Weinreb Jeffrey C, Rodby Roger A, Yee Jerry, Wang Carolyn L, Fine Derek, McDonald Robert J, Perazella Mark A, Dillman Jonathan R, Davenport Matthew S
American College of Radiology, Reston, VA.
Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT.
Kidney Med. 2020 Nov 10;3(1):142-150. doi: 10.1016/j.xkme.2020.10.001. eCollection 2021 Jan-Feb.
Inaugural consensus statements were developed and endorsed by the American College of Radiology (ACR) and National Kidney Foundation to improve and standardize the care of patients with kidney disease who have indication(s) to receive ACR-designated group II or group III intravenous gadolinium-based contrast media (GBCM). The risk of nephrogenic systemic fibrosis (NSF) from group II GBCM in patients with advanced kidney disease is thought to be very low (zero events following 4931 administrations to patients with estimated glomerular filtration rate [eGFR] <30 mL/min per 1.73 m; upper bounds of the 95% confidence intervals: 0.07% overall, 0.2% for stage 5D chronic kidney disease [CKD], 0.5% for stage 5 CKD and no dialysis). No unconfounded cases of NSF have been reported for the only available group III GBCM (gadoxetate disodium). Depending on the clinical indication, the potential harms of delaying or withholding group II or group III GBCM for an MRI in a patient with acute kidney injury or eGFR less than 30 mL/min per 1.73 m should be balanced against and may outweigh the risk of NSF. Dialysis initiation or alteration is likely unnecessary based on group II or group III GBCM administration.
美国放射学会（ACR）和美国国家肾脏基金会制定并认可了首份共识声明，以改善和规范有指征接受ACR指定的II组或III组静脉注射钆基造影剂（GBCM）的肾病患者的护理。对于晚期肾病患者，II组GBCM导致肾源性系统性纤维化（NSF）的风险被认为非常低（估计肾小球滤过率[eGFR]<30 mL/min/1.73 m²的患者接受4931次给药后无事件发生；95%置信区间的上限：总体为0.07%，5D期慢性肾脏病[CKD]为0.2%，5期CKD且未透析为0.5%）。对于唯一可用的III组GBCM（钆塞酸二钠），尚未报告无混淆因素的NSF病例。根据临床指征，对于急性肾损伤或eGFR低于30 mL/min/1.73 m²的患者，延迟或不给予II组或III组GBCM进行MRI检查的潜在危害应与NSF风险相权衡，且可能超过NSF风险。基于II组或III组GBCM给药，启动或改变透析可能没有必要。
