A 66-year-old diabetic man with chronic kidney disease (eGFR 38 mL/min/1.73 m2) is scheduled for coronary and peripheral angiography with iodinated contrast. Which single intervention has the strongest evidence for preventing contrast-induced acute kidney injury in this patient?
- A Prophylactic N-acetylcysteine orally for 48 hours
- B Intravenous isotonic (0.9 percent) saline expansion before and after the procedure ✓
- C Furosemide-assisted forced diuresis during the procedure
- D Prophylactic sodium bicarbonate infusion alone without volume expansion
Correct answer: B. Intravenous isotonic (0.9 percent) saline expansion before and after the procedure
Explanation
Periprocedural intravenous isotonic saline remains the best-supported preventive measure, acting by maintaining renal medullary perfusion and reducing tubular toxicity. N-acetylcysteine has shown inconsistent benefit and is no longer considered reliable protection. Forced diuresis with loop diuretics worsens hypovolemia and increases injury risk, and bicarbonate offers no proven advantage over adequate isotonic volume expansion.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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