Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
J Korean Med Sci. 2024 Oct 7;39(38):e298. doi: 10.3346/jkms.2024.39.e298.
Intravascular administration of iodinated contrast media can cause contrast-induced acute kidney injury, especially in patients with an estimated glomerular filtration rate (eGFR) less than 30 mL/min/1.73 m². The American College of Radiology (ACR) and the European Society of Urogenital Radiology (ESUR) guidelines recommend renal function screening based on medical history, but their effectiveness has been under-evaluated. This retrospective study included 2,560 consecutive adult outpatients without eGFR measurements within 180 days before contrast-enhanced computed tomography (CT) at a single tertiary hospital from July through September 2023. On the day of CT, they underwent eGFR tests and 1.1% had an eGFR < 30 mL/min/1.73 m², preferentially with histories of gout and renal disease. According to the ACR and ESUR strategies, 16.9% and 38.8% of all study participants were positive, respectively, identifying 92.6% and 96.3% of patients with renal insufficiency. Both strategies demonstrated high negative predictive values. These results support selective renal function screening before contrast-enhanced examinations.
血管内给予碘造影剂可引起造影剂诱导的急性肾损伤，尤其是在估算肾小球滤过率（eGFR）<30 mL/min/1.73 m²的患者中。美国放射学院（ACR）和欧洲泌尿生殖放射学会（ESUR）指南建议根据病史进行肾功能筛查，但它们的效果尚未得到充分评估。这项回顾性研究纳入了 2023 年 7 月至 9 月期间在一家三级医院进行增强 CT 检查前 180 天内无 eGFR 测量值的 2560 例连续成年门诊患者。在 CT 检查当天，他们进行了 eGFR 测试，其中 1.1%的患者 eGFR<30 mL/min/1.73 m²，这些患者更有痛风和肾脏疾病病史。根据 ACR 和 ESUR 策略，分别有 16.9%和 38.8%的所有研究参与者呈阳性，分别确定了 92.6%和 96.3%的肾功能不全患者。两种策略均具有较高的阴性预测值。这些结果支持在增强检查前选择性进行肾功能筛查。
