رجل عمره ٦٨ سنة مصاب بالسكري ومرض كلى مزمن (الكرياتينين ١٫٨)، مجدول لأشعة مقطعية بالصبغة غداً لتقييم ألم البطن. يأخذ ميتفورمين وإيبوبروفين. الضغط ١٣٢/٨٠. أي إجراء يقلل خطر إصابة الكلى؟

A 68-year-old diabetic man with CKD (creatinine 1.8) is scheduled for contrast CT tomorrow for abdominal pain. He takes metformin and ibuprofen. BP 132/80. Which measure reduces the risk of kidney injury?

1. Doubling metformin to control glucose while fasting
2. Complete fluid restriction for twelve hours before the scan
3. IV hydration as ordered and review of metformin and the NSAID
4. A strong diuretic before contrast to flush the kidneys

Answer: C) IV hydration as ordered and review of metformin and the NSAID. Risk factors are diabetes, CKD, dehydration and nephrotoxic drugs. Hydration, stopping NSAIDs, reviewing metformin and minimal contrast reduce risk.