What nephrologists need to know about gadolinium

  title={What nephrologists need to know about gadolinium},
  author={Jeffrey G. Penfield and Robert F. Reilly},
  journal={Nature Clinical Practice Nephrology},
Gadolinium chelates are commonly used to improve tissue contrast in MRI. Until recently the use of gadolinium was thought to be risk-free compared with alternative contrast agents. Recent studies, however, have raised serious concerns regarding the safety of gadolinium chelates. Although safe in patients with normal kidney function, administration of these agents in people with renal dysfunction can result in up to three clinical problems that the nephrologist should be familiar with. The first… 

Application of extracellular gadolinium-based MRI contrast agents and the risk of nephrogenic systemic fibrosis.

Despite the NSF risk, contrast-enhanced MRI is a safe diagnostic procedure which can be used reliably and safely even in patients with severe renal failure, and does not necessarily have to be replaced by other methods.

Gadolinium-Induced Fibrosis.

It is proposed that the name gadolinium-induced fibrosis (GIF) more accurately reflects the totality of knowledge regarding this disease and use of high-risk GBCAs, such as formulated gadodiamide, should be avoided in patients with renal disease.

Nephrogenic systemic fibrosis and the use of gadolinium-based contrast agents

Nephrogenic systemic fibrosis (NSF) is a disease seen exclusively in patients with decreased renal function. The use of gadolinium-based contrast agents (GBCAs) has a strong association with NSF.

Gadodiamide-associated nephrogenic systemic fibrosis: why radiologists should be concerned.

Development of NSF was strongly associated with gadodiamide administration in the setting of either acute hepatorenal syndrome or dialysis-dependent chronic renal insufficiency.

Gadolinium-associated plaques: a new, distinctive clinical entity.

Doctors should be aware that GAP can occur without NSF or renal disease and is associated with the use of radiologic dyes, which is related to a particular type of gadolinium used for contrast-enhanced radiologic studies.

Is it Safe to Use Gadolinium-Based Contrast Agents in Mri?

  • R. PullicinoK. Das
  • Medicine, Biology
    The journal of the Royal College of Physicians of Edinburgh
  • 2017
The development of the gadolinium contrast agents, their use and the advice related to this new information are reviewed.

Risk of nephrogenic systemic fibrosis: evaluation of gadolinium chelate contrast agents at four American universities.

The benchmark incidence of nephrogenic systemic fibrosis related to the confirmed use of different gadolinium chelate contrast agents at four U.S. university tertiary care centers was much greater at the two centers where gadodiamide was used than at theTwo center where gadopentetate dimeglumine was used.

Pathogenesis, Diagnosis, and Therapy

To reduce the risk of NSF, renal function must be determined before exposure to gadolinium-containing MR contrast agents, and a sufficient period of time for elimination of the contrast agent from the body should be allowed before readministration of the Contrast Agent.

Gadolinium and nephrogenic systemic fibrosis.

  • V. Runge
  • Medicine
    AJR. American journal of roentgenology
  • 2009
The scientific literature, and specifically all prospective, controlled clinical trials, confirm that the five gadolinium chelates currently on the U.S. market with extracellular distribution—in order of their FDA approval, Magnevist, ProHance, Omniscan, OptiMARK, and MultiHance are safe.



The safety of gadolinium in patients with stage 3 and 4 renal failure.

  • I. ErgünK. Keven O. Karatan
  • Medicine
    Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
  • 2006
An ARF can occur after gadolinium-based contrast agents in patients with moderate to severe chronic renal failure and risk factors for ARF include diabetic nephropathy and low GFR.

Gadodiamide-associated nephrogenic systemic fibrosis: why radiologists should be concerned.

Development of NSF was strongly associated with gadodiamide administration in the setting of either acute hepatorenal syndrome or dialysis-dependent chronic renal insufficiency.

Gadodiamide administration causes spurious hypocalcemia.

Gadodiamide administration causes spurious hypocalcemia, particularly at doses of 0.2 mmol/kg or higher and in patients with renal insufficiency.

Nephrotoxicity of high‐dose gadolinium compared with iodinated contrast

High‐dose gadolinium chelates are significantly less nephrotoxic than iodinated contrast, and none had gadolinia contrast‐induced renal failure despite the high gadoliniam dose and high prevalence of underlying renal insufficiency.

Gadolinium is detectable within the tissue of patients with nephrogenic systemic fibrosis.

Gadolinium-based MR contrast agents and nephrogenic systemic fibrosis.

The author of a recent article has suggested that administration of intravenous contrast material for magnetic resonance (MR) imaging (ie, gadolinium chelates) has been associated with a small cluster of patients with NSF in Austria (five of nine imaged patients).

Nephrogenic systemic fibrosis: a population study examining the relationship of disease development to gadolinium exposure.

It is concluded that GCCA exposure is a major risk factor for NSF in the ESRD population and gadolinium exposure should be avoided in patients with E SRD.

Nephrogenic systemic fibrosis: suspected causative role of gadodiamide used for contrast-enhanced magnetic resonance imaging.

It is shown that gadodiamide plays a causative role in nephrogenic systemic fibrosis, and seven patients became severely disabled, and one died 21 mo after exposure.

Case-control study of gadodiamide-related nephrogenic systemic fibrosis.

Increasing cumulative gadodiamide exposure, high-dose epoietin-beta treatment, and higher serum concentrations of ionized calcium and phosphate increase the risk of gaddiamide-related nephrogenic systemic fibrosis in renal failure patients.