Histomorphological changes after renal X-ray arteriography using iodine and gadolinium contrast media in an ischemic porcine model
ABSTRACT Gadolinium contrast media (Gd-CM) are regarded as non-nephrotoxic or considerably less nephrotoxic than iodine contrast media (I-CM), and have therefore come to be used as a substitute for I-CM in patients with renal insufficiency in a variety of radiographic examinations.
To investigate renal histomorphological changes caused by Gd-CM in comparison with I-CM after renal X-ray arteriography in an ischemic porcine model,and to evaluate these changes in relation to the nephrotoxicity of the CM used.
Test solutions: gadopentetate, gadodiamide, iohexol, gadobutrol,iopromide, iodixanol, mannitol, and saline. The experiments were performed on 152 animals. Each pig was randomized to receive one test solution injected into the balloon occluded(10 min) right renal artery. The kidneys were evaluated histomorphologically.The severity of histomorphological changes was graded subjectively: 15 minimal, 25 mild, 35 moderate, and 4=marked.
The main histological changes were 1) proximal tubular and glomerular necrosis,2) hemorrhage/congestion of the cortex, medulla, and glomeruli, 3) proximal tubular vacuolation, and 4) protein-filled tubules in the cortex and medulla. Necrosis and hemorrhage/congestion were more frequent after injections with gadopentetate, mannitol solution iso-osmotic to gadopentetate, and gadobutrol compared to all other groups(P<0.001). The degree of necrosis and hemorrhage/congestion was related to the degree of impairment of renal function, but inversely related to vacuolation and tubular protein filling.
In ischemic porcine kidneys, the histomorphological changes caused by Gd-CM are similar to those caused by I-CM. Vacuolation appears to be independent of the osmolality and viscosity of the CM, and does not seem to be an indicator of renal impairment. "High-osmolal" Gd-CM are more nephrotoxic than "low- and iso-osmolal" I-CM when compared in equal volumes of concentrations, resulting in equal X-ray attenuation.
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ABSTRACT: Increasing use is made of extracellular MRI contrast agents that alter the image contrast following intravenous administration; they predominantly shorten the T1 relaxation time of tissues. The degree and location of these changes provide substantial diagnostic information. However gadolinium-based contrast agents (Gd-CA) are not inert drugs. They may cause acute non-renal adverse reactions (e.g. anaphylactoid reactions), acute renal adverse reactions (e.g. contrast induced nephropathy), delayed adverse reactions (nephrogenic systemic fibrosis) and problems at the site of injection (e.g. local necrosis). This review describes the current status of Gd-CA, their mechanism of action, chemical structure, pharmacokinetics, dosage, elimination, nephrotoxicity and adverse events.European Journal of Radiology 06/2008; 66(2):160-7. DOI:10.1016/j.ejrad.2008.01.023 · 2.16 Impact Factor
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ABSTRACT: Magnetic resonance angiography (MRA) and NSF in renally impaired patients have a close relationship due to the frequent coincidence of vascular and renal pathologies, the relatively large amount of contrast media applied and the delayed excretion. The date of the first NSF cases described in literature falls into the development of multi-stationary MRA--an investigation that requested multiple bolus injections or one large bolus of the contrast agent. It is therefore easily understood that NSF was regarded initially as possible complication of MRA. A review on the history of MRA is presented and various techniques for MRA are described. While many neuroradiological indications can be solved by native MRA, most angiographic indications throughout the body rely on the application of intravenous contrast agents. The paper discusses options for alternative methods in vascular imaging and offers guidelines for patients with renal impairment. NSF must always be balanced versus the outcome of an investigation, respectively versus the outcome of a denied MRA. Moreover, in patients with chronic kidney disease (CKD) and a proper justification for a vascular investigation, neither CT angiography nor DSA should replace MRA. Restrictions in contrast media dose for CKD patients are mandatory and obviously reduce the risk of NSF. Gadolinium-based contrast agents with lower stability are now contraindicated in patients with reduced renal function. The role of blood pool agents is under evaluation. Since the awareness of the new disease grew over the last year, radiologists were able to reduce the number of newly diagnosed NSF cases by more careful consideration of contrast application and agent in renally impaired patients, which gives hope that NSF can be avoided by respecting some easy rules.European Journal of Radiology 06/2008; 66(2):213-9. DOI:10.1016/j.ejrad.2008.01.031 · 2.16 Impact Factor
- Acta Radiologica 07/2008; 49(5):489. DOI:10.1080/02841850802136751 · 1.35 Impact Factor