Rieger Johannes, Sitter Thomas, Toepfer Marcel, Linsenmaier Ulrich, Pfeifer Klaus Jürgen, Schiffl Helmut
Department of Radiology, Medizinische Klinik - Innenstadt, Ludwig-Maximilians-University, Munich, Germany.
Nephrol Dial Transplant. 2002 May;17(5):824-8. doi: 10.1093/ndt/17.5.824.
The study was designed to investigate the safety and feasibility of gadopentetate dimeglumine, a gadolinium-based contrast medium, as an alternative angiographic contrast agent in patients with impaired renal function and high risk for iodinated contrast-induced nephropathy.
Gadopentetate dimeglumine was used as the radiographic contrast agent in 32 diagnostic or interventional angiographic procedures in 29 patients (59% diabetics) with severe renal insufficiency (average serum creatinine of 3.6+/-1.4 mg/dl). The average dose of gadopentetate dimeglumine was 0.34+/-0.06 mmol/kg body weight. Gadopentetate dimeglumine was used either alone (n=20) or in conjunction with carbon dioxide (n=12).
Thirty-two angiographic procedures (24 diagnostic angiographies and 8 interventional procedures) were performed in 29 patients. For diagnostic purposes, eleven selective renal arteriographies, six angiographies of the iliac arteries and lower extremities, and seven venous angiographies of the upper extremity and central veins were performed. Interventional procedures consisted of two percutaneous transluminal renal angioplasties with stenting, four percutaneous peripheral vascular interventions, and two balloon angioplasties of a dialysis fistula. None of the patients, except one, had evidence of post-procedure contrast material-induced renal failure (increase in serum creatinine >0.5 mg/dl within 72 h) or other complications. This patient had a clinically important increase in serum creatinine level after percutaneous transluminal renal angioplasty and stenting, probably due to cholesterol embolism. Gadopentetate dimeglumine had sufficient radiographic density to allow adequate diagnostic visualization with digital subtraction equipment in all cases.
Gadopentetate dimeglumine is an alternative and safe radiographic contrast agent for angiography and interventional procedures in patients with severe pre-existing renal impairment. In this population with high risk for contrast-induced acute renal failure, it is obviously less nephrotoxic than iodinated contrast media.
本研究旨在探讨钆喷酸葡胺（一种钆基造影剂）作为肾功能受损且有碘造影剂诱发肾病高风险患者的替代血管造影剂的安全性和可行性。
钆喷酸葡胺在29例（59%为糖尿病患者）严重肾功能不全（平均血清肌酐为3.6±1.4mg/dl）患者的32例诊断性或介入性血管造影检查中用作放射造影剂。钆喷酸葡胺的平均剂量为0.34±0.06mmol/kg体重。钆喷酸葡胺单独使用（n = 20）或与二氧化碳联合使用（n = 12）。
29例患者进行了32例血管造影检查（24例诊断性血管造影和8例介入性检查）。诊断方面，进行了11例选择性肾动脉造影、6例髂动脉和下肢血管造影以及7例上肢和中心静脉静脉造影。介入性检查包括2例经皮腔内肾血管成形术加支架置入术、4例经皮外周血管介入术和2例透析瘘管球囊血管成形术。除1例患者外，所有患者均无术后造影剂诱发肾衰竭（72小时内血清肌酐升高>0.5mg/dl）或其他并发症的证据。该患者在经皮腔内肾血管成形术加支架置入术后血清肌酐水平有临床意义的升高，可能是由于胆固醇栓塞。钆喷酸葡胺具有足够的放射密度，在所有病例中均可通过数字减影设备进行充分的诊断性显影。
钆喷酸葡胺是严重肾功能损害患者血管造影和介入性检查的一种替代且安全的放射造影剂。在这种有造影剂诱发急性肾衰竭高风险的人群中，它显然比碘造影剂的肾毒性小。
