-6386(15)01413-4/abstractThe Article by Nancy Cook in Circulation that Jennie was talking about: Use and misuse of the receiver operating characteristic curve in risk prediction. https://www.ncbi.nlm.nih.gov/pubmed/17309939Discovery of new risk loci for IgA nephropathy implicates genes involved in immunity against intestinal pathogens https://www.nature.com/articles/ng.3118Genome-wide polygenic risk predictors for kidney disease https://www.nature.com/articles/s41581-018-0067-6Where does Matt find minutia like the grams of IgA produced a day? Here: https://www.annualreviews.org/doi/abs/10.1146/annurev-pathol-011110-130216Animal models of IgA nephropathy: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4337240/Matt’s Book Originals: https://www.amazon.com/gp/product/014312885X/ref=dbs_a_def_rwt_bibl_vppi_i1Eric Neilson, Dean of Northwestern University https://www.feinberg.northwestern.edu/faculty-profiles/az/profile.html?xid=23239Brussels sprout Insta-famous dog and future dean of the medical school: https://www.instagram.com/brussels.sprout/?hl=enJosh Farkas Rantorial about Contrast Nephropathy: https://twitter.com/PulmCrit/status/1134922050794139648Swapnil’s Tweetorial about Contrast Nephropathy: https://twitter.com/hswapnil/status/1133906398096609280Tukaram’s pic of NEJM’s progression from Contrast Induced Nephropathy to Contrast Associated Nephropathy: https://twitter.com/tukaramj/status/1135214980985266178Zero sodium dialysate for heart failure? https://twitter.com/i/moments/1134811009217155072
Contrast induced nephropathy is the "white walker" of critical care and emergency medicine. Come take a listen as we discuss the potential error in creating a clinically non-meaningful entity, and how we should address this in our daily clinical work.
Solidify your understanding of contrast-induced nephropathy (CIN)! Quiz yourself on the 5 pearls we will be covering: Are there diagnostic criteria for CIN? (2:11) Is there a difference between exposure to intra-arterial vs. intra-venous contrast in terms of risk of CIN? (6:28) What are the biggest risk factors for CIN? (14:48) What preventive measures have been shown to best reduce the risk of CIN? (19:41) Can ESRD patients on hemodialysis still suffer from CIN? (23:32) Recap (25:49) For full show notes: https://www.coreimpodcast.com/2018/05/16/5-pearls-contrast-induced-nephropathy/
Making all your nephrology dreams come true with part 2 of our interview with @kidney_boy, Joel Topf, MD Salt Whisperer and Chief of Nephrology at Kashlak Memorial Hospital. Flush away your bad prescribing habits when it comes to nephrotoxic drugs in this fast paced run down of the medications which must stay on or off Santa’s naughty-list, backed up with a sack full of memorable research studies. Special thanks to Annie Medina, Justin Berk and Kate Grant for writing/producing this show and to physician artist, Kate Grant for her lovely/hilarious artwork (more at paintscientific.com). Full show notes available at http://thecurbsiders.com/podcast Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Time Stamps 00:00 Intro 03:00 Which medications should we exercise caution over in CKD? 03:31 Bactrim (Trimethoprim+Sulfamethoxazole) 07:00 NSAIDS 08:29 NSAIDS and the ‘Precision’ Trial NEJM 2016 looking at cardiovascular safety 12:50 The Male Physician Study JAMA 2001 13:50 Discussion about Nurses Health Study and use of analgesia, and CKD 15:15 Acute Interstitial Nephritis, Beta Lactam Antibiotics, and the risk of Acute kidney injury +/- CKD with Proton Pump Inhibitors 18:20 Advice for co-prescribing NSAIDS,ACE inhibitors and diuretics 20:39 Creatinine levels and ACE/ARB prescribing. How High can you go? 24:55 Facebook question from listener: measures to reduce proteinuria in hypertensive patients 27:20 Empagliflozin and renal protection in diabetic patients 32:00 Contrast Induced Nephropathy, the AMACING trial 2016. 38:00 Take Home Points 39:57 Outro Tags: chronic, kidney, disease, nephrology, renal, glomerular, filtration, crcl, gfr, creatinine, medications, pharmacology, bactrim, nsaids, ace-i, contrast, metformin, empagliflozin, nephropathy, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, meded, medicine, medical, primary, physician, resident, student
Contrast-induced nephropathy is cited as the third most common cause of iatrogenic acute kidney injury. In the Emergency Department, physicians must balance diagnosing life-threatening conditions using emergent imaging with the risk of potential harm caused by exposure to IV contrast. Recent studies, including the one discussed by Lauren in this episode, challenge the proposed causal ...The post REPLAY: Emergent Realizations – Contrast-Induced Nephropathy & Opioid Prescribing Patterns appeared first on Healthy Debate.
