Janus Nicolas, Launay-Vacher Vincent, Deray Gilbert
Service Icar, hôpital de la Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75013 Paris, France; Service de néphrologie, hôpital de la Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75013 Paris, France.
Service Icar, hôpital de la Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75013 Paris, France; Service de néphrologie, hôpital de la Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75013 Paris, France.
Nephrol Ther. 2018 Nov;14(6):484-490. doi: 10.1016/j.nephro.2018.09.002. Epub 2018 Oct 6.
The development of interventional radiology techniques regularly exposes patients to the potential renal toxocity of iodinated contrast media. Faced with this risk of nephrotoxicity, gadolinium-based contrast agents have long been considered as a safe alternative to iodinated contrast media, especially in sensitive or at risk patients. However, these gadolinium-based contrast agents are not devoid of nephrotoxicity and present another risk, a complication related to renal failure, the nephrogenic systemic fibrosis. European and US recommendations from health agencies have recently come closer, defining groups of patients at risk of nephrogenic systemic fibrosis according to their level of renal function and the type of gadolinium-based contrast agent used. What are the real renal risks for these products? How to evaluate the benefit-risk balance of the patient to choose a radiological examination in an informative, effective and safe way? This article focuses on the description of the risks of gadolinium-based contrast agents, reviews existing recommendations and best practices to guide the choice of clinicians.
介入放射学技术的发展经常使患者暴露于碘化造影剂潜在的肾毒性之下。面对这种肾毒性风险,钆基造影剂长期以来一直被视为碘化造影剂的安全替代品,尤其是在敏感或有风险的患者中。然而,这些钆基造影剂并非没有肾毒性,并且还存在另一种风险,即与肾衰竭相关的并发症——肾源性系统性纤维化。欧洲和美国卫生机构最近的建议趋于一致,根据患者的肾功能水平和所用钆基造影剂的类型来界定有肾源性系统性纤维化风险的患者群体。这些产品真正的肾脏风险是什么?如何评估患者的获益风险平衡,以便以信息充分、有效且安全的方式选择放射学检查?本文着重描述钆基造影剂的风险,回顾现有建议和最佳实践,以指导临床医生的选择。