fellow on rounds

Cardiac Cath Clearance: A Rant from the Renal Fellow

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Thank you very much for this very interesting consult for clearance for cardiac catheterization in this lovely man who is unfortunately having a myocardial infarction and needs some contrast dye. Even if his estimated GFR has been reported as > 60 ml/min, who knows what the real GFR is, right? So it was very important to get renal involved.

First of all, I have to say you guys need to come up with a better way to diagnose MIs- come on man its 2019 and you’re still using that “dye” to look at the heart- can’t you use like Co2 or something? Or just guess from the EKG where the stent should go in without actually having to put the whole 3 cc of dye in ?

The whole practice of medicine is changing towards safe practices so this is really not acceptable. Secondly, as I said before, even though the eGFR is reported > 60 ml/min, who knows what it is- it maybe 61 or 120- so do you really want to take the risk of dropping someone’s GFR from 61> 50 and tell them they now have CKD and have a higher risk of ending up on dialysis compared to general population? Think about it, whats the point of saving their life now if they will be on dialysis in 15 years from now?

So, my strong recommendation for this patient is NOT to get any dye. He is NOT cleared for cardiac cath and if you ask me this question 5 more times during the course of his stay, I’m going to say NO. Its against my work ethics, against the whole practice of nephrology and most importantly, against safe patient care. So please don’t call me again.

Yours truly
Renal Fellow.

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