Contrast-induced nephropathy is cited as the third most common cause of iatrogenic acute kidney injury. In the Emergency Department, physicians must balance diagnosing life-threatening conditions using emergent imaging with the risk of potential harm caused by exposure to IV contrast. Recent studies, including the one discussed by Lauren in this episode, challenge the proposed causal ... The post REPLAY: Emergent Realizations – Contrast-Induced Nephropathy & Opioid Prescribing Patterns appeared first on Healthy Debate.
Contrast-induced nephropathy is cited as the third most common cause of iatrogenic acute kidney injury. In the Emergency Department, physicians must balance diagnosing life-threatening conditions using emergent imaging with the risk of potential harm caused by exposure to IV contrast. Recent studies, including the one discussed by Lauren in this episode, challenge the proposed causal ... The post Emergent Realizations: Contrast-Induced Nephropathy & Opioid Prescribing Patterns appeared first on Healthy Debate.
Contrast-induced nephropathy is cited as the third most common cause of iatrogenic acute kidney injury. In the Emergency Department, physicians must balance diagnosing life-threatening conditions using emergent imaging with the risk of potential harm caused by exposure to IV contrast. Recent studies, including the one discussed by Lauren in this episode, challenge the proposed causal ...The post Emergent Realizations: Contrast-Induced Nephropathy & Opioid Prescribing Patterns appeared first on Healthy Debate.
This week we discuss a recent article in Annals of EM on contrast induced nephropathy and whether the phenomena is real or dogma. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_91_0_Final_Cut.m4a Download Leave a Comment Tags: AKI, CIN, Contrast Induced Nephropathy, Journal Update Show Notes ACR Table on CIN – FOAMCast FOAMCast: Episode 65 – Contrast Induced Nephropathy and Genitourinary Trauma REBEL EM: Contrast Induced Nephropahty: Fact or Myth Core EM: Acute Kidney Injury is not Associated with IV Contrast Use in the ED EM Lit of Note:
This week we discuss a recent article in Annals of EM on contrast induced nephropathy and whether the phenomena is real or dogma. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_91_0_Final_Cut.m4a Download Leave a Comment Tags: AKI, CIN, Contrast Induced Nephropathy, Journal Update Show Notes ACR Table on CIN – FOAMCast FOAMCast: Episode 65 – Contrast Induced Nephropathy and Genitourinary Trauma REBEL EM: Contrast Induced Nephropahty: Fact or Myth Core EM: Acute Kidney Injury is not Associated with IV Contrast Use in the ED EM Lit of Note: Punching Holes in CIN
We cover Free Open Access Medical Education (FOAM) on Contrast-Induced Nephropathy (CIN). Recent interes The American College of Radiology (ACR) Manual on Contrast Induced Nephropathy This Emergency Medicine Literature of Note post covers the AMACING trial, which looks at intravenous fluid administration (0.9% NaCl) versus usual care in patients "at risk" for CIN undergoing contrast-enhanced CT scan. The study found a difference of -0.1% (95% CI -2.25 to 2.06), which was below the non-inferiority margin. Prior literature shows similar results, with no clear-cut efficacy from prevention strategies for CIN. This post by Dr. Joel Topf (nephrologist @kidneyboy) on the Precious Bodily Fluids blog discusses a nephrologist's take on CIN. EM topics post on fluids in CIN. Core Content We then delve into core content on genitourinary trauma using Rosen’s Chapter 47 and Tintinalli’s Chapter265 as a guide. Thanks for listening! Jeremy Faust and Lauren Westafer
This week, Amol discusses contrast induced nephropathy. At an overall reported incidence of 10%, contrast induced nephropathy leads to worse clinical outcomes and double the rate of mortality. A systematic review and meta-analysis on the effectiveness of prevention strategies found that there is no strong evidence for any intervention beyond volume expansion with saline. N-acetyl ...The post An Exercise in Contrasts: Contrast Induced Nephropathy and Exercise in Cancer appeared first on Healthy Debate.
