What are concerns regarding gadolinium use in imaging studies for the diagnosis of renal artery stenosis (RAS)?

Updated: Nov 02, 2020
  • Author: Bruce S Spinowitz, MD, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

Concern regarding the association of gadolinium use with the development of nephrogenic systemic fibrosis (NSF) in patients with moderate to severe renal insufficiency significantly limits the use of this agent and, therefore, this modality, for the recognition of anatomic renal artery stenosis. In one study, for example, Broome et al reported an odds ratio of 22.3 for the development of NSF in dialysis patients who underwent enhanced imaging with the gadolinium-based contrast agent gadodiamide (vs patients in the study who underwent unenhanced imaging). [19]

However, all of the patients in the Broome study who developed NSF received 0.2 mmol/kg of gadodiamide; no cases of NSF were found among members of the cohort who received 0.1 mmol/kg of the agent. In a subsequent study, Garovic et al found no reported cases of NSF among 335 patients who underwent contrast-enhanced MRA, using 0.1 mmol/kg gadodiamide, for suspected or known renal artery stenosis. [20]


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