Материал: Advanced Imaging of the Abdomen - Jovitas Skucas

remove both iodinated and gadolinium contrast agents (146); several hemodialysis sessions or several weeks of continuous ambulatory dialysis are necessary to removal all contrast. It should be noted, however, that hemodialysis does not protect poorly functioning kidneys against contrast induced nephrotoxicity.

Contrast-associated nephropathy is a poorly understood and generally unpredictable phenomenon. Its prevalence is increased in patients with diabetic nephropathy.Also, elderly patients and those who are azotemic, hypertensive, dehydrated, or have hyperuricemia are at increased risk of developing contrast nephropathy. High blood urea nitrogen and high creatinine levels are additional risk factors.

Creatinine clearance is generally employed to monitor changes in renal function due to suspected contrast nephropathy, although the primary effect of contrast agents is on renal tubules rather than glomerular function. In either case, most changes are mild and reversible and do not need therapy.

Occasionally prolonged renal cortical contrast retention is evident after vascular contrast injection. While retention can be seen in such conditions as hypotension, in some patients retention persists for several days or even longer in the absence of any known underlying abnormality. Computed tomography performed hours after angiography identifies renal cortical contrast in a minority of patients; these patients are at an increased risk, albeit low, of contrastassociated nephropathy. The large contrast volumes used correlate with contrast retention and nephropathy.

Hydration prior to contrast injection is effective in decreasing the risk of contrast nephropathy. The use of low osmolar contrast agents also lessens the prevalence of contrast nephropathy. Preliminary results suggest that prophylactic prostaglandin E1 may have a role in patients at risk.

A neutral gadolinium chelate (gadobutrol), injected IV at doses of either 0.1 or 0.3mmol per kg of body weight in patients with marginal excretory function (creatinine clearance <30mL/min), did not affect renal function and thus appears to be a safe MR contrast agent even in patients with impaired renal function (147); hydration, treatment with diuretics, and hemodialysis are not required after the use of this contrast agent. Yet gadolinium contrast

ADVANCED IMAGING OF THE ABDOMEN

agents are not completely innocuous, and occasional reports describe acute renal failure after their use. Several reports describe use of gadolinium-based contrast agents for CT imaging in patients with renal insufficiency or prior severe reaction to an iodinated agent. In fact, the toxicity of gadolinium agents, at doses achieving equivalent x-ray stopping power, is greater than that of nonionic iodinated agents. This is in distinction to the use of approved lower gadolinium doses during MRI, which are insufficient for useful x-ray contrast, and which have negligible nephrotoxicity. The European Society of Urogenital Radiology position is that gadolinium-based contrast agents are more nephrotoxic than iodinated contrast agents in equivalent x-ray attenuation doses and use of gadolinium contrast agents for angiography or CT is not recommended.

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