Which strategies are recommended to reduce contrast-induced nephropathy in angiography procedures?

• A. Hydration only; use high-osmolar contrast; increase contrast.
• B. Adequate hydration, use iso-osmolar or low-osmolar contrast, minimize total contrast volume, and consider alternative imaging when feasible.
• C. Avoid hydration to prevent fluid overload.
• D. Hydration with diuretics and high-osmolar contrast.

Answer: (B)

Preventing contrast-induced nephropathy during angiography relies on combining protective hydration with safer contrast choices and careful use of contrast. Adequate hydration helps preserve kidney perfusion and dilutes the contrast load, reducing kidney exposure. When choosing contrast, iso-osmolar or low-osmolar agents are preferred because they carry a lower risk of nephrotoxicity compared with high-osmolar contrast. In addition, giving the smallest necessary amount of contrast minimizes renal stress, so optimizing technique to reduce total volume is important. When feasible, consider alternative imaging approaches that lessen or avoid contrast exposure altogether.

Using hydration alone with high-osmolar contrast or increasing the contrast amount would raise, not lower, the risk. Avoiding hydration to prevent fluid overload is not protective, since dehydration worsens renal perfusion. Hydration together with diuretics and high-osmolar contrast would also increase risk, as diuretics can lead to kidney stress and high-osmolar agents are more nephrotoxic.