Intravenous Contrast Causes Nephropathy.

Eric Steinberg, Joseph Bove

Journal: Emergency medicine clinics of North America 2026;44(3):483-494

PMID: 42342304

Full Text on W.B. Saunders View on PubMed

Abstract

Modern evidence has largely discredited the long-held belief that intravenous contrast routinely causes nephropathy. Early studies with high-osmolality agents and no controls suggested "contrast-induced nephropathy," but recent research using controlled cohorts shows contrast is rarely the direct cause of acute kidney injury (AKI). Guidelines now favor the term "contrast-associated AKI," emphasizing correlation over causation. In patients with estimated glomerular filtration rate 30 mL/min or greater, contrast can be safely used without delay or prophylactic hydration. Overly cautious policies delay diagnosis and harm patient care, especially in emergency settings. Contrast should be viewed as a vital diagnostic tool, not a toxin.

Address: Department of Emergency Medicine, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07503, USA. Electronic address: [email protected].; Department of Emergency Medicine, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07503, USA.

DOI: 10.1016/j.emc.2026.01.004

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MeSH Terms: Humans, Contrast Media, Acute Kidney Injury, Glomerular Filtration Rate