title: Imaging patients with kidney disease: how do we approach contrast-related toxicity?
abstract: The approach to imaging patients with kidney disease with iodinated radiocontrast and gadolinium-based contrast has changed dramatically in recent times. The complications of these contrast agents, radiocontrast nephropathy and nephrogenic systemic fibrosis, respectively, underlie the changes in the imaging practice used in these patients. Rather than to completely avoid the use of these contrast agents, one must remain judicious in the choice of imaging modality in this group of patients. A prudent approach would be to (1) identify patients at high risk to develop contrast-related complications, (2) use noncontrast-based imaging techniques in these patients, as long as they are suitably diagnostic and safe and (3) if the risk:benefit ratio of the imaging information favors a contrast-based study, then appropriate prophylactic steps and use of contrast agents with the lowest risk of complication should be used after obtaining informed consent. This will allow one to maximize the diagnostic efficiency while also limiting the adverse effects.
authors.affiliation: Section of Nephrology, Department of Medicine, Yale University School of Medicine, VA Connecticut Health Care System, New Haven, 06520-8029, USA. mark.perazella@yale.edu
authors.forename: Mark A
authors.initials: MA
authors.lastname: Perazella
authors.forename: Robert F
authors.initials: RF
authors.lastname: Reilly
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000150:complications* / Q000517:prevention & control; D003287:Contrast Media / Q000008:administration & dosage* / Q000009:adverse effects*; D003952:Diagnostic Imaging / Q000379:methods* / Q000592:standards; D005682:Gadolinium / Q000008:administration & dosage* / Q000009:adverse effects*; D019786:Gadolinium DTPA / Q000008:administration & dosage / Q000009:adverse effects; D006571:Heterocyclic Compounds / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D007258:Informed Consent; D007457:Iodine Radioisotopes / Q000008:administration & dosage / Q000009:adverse effects; D008279:Magnetic Resonance Imaging / Q000379:methods; D008536:Meglumine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D054989:Nephrogenic Fibrosing Dermopathy / Q000139:chemically induced; D009942:Organometallic Compounds / Q000008:administration & dosage / Q000009:adverse effects; D018579:Patient Selection; D019275:Radiopharmaceuticals / Q000008:administration & dosage / Q000009:adverse effects*; D012078:Renal Artery Obstruction / Q000175:diagnosis; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D003287:Contrast Media; D006571:Heterocyclic Compounds; D007457:Iodine Radioisotopes; D009942:Organometallic Compounds; D019275:Radiopharmaceuticals; C062402:gadoteridol; C064572:gadobenic acid; D008536:Meglumine; C064925:gadodiamide; D005682:Gadolinium; D019786:Gadolinium DTPA; C109932:gadofosveset trisodium