Kidney Cancer: Diagnosis and Evaluation: Difference between revisions
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**# '''Patients with a diagnosis of a paraproteinemia syndrome/disease (e.g., multiple myeloma), history of a kidney transplant, renal tumor, renal surgery, or single kidney may also be at higher risk''' | **# '''Patients with a diagnosis of a paraproteinemia syndrome/disease (e.g., multiple myeloma), history of a kidney transplant, renal tumor, renal surgery, or single kidney may also be at higher risk''' | ||
*** '''The patients at highest risk for developing CIN are those with both diabetes and pre-existing renal insufficiency.''' | *** '''The patients at highest risk for developing CIN are those with both diabetes and pre-existing renal insufficiency.''' | ||
** '''Metformin''' | ** '''<span style="color:#ff0000">Metformin''' | ||
*** '''Patients with type 2 diabetes mellitus receiving metformin may have an accumulation of the drug after administering intravascular radiologic contrast medium (IRCM), resulting in biguanide lactic acidosis''' | *** '''Patients with type 2 diabetes mellitus receiving metformin may have an accumulation of the drug after administering intravascular radiologic contrast medium (IRCM), resulting in biguanide lactic acidosis''' | ||
*** '''Biguanide lactic acidosis''' | *** '''Biguanide lactic acidosis''' | ||
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**** '''Rare in patients with normal renal function (no defined threshold but some studies suggest <60).''' | **** '''Rare in patients with normal renal function (no defined threshold but some studies suggest <60).''' | ||
***** '''In patients with normal renal function and no known comorbidities there is no need to discontinue metformin before IRCM use, nor is there a need to check creatinine following the imaging study.''' | ***** '''In patients with normal renal function and no known comorbidities there is no need to discontinue metformin before IRCM use, nor is there a need to check creatinine following the imaging study.''' | ||
***** '''In patients with renal insufficiency metformin should be discontinued the day of the study and withheld for 48 hours. | ***** '''<span style="color:#ff0000">In patients with renal insufficiency metformin should be discontinued the day of the study and withheld for 48 hours. Post-procedure creatinine should be measured at 48 hours and metformin started once kidney function is normal.''' | ||
**** It is not necessary to discontinue metformin before gadolinium-enhanced MRI studies when the amount of gadolinium administered is in the usual dosage range of 0.1 to 0.3 mmol per kilogram of body weight. | **** It is not necessary to discontinue metformin before gadolinium-enhanced MRI studies when the amount of gadolinium administered is in the usual dosage range of 0.1 to 0.3 mmol per kilogram of body weight. | ||
*** Prevention of CIN is of great concern and has been a subject of many different studies. Hydration is the major preventative action against CIN. Periprocedural IV hydration with 0.9% saline at 100 mL/hr 12 hours before to 12 hours after has been shown to decrease the incidence of CIN after IV contrast use | *** Prevention of CIN is of great concern and has been a subject of many different studies. Hydration is the major preventative action against CIN. Periprocedural IV hydration with 0.9% saline at 100 mL/hr 12 hours before to 12 hours after has been shown to decrease the incidence of CIN after IV contrast use | ||