Katarina Leyba1, Brent Wagner2,3,4. 1. University of New Mexico School of Medicine, Albuquerque, New Mexico, USA. 2. Kidney Institute of New Mexico. 3. New Mexico Veterans Administration Health Care System. 4. Department of Medicine, University of New Mexico Health Care System.
Abstract
PURPOSE OF REVIEW: The hegemony of gadolinium-based contrast agent-induced adverse events stretches beyond those who have renal impairment. 'Nephrogenic' systemic fibrosis is a misnomer: gadolinium-based contrast agents are the known trigger for the disease; kidney impairment is a risk factor. Impaired (true) glomerular filtration may be one catalyst for gadolinium-based contrast agent-induced adverse events, but it is increasingly evident that the same cluster of symptoms occurs in patients with normal renal function. RECENT FINDINGS: It has been known for nearly 30 years that gadolinium-based contrast agents distribute and are cleared according to a three compartment model. Single doses of gadolinium-based contrast agents can trigger 'nephrogenic' systemic fibrosis in nondialysis dependent patients. Manifestations have occurred years after exposure. Renal insufficiency alone is not an adequate explanation for 'nephrogenic' systemic fibrosis, and the continuum of its symptoms with the adverse events reported by patients with normal renal function clearly indicate that the physiologic reactions are largely undefined. SUMMARY: Gadolinium-based contrast agents should be used with extreme caution.
PURPOSE OF REVIEW: The hegemony of gadolinium-based contrast agent-induced adverse events stretches beyond those who have renal impairment. 'Nephrogenic' systemic fibrosis is a misnomer: gadolinium-based contrast agents are the known trigger for the disease; kidney impairment is a risk factor. Impaired (true) glomerular filtration may be one catalyst for gadolinium-based contrast agent-induced adverse events, but it is increasingly evident that the same cluster of symptoms occurs in patients with normal renal function. RECENT FINDINGS: It has been known for nearly 30 years that gadolinium-based contrast agents distribute and are cleared according to a three compartment model. Single doses of gadolinium-based contrast agents can trigger 'nephrogenic' systemic fibrosis in nondialysis dependent patients. Manifestations have occurred years after exposure. Renal insufficiency alone is not an adequate explanation for 'nephrogenic' systemic fibrosis, and the continuum of its symptoms with the adverse events reported by patients with normal renal function clearly indicate that the physiologic reactions are largely undefined. SUMMARY:Gadolinium-based contrast agents should be used with extreme caution.
Authors: Joseph Lunyera; Dinushika Mohottige; Anastasia-Stefania Alexopoulos; Hilary Campbell; C Blake Cameron; Nicole Sagalla; Timothy J Amrhein; Matthew J Crowley; Jessica R Dietch; Adelaide M Gordon; Andrzej S Kosinski; Sarah Cantrell; John W Williams; Jennifer M Gierisch; Belinda Ear; Karen M Goldstein Journal: Ann Intern Med Date: 2020-06-23 Impact factor: 25.391
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