Aims and objectives
Contrast induced nephropathy (CIN) after the admission of iodinated contrast agents (CA) remains a highly discussed topic.
The clinical problem of CIN does not only occur with iodinated radiographic CA,
but a similar phenomenon with probably different patho-mechanisms is also observed for Gadolinium (Gd) which has a much higher nephrotoxicity with a much narrower therapeutic margin.
there is restricted evidence regarding the development of NSF,
and Gd-induced CIN is thought to be...
Methods and materials
A database search was performed to identify all pediatric patients on oncology follow-up who had a non-enhanced CT after a Gd-enhanced MRI on the same day.
In all cases,
Gadobutrol was administered at a dose of 0.1mmol/kg body weight intravenously with a flow rate adjusted to the size of the vascular access (usually 1 ml/s).
As these were follow-up chest studies for assessment of pulmonary metastasis,
no contrast agent was administered. A sufficient display of some renal medulla on the chest...
10 examinations (31%) of 7 patients (30%,
4 male) fulfilled the required criteria.
Median patient age was 10.5 years (range,
2 – 17 years).
Six examinations (60%) in four patients (57%) displayed renal intramedullary opacifications likely to represent a medullary Gd deposit; two examples are given in Figures 2 and 3 .
Median medullary density of the positive examinations was 78.05 HU (range,
53.1 - 139.5 HU) and of the negative examinations 28.6 HU (range,
27.1 – 35.7 HU) which compared well...
We conclude that in some patients even with normal renal function prolonged medullary retention of Gd can be observed.
The only probable predisposing reason for this phenomenon appears to be poor hydration.
Particularly in combination with potential other nephrotoxic agents this may be a precondition to exacerbate latent renal impairment.
Therefore good hydration prior to Gd-MRI examinations might help to prevent potential renal tubular congestino even in children with a normal global renal...
1. Thomsen HS,
Nephrogenic systemic fibrosis and gadolinium-based contrast media: updated ESUR Contrast Medium Safety Committee guidelines.
2013 Mar;23(2):307–18. 2. Karcaaltincaba M,
Current status of contrast-induced nephropathy and nephrogenic systemic fibrosis in children.
2009 Jun;39 Suppl 3:382–4. 3. Thomsen HS.
Current evidence on prevention and management of...