Perazella Mark A
Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut 06520-8029, USA.
Curr Drug Saf. 2008 Jan;3(1):67-75. doi: 10.2174/157488608783333989.
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 for contrast-induced nephropathy existed with gadolinium-contrast as it possessed many similar qualities (hyperosmolar, renal excretion via glomerular filtration). Early studies in low risk patients suggested a benign renal profile, however, recent studies raise the possibility of nephrotoxicity. In addition, reports of a previously rare condition entitled nephrogenic systemic fibrosis (NSF) have recently emerged in patients with advanced kidney disease and have been linked to exposure to gadolinium-contrast. Nephrogenic systemic fibrosis is a debilitating disorder in which progressive and severe fibrosis of the skin and other systemic organs that leads to significant disability and is associated with increased mortality. Initially reported most commonly in end stage renal disease (ESRD) patients receiving dialysis, it is also described in patients with severe acute kidney injury (AKI) and advanced chronic kidney disease (stages 4 and 5) not requiring dialysis. In addition to underlying kidney disease, the risk of developing NSF is increased with larger doses of gadolinium (or multiple exposures), exposure to specific gadolinium chelates (non-ionic, linear), underlying pro-inflammatory states (in particular vascular endothelial dysfunction), and perhaps some currently unrecognized cofactors. No clearly effective therapies exist for NSF, although recovery from AKI and establishment of normal kidney function with renal transplantation appear to reverse or stabilize the disease in some cases. Avoidance of gadolinium exposure appears to be the best approach for patients who maintain risk factors. When gadolinium exposure occurs, aggressive hemodialysis following exposure may be useful as gadolinium is efficiently removed by this extracorporeal technique. Peritoneal dialysis clearance of gadolinium is poor, but aggressive peritoneal dialysis prescriptions have not been studied for gadolinium removal.
钆广泛用作磁共振成像（MRI）的造影剂，通常被认为是安全的。与碘化放射造影剂一样，钆造影剂也存在对比剂诱发肾病的问题，因为它具有许多相似的特性（高渗性，通过肾小球滤过经肾脏排泄）。早期对低风险患者的研究表明其肾脏情况良好，然而，最近的研究提出了肾毒性的可能性。此外，一种先前罕见的名为肾源性系统性纤维化（NSF）的病症报告最近出现在晚期肾病患者中，并与接触钆造影剂有关。肾源性系统性纤维化是一种使人衰弱的疾病，其中皮肤和其他全身器官会进行性严重纤维化，导致严重残疾并与死亡率增加相关。最初最常见于接受透析的终末期肾病（ESRD）患者，也见于患有严重急性肾损伤（AKI）和晚期慢性肾病（4期和5期）且无需透析的患者。除了潜在的肾脏疾病外，更大剂量的钆（或多次接触）、接触特定的钆螯合物（非离子型、线性）、潜在的促炎状态（特别是血管内皮功能障碍）以及可能一些目前尚未识别的辅助因素会增加发生NSF的风险。虽然对于NSF没有明确有效的治疗方法，但在某些情况下，从AKI恢复并通过肾移植建立正常肾功能似乎可以逆转或稳定该疾病。对于存在风险因素的患者，避免接触钆似乎是最佳方法。当发生钆接触时，接触后积极进行血液透析可能有用，因为通过这种体外技术可以有效清除钆。钆的腹膜透析清除效果不佳，但尚未研究积极的腹膜透析方案对钆清除的作用。
