Who must have a creatinine level prior to IV contrast?

reference: Manual on Contrast Media Version 9.0, ACR

All inpatients require a current (within one week) creatinine level or estimated glomerular filtration rate (eGFR) prior to an IV contrast-enhanced CT.

Outpatients being scheduled for a CT with IV contrast will not require a serum creatinine unless they meet one of the following criteria:

  1. Over 60 years old.
  2. Diabetic treated with insulin or other provider-prescribed medications (e.g., metformin).
  3. Receiving chemotherapy or an aminoglycoside within the last 1 month.
  4. Diagnosis of a collagen vascular disease.
  5. Diagnosis of a paraproteinemia syndrome or disease (e.g., multiple myeloma).
  6. History of “chronic kidney disease” including tumor, surgery, single kidney, or kidney transplantation.
  7. History of end-stage liver disease.
  8. History of severe congestive heart failure.

For outpatients, a measure of renal function is considered current if it has been obtained within one month.

All adult ED patients should have a same day Cr, with the exception of trauma or extremely stat situations. These parameters are intended to serve as guidelines. Obviously, medical necessity may mandate administering contrast without a current measure of renal function.