During the last decade, increased understanding of the role of chelating agents has led to the implementation of processes that have effectively eliminated the incidence of NSF. Nephrogenic systemic fibrosis has been observed in a small subset of patients with advanced CKD most of these cases are related to Group I GBCAs. In its chelated form, it can be safely administered in most patients at the approved doses. ![]() Is Routine Evaluation of Renal Function Necessary? 14įor nondialysis outpatients with suspected advanced (severe) CKD, GBCA can be administered one week apart for a nonurgent, clinically indicated study, taking into account the prolonged half-life of GBCA in patients with severe CKD. For this reason, GBCA can be readministered one week later for a nonurgent, clinically indicated study. 14 The most recent joint consensus statement from the American College of Radiology and the National Kidney Foundation states that “if multiple urgent Group II or Group III GBCA doses are indicated, subsequent dose(s) should not be delayed for fear of NSF.” 7įor patients undergoing hemodialysis, 3 dialysis sessions will clear >95% of a GBCA. 9 The European Society of Urogenital Radiology recommends at least 4 hours between GBCA injections in patients with an eGFR >30 mL/min/1.73 m 2. In patients with normal renal function, GBCA can be readministered after 24 hours if a GBCA-enhanced MRI examination is clinically necessary. 32 Thus, the following guidelines for the repeat administration of GBCA are recommended: 9 However, the mean half-life is prolonged to 5.6 hours in patients with moderate CKD and to 9.2 hours in those with severe CKD, and it can be as long as 30 hours when the GFR is 95% clearance after 3 sessions. Additional functional data will be reviewed such as calyceal transit time (CTT) and renal transit time (RTT).In patients with normal renal function, GBCAs have a half-life of approximately 1.5 hours 31 thus, more than 95% of an injected dose is eliminated within 24 hours. The enhancement intensity versus time will be evaluated for each GBCAs, providing an evaluation of how long renal parenchymal enhancement is maintained. The enhancement curves will provide peak enhancement values within the aorta and kidneys (Time to peak = TTP) and allow comparison between the GBCAs. A comparison of the enhancement curves will be performed of the three GBCAs in the normal pediatric population. ![]() fMRU enhancement curves are generated by drawing regions of interest in the aorta and renal parenchyma and calculating the average signal intensity over time. The fMRU software for analysis of the functional data provides enhancement curves of the aorta and kidneys. The fMRU is performed with Gadolinium based contrast agents (GBCAs), initially was performed with Magnevist, then switched to Gadavist, and most recently converted to Dotarem. Over 1000 studies have been performed between the institutions and the normal studies will be selected based on radiology reports and reviewed to confirm they are normal. Why Should I Register and Submit Results?Ī retrospective review will be performed of all functional MRI urography (fMRU) cases at two institutions (Children's Hospital of Philadelphia and Vanderbilt Children's Hospital).
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