title: [Kidney and iodinated and gadolinium-based contrast agents].
abstract: In patients with renal failure, iodinated contrast agents may cause acute deterioration of the renal function and gadolinium-based contrast agents (GBCAs) may cause nephrogenic systemic fibrosis (NSF). The administration of a contrast agent must thus be reviewed for each patient and evaluation of renal function is paramount even though its estimation using formulas derived from the creatinine level may fluctuate. For iodinated contrast agents, contrast induced nephropathy is reduced by hydratation, preferably intravenous, when the GFR is less than 60 ml/min. The risk for intravenous injections is less than the risk for arterial injections, and the GFR threshold may be reduced to 45 ml/min. For gadolinium-based contrast agents, patients at risk for NSF are those with end-stage renal disease and patients undergoing dialysis. In such cases, the injection of a gadolinium-based contrast agent is only considered after a risk-benefit analysis has been completed, an alternate linear or macrocyclic agent issued and the dose limited to 0,1 mmol Gd/kg. Recently, recommendations from US and European agencies have converged.
  
  
  OBJECTIVE
  to be familiar with the risk factors of CIN with iodinated contrast agents; to be familiar with hydration procedures for patients at risk of CIN; to be familiar with the diagnostic criteria of NSF; to be familiar with the classification of GBCA with regards to the risk of NSF; to be familiar with the contraindications of the different groups of GBCA.
authors.affiliation: Service de Radiologie, Hôpital Européen Georges-Pompidou, 20 rue Leblanc, 75015 Paris, France. olivier.clement@inserm.fr
authors.forename: O
authors.initials: O
authors.lastname: Clément
authors.forename: N
authors.initials: N
authors.lastname: Faye
authors.forename: L
authors.initials: L
authors.lastname: Fournier
authors.forename: N
authors.initials: N
authors.lastname: Siauve
authors.forename: G
authors.initials: G
authors.lastname: Frija
mesh_terms: D000368:Aged; D003287:Contrast Media / Q000008:administration & dosage / Q000633:toxicity*; D003404:Creatinine / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis; D003928:Diabetic Nephropathies / Q000150:complications / Q000175:diagnosis; D005260:Female; D005440:Fluid Therapy; D005682:Gadolinium / Q000633:toxicity*; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D007269:Injections, Intra-Arterial; D007275:Injections, Intravenous; D007455:Iodine / Q000633:toxicity*; D007677:Kidney Function Tests; D018810:Magnetic Resonance Angiography; D054989:Nephrogenic Fibrosing Dermopathy / Q000139:chemically induced* / Q000175:diagnosis* / Q000517:prevention & control; D011655:Pulmonary Embolism / Q000175:diagnosis; D051437:Renal Insufficiency / Q000139:chemically induced* / Q000175:diagnosis* / Q000517:prevention & control; D018570:Risk Assessment
chemical_list: D003287:Contrast Media; D007455:Iodine; D005682:Gadolinium; D003404:Creatinine