This week, Amol discusses contrast induced nephropathy. At an overall reported incidence of 10%, contrast induced nephropathy leads to worse clinical outcomes and double the rate of mortality. A systematic review and meta-analysis on the effectiveness of prevention strategies found that there is no strong evidence for any intervention beyond volume expansion with saline. N-acetyl ... The post An Exercise in Contrasts: Contrast Induced Nephropathy and Exercise in Cancer appeared first on Healthy Debate.
This EM Cases episode is Part 1 of The Highlights of The University of Toronto, Divisions of Emergency Medicine, Update in EM Conference from Whistler 2015 with Paul Hannam on Pearls and Pitfalls of Intraosseus Line Placement, Anil Chopra on who is at risk and how to prevent Contrast Induced Nephropathy, and Joel Yaphe on the Best of EM Literature from 2014, including reduction of TMJ dislocations, the TRISS trial (on transfusion threshold in sepsis), PEITHO study for thrombolysis in submassive PE, Co-trimoxazole and Sudden Death in Patients Receiving ACE inhibitors or ARBs, the effectiveness and safety of outpatient Tetracaine for corneal abraisons, chronic effects of shift work on cognition and much more... The post Episode 61 Whistler's Update in EM Conference 2015 Highlights Part 1 appeared first on Emergency Medicine Cases.
This EM Cases episode is Part 1 of The Highlights of The University of Toronto, Divisions of Emergency Medicine, Update in EM Conference from Whistler 2015 with Paul Hannam on Pearls and Pitfalls of Intraosseus Line Placement, Anil Chopra on who is at risk and how to prevent Contrast Induced Nephropathy, and Joel Yaphe on the Best of EM Literature from 2014, including reduction of TMJ dislocations, the TRISS trial (on transfusion threshold in sepsis), PEITHO study for thrombolysis in submassive PE, Co-trimoxazole and Sudden Death in Patients Receiving ACE inhibitors or ARBs, the effectiveness and safety of outpatient Tetracaine for corneal abraisons, chronic effects of shift work on cognition and much more... The post Episode 61 Whistler’s Update in EM Conference 2015 Highlights Part 1 appeared first on Emergency Medicine Cases.
The exact pathophysiology of contrast-induced nephropathy (CIN) is not fully clarified, yet the osmotic characteristics of contrast media (CM) have been a significant focus in many investigations of CIN. Osmotic effects of CM specific to the kidney include transient decreases in blood flow, filtration fraction, and glomerular filtration rate. Potentially significant secondary effects include an osmotically induced diuresis with a concomitant dehydrating effect. Clinical experiences that have compared the occurrence of CIN between the various classes of CM based on osmolality have suggested a much less than anticipated advantage, if any, with a lower osmolality. Recent animal experiments actually suggest that induction of a mild osmotic diuresis in association with iso-osmolar agents tends to offset potentially deleterious renal effects of high viscosity-mediated intratubular CM stagnation.
Celia Bradford gives a brief and superb summary of contrast induced nephropathy. The Prezi presentation she refers to can be found here: http://prezi.com/t79w4fwm1i_u/renal-protection-should-i-care/ Thanks for all the following for the podcasts - please subscribe on iTunes and leave feedback!
Guest: Michael Rudnick, MD Host: Lee Freedman, MD Dr. Rudnick reviews the reasons for the rising incidence of contrast-induced renal problems. He outlines the risk factors for "CIN" - both related to procedures and patients - and then comments on the clinical significance of this growing issue.
Guest: Michael Rudnick, MD Host: Lee Freedman, MD How can we protect our patients who have renal insufficiency from a further decline in kidney function when they need a test or procedure that involves the use of intravenous contrast? What type of hydration is most effective? Are certain medications protective? Dr. Rudnick reviews the data on all of these points in this helpful discussion.
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