Here is a familiar scenario…..You need an emergent CT with IV contrast- whether it’s a trauma patient or a stroke patient or PE or dissection and you just don’t have the time to wait for a creatinine.
Are you going to harm the patient by giving IV contrast?
Want to sound informed when talking to your friendly neighborhood radiologist?
Let’s answer the question: Is IV contrast for CT independently associated with increased risk for AKI?  We will discuss a recent Annals publication.
Study: single center retrospective cohort analysis.
Subjects: 17934 patients in the ED who underwent contrast enhanced, unenhanced, or no CT from 2009-2014
Intervention: CT with or without IV contrast
Primary outcome: incidence of AKI
Secondary outcomes: CKD, dialysis, renal transplant at 6 months
Results: rates of AKI were similar in all groups and contrast administration was not associated with increased risk of CKD, dialysis, or renal transplant at 6 months
Take home point: IV contrast administration does not lead to increased frequency of AKI or adverse outcomes at 6 months (including CKD, dialysis, renal transplant)

Hinson, Jeremiah S. et al.  Risk of Acute Kidney Injury after Intravenous Contrast Media Administration.  Annals of Emergency Medicine, May 2017, Volume 69 , Issue 5 , 577 – 586.