One major concern when bringing a critically ill patient for a CT scan is the potential for acute kidney injury (AKI) by applying iodinated contrast media intravenously. Post-contrast AKI carries the risk of more permanent renal failure, dialysis and even death. The authors of this review article nicely summarize current evidence on this issue and show, that the risk of AKI secondary to contrast material (particularly when administered intravenously for contrast-enhanced CT) has been exaggerated in the past by older, noncontrolled studies.
In fact, by reviewing more recent evidence they come to the conclusion that the risk is almost nonexistent in patients with normal renal function. Even in patients with pre-existing renal insufficiency the risk of secondary contrast-induced AKI is probably much smaller than traditionally assumed.
Again they emphasize on the fact that volume expansion is the only preventive strategy with a convincing evidence base.
Nevertheless, the benefits of a contrast-enhanced exam still will have to be balanced with the remaining risk of AKI.