MCQ-Contrast Associated Acute Kidney Injury – A Myth Or A Truth

Contrast Associated Acute Kidney Injury – A Myth Or A Truth

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1. A 67-year-old man with CKD stage 3a develops AKI within 24 hours of a contrast-enhanced CT angiogram. Which finding most strongly argues against isolated contrast-associated AKI as the sole diagnosis?

A. Diabetes mellitus

B. Rise in creatinine within 48 hours of contrast exposure

C. Baseline ischemic cardiomyopathy

D. Plethoric IVC with hepatic venous systolic blunting

E. NGAL elevation to 350 ng/mL

2. Which combination of findings most strongly supports intrinsic tubular injury rather than a transient hemodynamic reduction in GFR?

A. Low FENa with hyaline casts

B. FEUrea <35% in a patient on diuretics

C. Rising creatinine with preserved urine output

D. Muddy brown casts with elevated NGAL

E. Rapid normalization of creatinine within 24 hours

3. In this patient, why is additional fluid administration after AKI onset most likely to worsen renal function?

A. Increased contrast concentration in renal tubules

B. Augmentation of renal arterial vasoconstriction

C. Elevation of renal venous pressure reducing filtration gradient

D. Direct stimulation of tubular inflammation

E. Promotion of osmotic nephrosis

4. 4. Which clinical scenario represents a physiologically defensible indication for sodium bicarbonate use in this patient?

A. CKD with recent contrast exposure

B. Rising creatinine attributed to contrast

C. NGAL-positive AKI

D. Severe metabolic acidosis with vasopressor-refractory hypotension

E. Oliguria with mild volume overload

5. Which clinical trajectory most reliably predicts progression to a need for renal replacement therapy?

A. Creatinine increase from 1.6 to 2.9 mg/dL

B. Elevated NGAL concentration

C. Presence of muddy brown casts

D. Persistent oliguria beyond 24–36 hours despite optimized hemodynamics

E. Exposure to iodinated contrast in CKD

6. How does identifying a mixed AKI phenotype (hemodynamic + congestion + tubular injury) most directly alter immediate management?

A. Prompts early initiation of CRRT

B. Supports aggressive fluid resuscitation

C. Justifies expectant management until creatinine plateaus

D. Shifts focus toward decongestion and perfusion optimization

E. Confirms contrast-induced ATN as dominant mechanism

7. Which statement best characterizes the current role of AI-driven AKI prediction models in complex ICU patients?

A. They accurately distinguish toxic from hemodynamic AKI

B. They replace urine microscopy and bedside assessment

C. They reliably predict need for CRRT

D. They provide early risk and trajectory alerts without mechanistic adjudication

E. They outperform clinician judgment in fluid management decisions

8. Which combination of findings would most strongly support proceeding with a repeat contrast study within 24–48 hours?

A. Rising creatinine alone

B. CKD stage 3 with diabetes mellitus

C. Stable MAP ≥70 mmHg, improving congestion, stabilizing renal indices, high ischemic risk

D. Persistently elevated NGAL

E. Prior contrast exposure within the last 48 hours

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Comment (2)
Chethan V says:

December 19, 2025 at 12:07 pm

Good one

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Chethan V says:

December 19, 2025 at 12:05 pm

Excellent clinical queries

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Contrast Associated Acute Kidney Injury – A Myth Or A Truth

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