I have stage 3 CKD and hypertension that is not very well controlled with 4 different classes of blood pressure medications. I have had kidney ultrasounds, MRI (without contrast), blood work etc. but cannot determine the cause of the hypertension. I understand the gold standard for determining renal stenosis is an angiogram but I have been hesitant to do it because of CIN/AKI risk. I have a CO2 angiogram scheduled but the doctor who will do it says if he spots a possible lesion, he will need to administer 15-20ccs of contrast. I have read conflicting information on CIN risk factors and don’t know if I should have it done. Is 15-20ccs a lot of contrast? My current EGFR is 44 and my BP usually runs around 140s/150s over 70s/80s. Thanks.

I am unable to give medical advice without performing a complete history and physical examination.  It is true that there may a risk of contrast induced nephropathy (CIN) but the risk must be evaluated by your physician who can tell you the chances of finding a treatable problem in contrast to the risk to your kidney function.  There is no absolute correct answer.  It is best to discuss your concerns with your physician and make the best decision that you can.

 

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