A 68-year-old man with eGFR 28 mL/min (CKD G4) and type 2 diabetes is scheduled for coronary angiography. Serum creatinine is 2.4 mg/dL. Which measure is most effective in preventing contrast-associated AKI?

• A IV N-acetylcysteine 1200 mg twice daily for 2 days
• B IV furosemide to maintain urine output >150 mL/hr
• C Oral theophylline for 3 days post-procedure
• D IV normal saline hydration before and after the procedure ✓

Explanation

IV isotonic saline is the single most effective measure for preventing contrast-associated AKI in high-risk patients (eGFR <30, diabetes). KDIGO and major guidelines recommend volume expansion with isotonic crystalloid. N-acetylcadjuc has inconsistent evidence and is not superior to hydration alone. Theophylline has limited data. Loop diuretics can worsen AKI.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.