Division of Nephrology, Perelman School of Medicine at the University of Pennsylvania, PA.
Division of Nephrology, Perelman School of Medicine at the University of Pennsylvania, PA; Corporal Michael J Crescenz Philadelphia Veterans Affairs Hospital Philadelphia, PA.
Am J Kidney Dis. 2021 Apr;77(4):517-528. doi: 10.1053/j.ajkd.2020.07.012. Epub 2020 Aug 27.
Gadolinium-based contrast agents (GBCAs) improve the diagnostic capabilities of magnetic resonance imaging. Although initially believed to be without major adverse effects, GBCA use in patients with severe chronic kidney disease (CKD) was demonstrated to cause nephrogenic systemic fibrosis (NSF). Restrictive policies of GBCA use in CKD and selective use of GBCAs that bind free gadolinium more strongly have resulted in the virtual elimination of NSF cases. Contemporary studies of the use of GBCAs with high binding affinity for free gadolinium in severe CKD demonstrate an absence of NSF. Despite these observations and the limitations of contemporary studies, physicians remain concerned about GBCA use in severe CKD. Concerns of GBCA use in severe CKD are magnified by recent observations demonstrating gadolinium deposition in brain and a possible systemic syndrome attributed to GBCAs. Radiologic advances have resulted in several new imaging modalities that can be used in the severe CKD population and that do not require GBCA administration. In this article, we critically review GBCA use in patients with severe CKD and provide recommendations regarding GBCA use in this population.
钆基造影剂（GBCA）可提高磁共振成像的诊断能力。虽然最初认为没有重大不良反应，但 GBCA 在严重慢性肾脏病（CKD）患者中的使用被证明会导致肾源性系统性纤维化（NSF）。对 CKD 中 GBCA 使用的限制政策以及对与游离钆结合更强的 GBCA 的选择性使用，已导致 NSF 病例几乎消除。目前关于在严重 CKD 中使用与游离钆具有高结合亲和力的 GBCA 的研究表明不存在 NSF。尽管有这些观察结果和当前研究的局限性，医生仍然担心在严重 CKD 中使用 GBCA。最近的观察结果表明，在大脑中存在钆沉积，并可能存在归因于 GBCA 的全身综合征，这加剧了对严重 CKD 中 GBCA 使用的担忧。放射学的进步产生了几种新的成像方式，可用于严重 CKD 人群，并且不需要 GBCA 给药。在本文中，我们批判性地审查了严重 CKD 患者中 GBCA 的使用，并就该人群中 GBCA 的使用提供了建议。
