Clarify whether contrast is truly needed
When possible, limit the volume of contrast, avoid repeated doses over a short time frame, and use an iso-osmolar or low-osmolar contrast agent
Discontinue nephrotoxic agents
Provide an evidence-based intravenous crystalloid regimen with isotonic sodium bicarbonate or saline
Although it is not strictly evidence-based, use NAC in patients with significant baseline renal dysfunction (glomerular filtration rate < 45 mL/min/1.73 m2), multiple concurrent risk factors such as hypotension, diabetes, preexisting kidney injury, or congestive heart failure that limits the use of intravenous fluids, or who need a high volume of contrast dye
Avoid using intravenous NAC, given its lack of benefit and risk of anaphylactoid reactions.