For outpatients, direct patient questioning is required. Factors to be considered include known urinary tract disease, surgery, or history of dialysis; advanced patient age (> 60), coexistent systemic diseases associated with impaired renal function (diabetes, hypertension). Our general history screening form also includes questions about medications, cancer, and other systemic diseases. So, if a patient indicates a history of an underlying illness (e.g., multiple myeloma, liver disease) or nephrotoxic drug use (non-steroidal anti-inflammatories, aminoglycosides), our index of suspicion is heightened. The ACR has provided a table of recommended time intervals over which repeat eGFR should be performed in patients with known or suspected renal compromise. For at risk patients in a stable clinical state, an eGFR within 6 weeks is recommended. For patients with known renal insufficiency or potentially unstable state, an eGFR within 1-2 weeks (or even less, depending on clinical circumstance) should be obtained.
Advanced Discussion (show/hide)»
The Modification of Diet in Renal Disease (MDRD) equation is given by the following equation, computed and reported automatically by most laboratory systems:
eGFR (mL/min/1.73 m²) = 175 x (serum creatinine in mg/dl)−1.154 x (age in yrs)−0.203
This value is multiplied by 0.742 if the patient is female and by 1.212 if African American.
The updated Schwartz equation is given by
eGFR (mL/min/1.73 m²) = 0.413 x (height in cm) ÷ (serum creatinine in mg/dl)
American College of Radiology. ACR manual on contrast media, Version 9, 2013, pp 81-89.
Michaely HJ, Aschauer M, Deutschmann H, et al. Gadobutrol in renally impaired patients. Results of the GRIP study. Invest Radiol 2017; 52:55-60.
Nandwana SB, Moreno CC, Osipow MT, et al. Gadobenate dimeglumine administration and nephrogenic systemic fibrosis: Is there a real risk in patients with impaired renal function? Radiology 2015; 276:741-747.
Is gadolinium contrast nephrotoxic? Can it be given safely to patients with mild renal insufficiency?
What is NSF? How does gadolinium cause it?