, 16 tweets, 9 min read Read on Twitter
Very nice review on contrast associated (not contrast induced) AKI in @NEJM nejm.org/doi/full/10.10…
Written by stalwarts in the field
Gated, but definitely worth a read 1/
But I will have minor quibbles of course!
Here’s what they say on pathogenesis
With references from the 1990s! The era of high osmolar contrast media 🙄
Why not use this? ncbi.nlm.nih.gov/m/pubmed/29863… from @jclinicalinvest 2017? 2/
At least the pathophysiology image is better looking than @VijayanMD favorite one 😅
On dose of contrast there’s conflicting advice
4 ml/kg or 2x GFR? Or 350 ml?
Isn’t it just sensible to say use as less as possible and ignore the need for pretty pictures? 4/
This is on NAC
As much as I like PRESERVE, anyone with a 🧠 who had read ncbi.nlm.nih.gov/m/pubmed/21859… & ncbi.nlm.nih.gov/m/pubmed/18001… &/or a dash of common sense knew NAC was 🐄 💩 5/
This is well written on whether contrast AKI exists
It does - but some more definitive statements would have been nice
It is not a myth
But need for dialysis is <<<<1%
They do mention the problems with the small rise in creatinine problem
Time for me to plug the Bora-Bora criteria twitter.com/i/moments/1018… 7/
On risk scores, they claim all scores use post-procedural variables
The first author score is
But Citation 34 is ncbi.nlm.nih.gov/m/pubmed/25516… based only on pre-procedural data - and was best according to this SR: ncbi.nlm.nih.gov/m/pubmed/28545… 8/
All this on volume expansion
Unnecessary aspersions cast on AMACING IMO
But no mention of oral fluids?
Ahem, See ncbi.nlm.nih.gov/m/pubmed/23555… 9/
Though I agree with the Coca SR,
This ignores the POSEIDON trial though nephjc.com/poseidon which may be chance. Or maybe not 10/
Overall it is quite sensible, well written
I am nitpicking as always
I would have loved stronger opinions 🤔
Read it here nejm.org/doi/full/10.10…
Nicely done @Drroxmehran @stevenweisbord 👏🏼
Last point h/t @annlbugeja
In figure there is ‘suspend nephrotoxic medication’ advice
The text is more explicit - but lot of peeps might misconstrue this to stop RAS blockade. Don’t do that
RAS blockade is good
Stopping them to prevent a bump in creatinine is bad 12/11
Calling RAS blockade nephrotoxic also activates the @CharlieTomson klaxon

BTW, there’s a small RCT that shows stopping RAS in this setting doesn’t help ncbi.nlm.nih.gov/m/pubmed/18438… 13/11
And I wish they had been less wishy-washy on the metformin issue
If severe contrast AKI is so rare, then do we need to hold it in the vast majority of patients? 14/11
Ending with my favorite quote on metformin & contrast
And for what I mean by @VijayanMD favorite schematic, scroll down in this #NephMadness scouting report ajkdblog.org/2018/03/15/nep… 16/11
Missing some Tweet in this thread?
You can try to force a refresh.

Like this thread? Get email updates or save it to PDF!

Subscribe to Swapnil Hiremath, MD, MPH
Profile picture

Get real-time email alerts when new unrolls are available from this author!

This content may be removed anytime!

Twitter may remove this content at anytime, convert it as a PDF, save and print for later use!

Try unrolling a thread yourself!

how to unroll video

1) Follow Thread Reader App on Twitter so you can easily mention us!

2) Go to a Twitter thread (series of Tweets by the same owner) and mention us with a keyword "unroll" @threadreaderapp unroll

You can practice here first or read more on our help page!

Follow Us on Twitter!

Did Thread Reader help you today?

Support us! We are indie developers!

This site is made by just three indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3.00/month or $30.00/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!