Skip to main content
SpringerLink
Log in

Nierenfunktion bei kontrastmittelverstärkter Bildgebung

Kidney function in contrast media-enhanced imaging

  • Leitthema
  • Published:
Der Radiologe Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Die potenziellen Nebenwirkungen kontrastmittelverstärkter Bildgebung stellen Nephrologen und Radiologen im klinischen Alltag immer wieder vor schwierige Entscheidungen.

Ziel der Arbeit

Bewertung der unmittelbar mit der Nierenfunktion in Zusammenhang stehenden Krankheitsbilder kontrastmittelinduziertes akutes Nierenversagen (KM-induziertes ANV) und nephrogene systemische Sklerose (NSF).

Material und Methoden

Literaturrecherche in PubMed und Medline über „Nierenfunktion“ und „Kontrastmittel“, ergänzt durch eigene Erfahrungen.

Ergebnisse

Für das KM-induzierte ANV erfolgt derzeit eine klinische Neubewertung, die NSF tritt unter bestimmten präventiven Maßnahmen und enger Indikationsstellung aktuell nicht mehr auf.

Diskussion

Nach aktueller Studienlage wurde das klinische Risiko eines KM-induzierten ANV lange Zeit überschätzt und sollte keinesfalls eine KM-Gabe verhindern, wenn es keine gleichwertigen diagnostischen Alternativen gibt. Die wirksamste Prophylaxe bleibt die Vermeidung überflüssiger KM-Gaben.

Abstract

Background

The potential adverse reactions to contrast media-enhanced imaging regularly offer challenges in decision-making for nephrologists and radiologists.

Objective

The clinical pictures of contrast media-induced acute kidney injury (CI-AKI) and nephrogenic systemic fibrosis (NSF) were evaluated, which are both caused by contrast media and closely linked to the kidney function.

Material and methods

The literature in PubMed and Medline was searched for the terms “kidney function” and “contrast media” and complemented by our own experiences.

Results

While there is an ongoing re-evaluation of the clinical relevance of CI-AKI, no new cases of NSF have recently been reported under consideration of certain preventive interventions and very restricted use of gadolinium-based contrast agents.

Conclusion

Considering the results of the latest clinical research, the potential risk of CI-AKI has been overestimated for a long time and should no longer outweigh the diagnostic benefit of contrast media-enhanced imaging. Nevertheless, the most effective prophylaxis for CI-AKI is the avoidance of unnecessary administration of contrast media.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Swick M (1974) Uroradiographic media. Urology 4(6):750–757

    Article  CAS  Google Scholar 

  2. Laniado M et al (1984) First use of GdDTPA/dimeglumine in man. Physiol Chem Phys Med Nmr 16(2):157–165

    CAS  PubMed  Google Scholar 

  3. Quinby WC, Austen GJ (1939) Suppression of urine complicating pyelography. N Engl J Med 221(21):814–816

    Article  Google Scholar 

  4. McDonald JS et al (2013) Frequency of acute kidney injury following intravenous contrast medium administration: a systematic review and meta-analysis. Radiology 267(1):119–128

    Article  Google Scholar 

  5. Andreucci M et al (2017) Update on the renal toxicity of iodinated contrast drugs used in clinical medicine. Drug Healthc Patient Saf 9:25–37

    Article  CAS  Google Scholar 

  6. Eng J et al (2016) Comparative effect of contrast media type on the incidence of contrast-induced nephropathy: a systematic review and meta-analysis. Ann Intern Med 164(6):417–424

    Article  Google Scholar 

  7. Work Group (2012) KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl 2:1–138

    Article  Google Scholar 

  8. Davenport MS, Cohan RH, Ellis JH (2015) Contrast media controversies in 2015: imaging patients with renal impairment or risk of contrast reaction. AJR Am J Roentgenol 204(6):1174–1181

    Article  Google Scholar 

  9. Stacul F et al (2011) Contrast induced nephropathy: updated ESUR Contrast Media Safety Committee guidelines. Eur Radiol 21(12):2527–2541

    Article  Google Scholar 

  10. Davenport MS et al (2013) Contrast material-induced nephrotoxicity and intravenous low-osmolality iodinated contrast material: risk stratification by using estimated glomerular filtration rate. Radiology 268(3):719–728

    Article  Google Scholar 

  11. Davenport MS et al (2013) Contrast material-induced nephrotoxicity and intravenous low-osmolality iodinated contrast material. Radiology 267(1):94–105

    Article  Google Scholar 

  12. McDonald RJ et al (2013) Intravenous contrast material-induced nephropathy: causal or coincident phenomenon? Radiology 267(1):106–118

    Article  Google Scholar 

  13. Wilhelm-Leen E, Montez-Rath ME, Chertow G (2017) Estimating the risk of radiocontrast-associated nephropathy. J Am Soc Nephrol 28(2):653–659

    Article  Google Scholar 

  14. Ehrmann S et al (2017) Contrast-associated acute kidney injury in the critically ill: systematic review and Bayesian meta-analysis. Intensive Care Med 43(6):785–794

    Article  Google Scholar 

  15. Herts BR et al (2008) Identifying outpatients with renal insufficiency before contrast-enhanced CT by using estimated glomerular filtration rates versus serum creatinine levels. Radiology 248(1):106–113

    Article  Google Scholar 

  16. Galle J, Floege J (2017) Choosing wisely recommendations in nephrology. Internist (Berl) 58(6):568–574

    Article  CAS  Google Scholar 

  17. Feldkamp T et al (2018) Radial access protects from contrast media induced nephropathy after cardiac catheterization procedures. Clin Res Cardiol 107(2):148–157

    Article  Google Scholar 

  18. Nyman U et al (2012) Are intravenous injections of contrast media really less nephrotoxic than intra-arterial injections? Eur Radiol 22(6):1366–1371

