Department of Urology, Columbia University School of Medicine, New York, New York, USA.
J Urol. 2010 Jan;183(1):27-33. doi: 10.1016/j.juro.2009.09.029.
Improvements in imaging technologies have dramatically increased the ability to accurately diagnose and treat many urological disease processes. As urological patients often have chronic kidney disease, the well characterized nephrotoxicity of contrast induced nephropathy when using iodine based contrast materials has long been a concern. With the development of gadolinium based contrast agents it seemed that the concern regarding nephrotoxicity had been resolved. In 1997 a new disorder, nephrogenic systemic fibrosis, appeared in patients with severe renal failure. Nephrogenic systemic fibrosis is a serious and potentially devastating disorder characterized by progressive thickening and hardening of the skin and other body tissues, and complicated by flexion contractures of the joints.
We performed a survey of the available literature on nephrogenic systemic fibrosis and magnetic resonance contrast media. We focused on mechanisms in the development of nephrogenic systemic fibrosis as well as its association with magnetic resonance contrast media, disease treatment and prevention, and its relevance to clinical urology.
An association between nephrogenic systemic fibrosis and gadolinium based contrast agents has been reported. Gadolinium is a toxic metal and it must be chelated to be a safe injectable contrast agent. It is now hypothesized that the majority of nephrogenic systemic fibrosis cases present with gadolinium based contrast agent exposure as the triggering factor, although this mechanism has not been elucidated. As gadolinium enhanced magnetic resonance imaging is an important tool in the diagnosis and surveillance of urological diseases, the severe consequences of nephrogenic systemic fibrosis demand that practicing urologists understand and know its history and treatment strategies.
This review provides clarification of the gadolinium based contrast agent characteristics, tissue interactions that lead to the development of nephrogenic systemic fibrosis, prevention possibilities and available treatment options.
成像技术的进步极大地提高了准确诊断和治疗许多泌尿科疾病的能力。由于泌尿科患者常有慢性肾脏病，因此使用碘基造影剂时造影剂肾病的特征性肾毒性一直是一个令人担忧的问题。随着钆基造影剂的发展，似乎已经解决了对肾毒性的担忧。1997 年，一种新的疾病——肾源性系统性纤维化，出现在肾功能衰竭严重的患者中。肾源性系统性纤维化是一种严重且潜在破坏性的疾病，其特征为皮肤和其他身体组织逐渐变厚和变硬，并伴有关节弯曲挛缩。
我们对有关肾源性系统性纤维化和磁共振对比剂的现有文献进行了调查。我们重点研究了肾源性系统性纤维化的发病机制及其与磁共振对比剂的关系、疾病的治疗和预防，以及其与临床泌尿科的相关性。
已经报道了肾源性系统性纤维化与基于钆的造影剂之间的关联。钆是一种有毒金属，必须螯合才能成为安全的可注射造影剂。现在假设大多数肾源性系统性纤维化病例的发病与基于钆的造影剂暴露有关，尽管这一机制尚未阐明。由于钆增强磁共振成像在泌尿科疾病的诊断和监测中是一种重要的工具，因此肾源性系统性纤维化的严重后果要求泌尿科医生了解并熟悉其病史和治疗策略。
本文综述提供了对基于钆的造影剂特征、导致肾源性系统性纤维化发展的组织相互作用、预防可能性和现有治疗选择的澄清。
