tion’, implying that most patients ‘should’ receive a particular action. In contrast, level 2 guidelines are essentially ‘suggestions’ and are deemed to be ‘weak’ or discretionary, recognising that management decisions may vary in different clinical contexts. Each recommendation was further graded from A to D by the quality of evidence underpinning them, with grade A referring to a high quality of evidence whilst grade D recognised a ‘very low’ evidence base. The overall strength and quality of the supporting evidence is summarised in table 1 . The guidelines focused on 4 key domains: (1) AKI definition, (2) prevention and treatment of AKI, (3) contrastinduced AKI (CI-AKI) and (4) dialysis interventions for the treatment of AKI. The full summary of clinical practice statements is available at www.kdigo.org, but a few key recommendation statements will be highlighted here.

/pdf/kdigo-clinical-practice-guidelines-for-acute-kidney-injury-27tybolw7l.pdf

KDIGO clinical practice guidelines for acute kidney injury.

Background Injections of radiocontrast agents are a frequent cause of acute decreases in renal function, occurring most often in patients with chronic renal insufficiency and diabetes mellitus. Methods We prospectively studied 78 patients with chronic renal insufficiency (mean [±SD] serum creatinine concentration, 2.1 ±0.6 mg per deciliter [186 ±53 μmol per liter]) who underwent cardiac angiography. The patients were randomly assigned to receive 0.45 percent saline alone for 12 hours before and 12 hours after angiography, saline plus mannitol, or saline plus furosemide. The mannitol and furosemide were given just before angiography. Serum creatinine was measured before and for 48 hours after angiography, and urine was collected for 24 hours after angiography. An acute radiocontrast-induced decrease in renal function was defined as an increase in the base-line serum creatinine concentration of at least 0.5 mg per deciliter (44 μmol per liter) within 48 hours after the injection of radiocontrast agents. Res...

Effects of Saline, Mannitol, and Furosemide on Acute Decreases in Renal Function Induced by Radiocontrast Agents

Comments on ‘KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease’

Nephrotoxicity of ionic and nonionic contrast media in 1196 patients: A randomized trial

https://www.kidney-international.org/article/S0085-2538(15)51387-2/pdf

Contrast-induced nephropathy: Definition, epidemiology, and patients at risk

https://www.kidney-international.org/article/S0085-2538(15)34695-0/pdf

Arnold S. Berns

Papers

Nephrotoxicity of contrast media.