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 10.3, 2017.
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?