Gadolinium-Contrast Toxicity in Patients with Kidney Disease: Nephrotoxicity and Nephrogenic Systemic Fibrosis

摘要: Gadolinium is widely employed as a contrast agent for magnetic resonance imaging (MRI) and has generally been considered to be safe. As with iodinated radiocontrast, concern contrast-induced nephropathy existed gadolinium-contrast it possessed many similar qualities (hyperosmolar, renal excretion via glomerular filtration). Early studies in low risk patients suggested benign profile, however, recent raise the possibility of nephrotoxicity. In addition, reports previously rare condition entitled nephrogenic systemic fibrosis (NSF) have recently emerged advanced kidney disease linked exposure gadolinium-contrast. Nephrogenic debilitating disorder which progressive severe skin other organs that leads significant disability associated increased mortality. Initially reported most commonly end stage (ESRD) receiving dialysis, also described acute injury (AKI) chronic (stages 4 5) not requiring dialysis. addition underlying disease, developing NSF larger doses gadolinium (or multiple exposures), specific chelates (non-ionic, linear), pro-inflammatory states (in particular vascular endothelial dysfunction), perhaps some currently unrecognized cofactors. No clearly effective therapies exist NSF, although recovery from AKI establishment normal function transplantation appear reverse or stabilize cases. Avoidance appears best approach who maintain factors. When occurs, aggressive hemodialysis following may useful efficiently removed by this extracorporeal technique. Peritoneal dialysis clearance poor, but peritoneal prescriptions studied removal.