Mike McGee

Surgeon, dad, recovering engineer. Surgical quality improvement, collaborative research. Division of Colorectal Surgery, University of Michigan

[Dr. Chacón-Lozsán F .'. @franciscojlk]

🩻Contrast-induced AKI:
one of the biggest myths still shaping clinical decisions

For decades we were taught:

👉 “Contrast damages the kidneys”
👉 “Avoid CT with contrast in CKD”
👉 “Hydrate, protect, delay imaging if needed”

But what if… most of this is wrong?🤔

->The uncomfortable reality

Modern evidence shows:

👉 Low-osmolar contrast rarely causes true nephrotoxicity
👉 Even in CKD, AKI, and ICU patients
👉 The risk is often overestimated—or nonexistent

So where did the fear come from?

📍 1950s high-osmolar contrast (actually toxic)
📍 Poorly controlled observational studies
📍 “Creatinine rise = contrast injury” assumption

👉 Correlation became causation
👉 And the dogma stayed

⚠️What recent data tells us

✔ No difference in AKI rates with vs without contrast
✔ No benefit from bicarbonate, NAC, or aggressive hydration
✔ Even ICU and AKI patients show no worsening outcomes

->Translation to real life

👉 The patient was going to develop AKI anyway...Not because of contrast!!

->The real problem: “Renalism”

👉 Avoiding necessary imaging
👉 Delaying diagnosis
👉 Choosing inferior tests

And that leads to:

❌ Missed PE
❌ Delayed sepsis source control
❌ Worse outcomes

->Clinical mindset shift

Instead of asking:

👉 “Will contrast harm the kidneys?”

We should ask:

👉 “Will NOT doing the scan harm the patient?”

->Who still deserves caution?

✔ eGFR <30
✔ Severe hemodynamic instability
✔ Multiple nephrotoxins

Even then:

👉 Optimize volume
👉 Minimize dose
👉 Don’t delay critical imaging

🤓Bottom line

✔ Contrast nephrotoxicity exists… but is rare
✔ The fear is bigger than the risk
✔ The harm of NOT imaging is often greater

In critical care

👉 We don’t treat creatinine
👉 We treat patients

And sometimes…

👉 The most dangerous thing is NOT the contrast

👉 It’s hesitation.

📃Reference
Florens N, Demiselle J.
Kidney360 7: 445–449, 2026. doi: https://t.co/CWzi7WC9Wx

[Nilofer Husnoo @NiloferHusnoo]

Patients' views on the timing of their first ileocolic resection for terminal ileal Crohn's disease: over 40% have surgery far too late! @stevebrownsheff @ColorectalDis https://t.co/l2IxH3ZeRE

[MSQC @MSQC_CQI]

It’s meeting day in Lansing!

[Taylor Goodstein, MD @TaylorGoodstein]

I am honored to have been selected as the first place winner for @JCO_ASCO’s inaugural narrative essay competition with my essay “A chance to heal with cold hard steel,” which explores grief and surgical courage. Check it out here: https://t.co/beV3UypMWn

[Michigan Surgery @UMichSurgery]

Congratulations to the new Editor-in-Chief of Diseases of the Colon and Rectum (DCR), Scott Regenbogen, MD!

DCR is a leading publication in the field of colorectal surgery, and we're confident it will continue to thrive under Dr. Regenbogen's leadership.

[Adam B. Weiner, MD @Adam_Weiner535]

The hardest lessons after training aren’t always in the OR or clinic.

🙏 I wrote this essay for anyone navigating their first year as an attending.

“Unseen Scars” in @JAMA_current

🔗https://t.co/0e09Zx1nb6

[Michigan Surgery @UMichSurgery]

Another familiar face is joining faculty in the Division of Colorectal Surgery: Alisha Lussiez, MD.

Dr. Lussiez did her general surgery residency here and is coming back as a Clinical Assistant Professor now that she's completed her fellowship. Welcome back!

[Mike McGee @michaelfmcgee]

Please consider donating to Ronald McDonald House Charities, who are helping me run the 2025 Chicago Marathon! Great folks doing great work for families! https://t.co/EQ4nvqn8IH

[WashU Medicine Section of Colon & Rectal Surgery @WashUColorectal]

Congratulations to Alisha Lussiez, MD, who received a SAFE accolade this year! Check the story in the link below for a full list of recipients from our department.

https://t.co/Khu2TuN5f6

#WashUMedicine #WashUSurgery

[UH Surgery Residents @UHSurgeryRes]

Congratulations to our APD @EmilySteinhagen for winning the CWRU School of Medicine Gender Equity award! We are so lucky to have an advocate like you!

[MSQC @MSQC_CQI]

We Appreciate all of you! 👏🏻

[Mike McGee @michaelfmcgee]

⁦@MSQCPSO⁩ Colorectal surgery after dark. Wisdom pearls from Drs. Jamie Ogilvie, Claire Peeples, Craig Reickert, and Cali Harbaugh

[Mike McGee @michaelfmcgee]

@AdamEhrlichMD @TempleGastro @Eagles @CrohnsColitisFn Go birds!

[Ezra Teitelbaum @EzraTeitelbaum]

@FilipinoSurgeon @JAMASurgery Potential interventions to improve patient outcomes based on these data include: hiding snakes in the scrub sink and prank calls into the OR saying that anesthesia has cancelled the surgeon’s next case because the patient added a drop of cream to their morning coffee…

[Mike McGee @michaelfmcgee]

I got soul but I’m not a soldier

[Reagan Collins @ReaganACollins]

Fell off my bike on the way to the hospital the first day and got vomited on the last day but survived sub-i 3/3 ☑️ Thanks @UMichSurgery for another great month of learning ft. The Big House! #goblue

[MSQC @MSQC_CQI]

It’s Meeting Day! ⁦@MichaelEnglesbe⁩

[MSQC @MSQC_CQI]

First Annual Hernia Summit! Off to an amazing start! 🙌🏻👏🏻👍🏻

[Sameh Emile, MD, FACS @dr_samehhany81]

Interesting concept: Can we associate sleeve gastrectomy and neoadjuvant chemotherapy as a neoadjuvant treatment for colon cancer with severe obesity?
@SWexner @Neil_J_Smart @AlaaEl_Hussuna @BoutrosMarylise @nirhoresh @MarkSoliman @juliomayol @DouradoJMD https://t.co/TZqJGJLTD7

[Mike McGee @michaelfmcgee]

@SeanLangenfeld Things I’ve plucked out out ileostomies in the ED/wards:
-Cole slaw
- Peanuts
- Sunflower seeds
- Kale