    Article  Google Scholar 

  19. Chou SH et al (2011) Persistent renal enhancement after intra-arterial versus intravenous iodixanol administration. Eur J Radiol 80(2):378–386

    Article  Google Scholar 

  20. Karlsberg RP, Dohad SY, Sheng R (2011) Contrast medium-induced acute kidney injury: comparison of intravenous and intraarterial administration of iodinated contrast medium. J Vasc Interv Radiol 22(8):1159–1165

    Article  Google Scholar 

  21. Kooiman J et al (2013) Contrast-induced acute kidney injury and clinical outcomes after intra-arterial and intravenous contrast administration: risk comparison adjusted for patient characteristics by design. Am Heart J 165(5):793–799.e1

    Article  Google Scholar 

  22. Nakaura T et al (2012) Low contrast agent and radiation dose protocol for hepatic dynamic CT of thin adults at 256-detector row CT: effect of low tube voltage and hybrid iterative reconstruction algorithm on image quality. Radiology 264(2):445–454

    Article  Google Scholar 

  23. Kanematsu M et al (2014) Whole-body CT angiography with low tube voltage and low-concentration contrast material to reduce radiation dose and iodine load. AJR Am J Roentgenol 202(1):W106–16

    Article  Google Scholar 

  24. Allen DW et al (2017) Risk prediction models for contrast-induced acute kidney injury accompanying cardiac catheterization: systematic review and meta-analysis. Can J Cardiol 33(6):724–736

    Article  Google Scholar 

  25. Tsai TT et al (2014) Validated contemporary risk model of acute kidney injury in patients undergoing percutaneous coronary interventions: insights from the National Cardiovascular Data Registry Cath-PCI Registry. J Am Heart Assoc 3(6):e1380

    Article  Google Scholar 

  26. Brar SS et al (2014) Haemodynamic-guided fluid administration for the prevention of contrast-induced acute kidney injury: the POSEIDON randomised controlled trial. Lancet 383(9931):1814–1823

    Article  Google Scholar 

  27. Putzu A et al (2017) Prevention of contrast-induced acute kidney injury by furosemide with matched hydration in patients undergoing interventional procedures: a systematic review and meta-analysis of randomized trials. JACC Cardiovasc Interv 10(4):355–363

    Article  Google Scholar 

  28. Er F et al (2012) Ischemic preconditioning for prevention of contrast medium-induced nephropathy: randomized pilot RenPro Trial (Renal Protection Trial). Circulation 126(3):296–303

    Article  CAS  Google Scholar 

  29. Bahrainwala JZ, Leonberg-Yoo AK, Rudnick MR (2017) Use of radiocontrast agents in CKD and ESRD. Semin Dial 30(4):290–304

    Article  Google Scholar 

  30. Lohrke J et al (2016) 25 years of contrast-enhanced MRI: developments, current challenges and future perspectives. Adv Ther 33(1):1–28

    Article  Google Scholar 

  31. Cowper SE et al (2000) Scleromyxoedema-like cutaneous diseases in renal-dialysis patients. Lancet 356(9234):1000–1001

    Article  CAS  Google Scholar 

  32. Grobner T (2006) Gadolinium—a specific trigger for the development of nephrogenic fibrosing dermopathy and nephrogenic systemic fibrosis? Nephrol Dial Transplant 21(4):1104–1108

    Article  CAS  Google Scholar 

  33. Pasquini L et al (2018) Gadolinium-based contrast agent-related toxicities. CNS Drugs 32(3):229–240. https://doi.org/10.1007/s40263-018-0500-1

    Article  CAS  PubMed  Google Scholar 

  34. Knobler R et al (2017) European dermatology forum S1-guideline on the diagnosis and treatment of sclerosing diseases of the skin, Part 2: scleromyxedema, scleredema and nephrogenic systemic fibrosis. J Eur Acad Dermatol Venereol 31(10):1581–1594

    Article  CAS  Google Scholar 

  35. Becker S et al (2012) Application of gadolinium-based contrast agents and prevalence of nephrogenic systemic fibrosis in a cohort of end-stage renal disease patients on hemodialysis. Nephron Clin Pract 121(1–2):91–94

    Article  Google Scholar 

  36. DGfN (2018) Nephrogene Systemische Fibrose (NSF) Register. https://www.dgfn.eu/nsf-register.html. Zugegriffen: 27. März 2018

    Google Scholar 

  37. Gheuens E, Daelemans R, Mesens S (2014) Dialysability of gadoteric acid in patients with end-stage renal disease undergoing hemodialysis. Invest Radiol 49(8):505–508

    Article  CAS  Google Scholar 

  38. Birka M et al (2013) Sensitive quantification of gadolinium-based magnetic resonance imaging contrast agents in surface waters using hydrophilic interaction liquid chromatography and inductively coupled plasma sector field mass spectrometry. J Chromatogr A 1308:125–131

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Nephrologie, Universitätsklinikum Essen, Universität Duisburg Essen, Hufelandstr. 55, 45147, Essen, Deutschland

    M. Jahn,  S. Becker &  A. Kribben

Authors
  1. M. Jahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Becker
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Kribben
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Kribben.

Ethics declarations

Interessenkonflikt

M. Jahn, S. Becker und A. Kribben geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Additional information

Erstveröffentlichung in Der Nephrologe (2018) 13:251–261. https://doi.org/10.1007/s11560-018-0261-3

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jahn, M., Becker, S. & Kribben, A. Nierenfunktion bei kontrastmittelverstärkter Bildgebung. Radiologe 59, 425–434 (2019). https://doi.org/10.1007/s00117-019-0529-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00117-019-0529-2

Schlüsselwörter

Keywords

Search

Navigation