Occurs within 24 hrs of administration followed by oliguric phase
Usually improves within a week and rarely needs dialysis
Initial injection is an osmotic load, leads to volume expansion and diuresis. Follwed by intense vasoconstriction suggesting possible ischemic role in pathophysiology.
There is also a direct toxic effect to the kidneys however
High Risk patients: HTN, DM, Chronic Renal Insuff, Bence Jones proteinuria and large injections of IV dye
Possible prophylaxis: There is almost no data studying this effect in the Emerg Dept patient. One trial look at IV acetylcysteine in the Emergent CT (RAPPID trial) did show benefit but has flaws within the study. IV hydration and sodium bicarbonate