All right, welcome back to the Internet Book of Critical Care Podcast.

I'm here with Adam Thomas and we're going to talk about contrast to thethropathy.

We got a little treat here today.

Don't we, Josh.

This one you threw in at the last minute because that's so important.

How many times at two in the morning do we have a patient

that's dying in front of us? They haven't made a lick of pee for a while. And literally, I think

they're going to die if I don't figure out what's going on. And we call up our friendly radiologist

who says, oh, I can't use that contrast on the CT scan because their GFR is 15. In that inner voice you probably got Josh that you want to correct them and say, well,

their GFR is zero because they're not peeing, but you don't, do you?

No, that's deep, dark secret.

So today we're going to talk about Venus injections of contrast, so that classic CT scan

that we do.

And Josh is going to walk us through every step of the way of this

linear falsity of thinking between contrast dye causing increased creatinin, leading to possible

true kidney injury with elevated renal bile markers, leading to a patient-centered outcome like

dialysis. So start us off. Where did this beast of a myth start? Where was it born?

And why is it so entrenched in our thinking? Yeah, this whole topic is fascinating. And I think

someday this is going to be like a case study and medical reasoning gone awry. The whole concept

came out of the 1950s where folks noticed that there were a couple of patients who got intravenous pylography,

essentially IV contrast and they developed a renal failure.

And there seemed to be a temporal correlation between these events.

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