title: Acute phase reaction to gadolinium-DTPA in dialysis patients.
abstract: BACKGROUND
  Several late sequelae of the administration of gadolinium (Gd)-containing MRI contrast agents have been described in patients with advanced renal failure. In an observational series, we found a remarkable frequency of peracute reactions after administration of Gd-DTPA used for cardiovascular evaluation before renal transplantation.
  
  
  METHODS
  In a 26-month observational period, 13 of 136 haemodialyzed or CAPD patients exhibited onset of fever, chills and nausea within hours after administration of Gd-DTPA peracute. A minority showed persistent cessation of residual diuresis. We performed blood cultures in most patients and evaluated white blood cell (WBC) counts, eosinophils, CRP, heart rate and blood pressure.
  
  
  RESULTS
  Within an average of 12 h (range 12-36 h) after Gd administration, the 13 patients (9 males, 4 females; median age 61 years, range 47-79) developed consistent symptomatology with fever (median 39.0 degrees C, range 37.5-39.5), chills, malaise, hypotension, vomiting, dyspnoea-initially raising suspicion of septicaemia. Subsequent blood cultures on bacterial contamination of the injected product remained negative throughout; bacterial or endotoxin contamination of the reagent was excluded. Steroids were tried in the first two patients without a noticeable effect. In all subsequent patients, symptoms were attenuated during the first 5 h dialysis (F60HPS with 280 ml/min blood flow) and disappeared within 72 h. CRP levels remained markedly elevated up to 14 days. Lymphopenia was seen in all patients, and polymorphic neutrophils (PMN) remained normal. Two polyuric patients developed persistent anuria. After a median of 16 months, none of these patients developed nephrogenic systemic fibrosis.
  
  
  CONCLUSIONS
  This series with unusually severe acute phase reactions was caused by one specific preparation. Such peracute reactions may be relevant for the so-far largely unresolved pathogenesis of the skin reaction to some Gd products in end-stage renal disease (ESRD) patients. It remains unresolved whether the reaction observed with Gd-DTPA do in principle also occur with other Gd reagents.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Heidelberg, Heidelberg, Germany.
authors.forename: Henning
authors.initials: H
authors.lastname: Steen
authors.forename: Evangelos
authors.initials: E
authors.lastname: Giannitsis
authors.forename: Claudia
authors.initials: C
authors.lastname: Sommerer
authors.forename: Udo
authors.initials: U
authors.lastname: Bahner
authors.forename: Margit
authors.initials: M
authors.lastname: Brandl
authors.forename: Christoph
authors.initials: C
authors.lastname: Merbach
authors.forename: Constanze
authors.initials: C
authors.lastname: Merten
authors.forename: Eberhard
authors.initials: E
authors.lastname: Ritz
authors.forename: Hugo A
authors.initials: HA
authors.lastname: Katus
authors.forename: Martin
authors.initials: M
authors.lastname: Zeier
authors.forename: Vedat
authors.initials: V
authors.lastname: Schwenger
mesh_terms: D000210:Acute-Phase Reaction / Q000139:chemically induced* / Q000276:immunology; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis*; D003287:Contrast Media / Q000009:adverse effects*; D005260:Female; D019786:Gadolinium DTPA / Q000009:adverse effects*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D016030:Kidney Transplantation; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA