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Vascular Access
Published in James Michael Forsyth, How to Be a Safe Consultant Vascular Surgeon from Day One, 2023
It is worth knowing the ESVS guideline recommendations because on the whole they help streamline your practice. However, I would be ready for some push-back. I remember quoting the ESVS recommendation to avoid MRA in end-stage renal failure patients because of the potential risk of nephrogenic systemic fibrosis. This was in the middle of an MDT. I then found myself in the awkward position of being told by a very experienced and confident interventional radiologist that these risks were very small. I did go away and do some reading about nephrogenic systemic fibrosis after this and found a systematic review and meta-analysis (Woolen et al 2020) that explored this very question. The conclusion from this paper was this: “This study's findings suggest that the risk of NSF from group II GBCA administration in stage 4 or 5 CKD is likely less than 0.07%. The potential diagnostic harms of withholding group II GBCA for indicated examinations may outweigh the risk of NSF in this population.” The moral of the story here is don't be a smart arse. The other moral of the story is to stick to your speciality. I am not a radiologist, and therefore, I am not going to win a radiology argument with a radiologist. I should just stick to vascular surgery because that is what I am good at (I vaguely think so anyways). This is one of the reasons why I don't have a chapter in this book dedicated to radiology (LOLS).
Diabetic Nephropathy
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
With renal failure, renal excretion of drugs is often poor. Revised doses are required for common drugs that include cephalosporins, penicillins, aminoglycosides, fluoroquinolones, digoxin, and vancomycin. Serum concentrations of drugs can be reduced by hemodialysis, so they should be supplemented when the procedure is done. The NSAIDs are usually avoided with CKD since they can reduce kidney function, worsen hypertension, and cause electrolyte disturbances. Drugs that should never be used with CKD include nitrofurantoin and phenazopyridine. Gadolinium, used as an MRI contrast agent, has caused nephrogenic systemic fibrosis in some CKD patients. Since risks are very high with a GFR of less than 30 mL/min/1.73 m2, gadolinium must be avoided whenever this is possible in CKD patients.
Liver and spleen metastases
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Wolfgang Schima, Helmut Kopf, Claus Kölblinger
With its inherent high soft tissue contrast, provision of biochemical (e.g. fat content) as well as anatomical information, multiplanar imaging, and sensitivity to blood flow and blood breakdown products, MRI represents a powerful tool in liver imaging. Gadolinium-enhanced MRI minimizes the risk of contrast-induced nephropathy inherent to iodine contrast material (40). However, there is a higher risk of developing nephrogenic systemic fibrosis in patients with renal insufficiency (41,42). In this patient group (eGFR <30 mL/min/1.73m2), use of gadolinium-based (non-specific gadolinium chelates as well as liver-specific gadolinium-based) MR contrast agents should be avoided, with unenhanced MRI including diffusion-weighted imaging as an alternative.
Gadolinium-based contrast agents – what is the evidence for ‘gadolinium deposition disease’ and the use of chelation therapy?
Published in Clinical Toxicology, 2020
Kerry A. Layne, David M. Wood, Paul I. Dargan
In 2015, results from a study were published that utilised a murine model of nephrogenic systemic fibrosis to further investigate the underlying pathophysiology of the skin changes that can develop after gadolinium-based contrast agent exposure in patients with severe kidney disease [58]. Mice with surgically-induced renal impairment were exposed to a course of 10 injections (3 injections per week) of gadodiamide (linear agent) 0.5 mmol/kg, with the treatment group receiving deferiprone 125 mg/kg, a drug used to chelate iron, in their drinking water for 16 weeks [58]. The mice subsequently developed skin changes typical of nephrogenic systemic fibrosis. However the group that had received deferiprone had significantly (p < 0.05) decreased skin thickness and dermal fibrosis compared to the gadodiamide-only group [58]. The researchers concluded that catalytic iron plays a role in the development of nephrogenic systemic fibrosis although they did not present data to substantiate this [49].
Cardiovascular rEmodelling in living kidNey donorS with reduced glomerular filtration rate: rationale and design of the CENS study
Published in Blood Pressure, 2020
Kjersti Benedicte Blom, Kaja Knudsen Bergo, Emil Knut Stenersen Espe, Vigdis Rosseland, Ole Jørgen Grøtta, Geir Mjøen, Anders Åsberg, Stein Bergan, Helga Sanner, Tone Kristin Bergersen, Reidar Bjørnerheim, Morten Skauby, Ingebjørg Seljeflot, Bård Waldum-Grevbo, Dag Olav Dahle, Ivar Sjaastad, Jon Arne Birkeland
Native T1 mapping is often used in combination with gadolinium-based contrast agents to provide information about the extracellular volume [67] and diffuse fibrosis [68]. However, known risk factors when using gadolinium-based contrast agents include allergic reactions and nephrogenic systemic fibrosis in patients with advanced renal disease [69]. Also, several studies have shown signs of gadolinium deposition in the brain after repeated exposure to gadolinium-based contrast agents, of which the consequences are not known [70]. Kidney donors are healthy before kidney donation, and we do not expect changes in T1 value due to other pathology such as oedema, amyloidosis or iron overload. We can therefore assume that, if found, an increase in native T1 values in living kidney donors compared to controls are due to development of interstitial cardiac fibrosis secondary to a reduction in GFR. Moreover, the added value of post-contrast T1 compared to purely native T1 is still a matter of debate [71]. Therefore, we have chosen not to expose the study participants to gadolinium-based contrast agents.
Metal Nanoparticles in Infection and Immunity
Published in Immunological Investigations, 2020
Putting the emerging literature on metal nanoparticles into a historical perspective may be helpful. Over the course of the past two centuries, the toxicity of many metals was not noticed until they had been in use for decades. Examples include the use of mercury salts in manufacture of wool felt for hats in the 19th century, and the use of lead additives in gasoline. Tetraethyl lead was added to gasoline beginning in the 1920s to increase the octane of gasoline and prevent engine “knocking;” it was not removed from gasoline in the United States until the late 1970s. Similarly, lead oxide in house paint was not banned until 1978. A more recent example is the discovery of the toxicity of gadolinium, which is used as a contrast agent for magnetic resonance imaging (MRI). Gadolinium contrast agents were first used in human is 1988, and it was not until 12 years later that a skin condition similar to scleromyxoedema was recognized in patients with kidney failure receiving hemodialysis (Cowper et al. 2000). It was not until 2006 that the link was made between this skin condition and gadolinium (Grobner 2006; Larson et al. 2015; Swaminathan et al. 2007). The name of the condition was changed to nephrogenic systemic fibrosis after recognition of multi-organ involvement. In other words, discovery of the link between gadolinium administration and this condition took 18 years. Therefore, if there are unexpected toxicities from metal nanoparticles, these adverse effects might not be discovered right away and might require careful detective work to establish a connection. It appears that more research on potential toxicities of metal nanoparticles is sorely needed.