Clinical knowledge
Evidence-based lookup · guidelines, drug references, hospital protocols · patient-scoped when a focus is set
Focus: Mr. Pillai, CICU 12
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Guidelines (ESC, ACC/AHA, KDIGO)
Drug references
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OmniSense · knowledge lookup
1.8s · 4 sources matched · patient context applied
KDIGO defines AKI in 3 stages based on creatinine rise and/or urine output criteria:
Stage 1: Cr rise ≥0.3 mg/dL within 48h OR 1.5–1.9× baseline within 7 days OR UO <0.5 mL/kg/h for 6–12h.
Stage 2: Cr 2.0–2.9× baseline OR UO <0.5 mL/kg/h for ≥12h.
Stage 3: Cr ≥3.0× baseline OR Cr ≥4.0 mg/dL OR initiation of RRT OR UO <0.3 mL/kg/h for ≥24h OR anuria ≥12h.
For contrast-induced nephropathy specifically: onset typically 24–72h post-contrast. Peak creatinine usually at 3–5 days, with recovery by 7–14 days in most cases. Risk factors include baseline CKD (eGFR <60), diabetes, volume depletion, and high contrast load.
Applied to Mr. Pillai: creatinine rose from 0.9 to 1.4 mg/dL (+0.5) within 24h of PCI with 145 mL Omnipaque. This meets KDIGO Stage 1 criteria. Current eGFR 42 (from baseline ~60). He has two modifiable risk amplifiers: ACE-i (ramipril) and metformin — both flagged for hold.
When to start RRT: KDIGO does not recommend a specific creatinine threshold for RRT initiation in CIN. Indications are the standard emergent criteria — refractory hyperkalaemia, refractory fluid overload, acidosis (pH <7.1), or uraemic complications. The STARRT-AKI trial (2020) found no benefit to early vs. standard-timing RRT in the absence of urgent indications. Mr. Pillai is not near RRT territory — his potassium is 4.6, bicarbonate 22, and he is producing urine.
Stage 1: Cr rise ≥0.3 mg/dL within 48h OR 1.5–1.9× baseline within 7 days OR UO <0.5 mL/kg/h for 6–12h.
Stage 2: Cr 2.0–2.9× baseline OR UO <0.5 mL/kg/h for ≥12h.
Stage 3: Cr ≥3.0× baseline OR Cr ≥4.0 mg/dL OR initiation of RRT OR UO <0.3 mL/kg/h for ≥24h OR anuria ≥12h.
For contrast-induced nephropathy specifically: onset typically 24–72h post-contrast. Peak creatinine usually at 3–5 days, with recovery by 7–14 days in most cases. Risk factors include baseline CKD (eGFR <60), diabetes, volume depletion, and high contrast load.
Applied to Mr. Pillai: creatinine rose from 0.9 to 1.4 mg/dL (+0.5) within 24h of PCI with 145 mL Omnipaque. This meets KDIGO Stage 1 criteria. Current eGFR 42 (from baseline ~60). He has two modifiable risk amplifiers: ACE-i (ramipril) and metformin — both flagged for hold.
When to start RRT: KDIGO does not recommend a specific creatinine threshold for RRT initiation in CIN. Indications are the standard emergent criteria — refractory hyperkalaemia, refractory fluid overload, acidosis (pH <7.1), or uraemic complications. The STARRT-AKI trial (2020) found no benefit to early vs. standard-timing RRT in the absence of urgent indications. Mr. Pillai is not near RRT territory — his potassium is 4.6, bicarbonate 22, and he is producing urine.
Sources cited · 4 matches
Guideline
KDIGO Clinical Practice Guideline for Acute Kidney Injury (2024 update)
Section 2.1 — Definition and staging of AKI. Table 2: KDIGO stages by creatinine and urine output criteria. Section 5.3 — Contrast-induced AKI prevention and management.
pp. 14–18, 52–56 · 92% match · Indexed 2026-03-15
Evidence
STARRT-AKI Trial (NEJM 2020)
Accelerated vs standard-timing initiation of RRT in AKI. n=2927. No significant difference in 90-day mortality. Conclusion: no benefit to early RRT in the absence of urgent indications.
NEJM 383;3:240–251 · 87% match · Indexed 2026-03-15
Protocol
Aster Medcity — CIN Prevention Pathway v2.1
Hospital-specific protocol for contrast-induced nephropathy prevention. NaHCO3 1 mL/kg/h pre- and post-procedure. Hold metformin 48h. Hold ACE-i/ARB if eGFR <45. Minimum contrast volume strategy.
Internal document · 85% match · Indexed 2026-04-01
Drug
Metformin — renal dose adjustment (BNF / Aster formulary v8.2)
eGFR 30–45: reduce dose to 500mg BD, review at 3 months. eGFR <30: contraindicated. Hold 48h before and after iodinated contrast if eGFR <45. Risk of lactic acidosis in renal impairment.
BNF 82 (2024) + Aster formulary v8.2 · 81% match · Indexed 2026-03-20
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Corpus: 342 documents indexed
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