Med. Pro Praxi 2007; 4(11): 478-480

Systémová nefrogenní fibróza a kontrastní látky používané v magnetické rezonanci

doc. MUDr. Josef Vymazal DSc
Radiodiagnostické oddělení, Nemocnice Na Homolce, Praha

Systémová nefrogenní fibróza (SNF) popsaná poprvé v roce 1997 u pacientů s renální insuficiencí postihuje různé orgány – kůži, ledviny, srdce, játra a plíce. Onemocnění bývá invalidizující, může být i letální. V posledních letech je SNF dávána do souvislosti s podáním (zvláště některých) chelátů gadolinia, používaných jako kontrastní látky u magnetické rezonance. Pravděpodobným mechanizmem vzniku SNF u těchto látek je nízká stabilita některých chelátů, kdy dojde k uvolnění toxického gadolinia. Tento mechanizmus je možný zvláště u pacientů s poruchou funkce ledvin, kdy eliminace kontrastní látky je prodloužena z řádově 1–2 hodin i na desítky hodin. Uvolněné gadolinium je pak nahrazeno v chelátu jiným kovem. Jde o tzv. transmetalaci. Druhý mechanizmus vychází z přítomnosti nadbytečného chelátu v nestabilních kontrastních látkách. Tento chelát vychytává kovy tělu vlastní, např. Zn. U pacientů s hodnotami glomerulární filtrace pod 30 ml/min na 1,73 m2 (přibližně kreatinin 200 μmol/l) jsou kvůli riziku rozvoje SNF v současné době kontraindikovány kontrastní látky gadodiamide a gadopentate.

Keywords: systémová nefrogenní fibróza, magnetická rezonance, kontrastní látka, gadolinium

Published: December 19, 2007  Show citation

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Vymazal J. Systémová nefrogenní fibróza a kontrastní látky používané v magnetické rezonanci. Med. praxi. 2007;4(11):478-480.
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    References

    1. Bongartz G. Imaging in the time of NFD/NSF: do we have to change our routines concerning renal insufficiency? Magma 2007; 20: 57-62. Go to original source... Go to PubMed...
    2. Broome DR, Girguis MS, Baron PW, Cottrell AC, Kjellin I, Kirk GA. Gadodiamide-associated nephrogenic systemic fibrosis: why radiologists should be concerned. AJR Am J Roentgenol 2007; 188: 586-592. Go to original source... Go to PubMed...
    3. Dupont A, Majithia V, Ahmad S, McMurray R. Nephrogenic fibrosing dermopathy, a new mimicker of systemic sclerosis. Am J Med Sci 2005; 330: 192-194. Go to original source... Go to PubMed...
    4. Gibson SE, Farver CF, Prayson RA. Multiorgan involvement in nephrogenic fibrosing dermopathy: an autopsy case and review of the literature. Arch Pathol Lab Med 2006; 130: 209-212. Go to original source...
    5. Grobner T, Prischl FC. Gadolinium and nephrogenic systemic fibrosis. Kidney Int 2007; 72: 260-264. Go to original source... Go to PubMed...
    6. Grobner T. Gadolinium-a specific trigger for the development of nephrogenic fibrosing dermopathy and nephrogenic systemic fibrosis? Nephrol Dial Transplant 2006. Go to original source...
    7. High WA, Ayers RA, Chandler J, Zito G, Cowper SE. Gadolinium is detectable within the tissue of patients with nephrogenic systemic fibrosis. J Am Acad Dermatol 2007; 56: 21-26. Go to original source... Go to PubMed...
    8. Chewning RH, Murphy KJ. Gadolinium-based Contrast Media and the Development of Nephrogenic Systemic Fibrosis in Patients with Renal Insufficiency. J Vasc Interv Radiol 2007; 18: 331-333. Go to original source... Go to PubMed...
    9. Karlik SJ. Gadodiamide-associated nephrogenic systemic fibrosis. AJR Am J Roentgenol 2007; 188: W584. Go to original source... Go to PubMed...
    10. Kuo PH, Kanal E, Abu-Alfa AK, Cowper SE. Gadolinium-based MR contrast agents and nephrogenic systemic fibrosis. Radiology 2007; 242: 647-649. Go to original source... Go to PubMed...
    11. Lin SP, Brown JJ. MR contrast agents: physical and pharmacologic basics. J Magn Reson Imaging 2007; 25: 884-899. Go to original source... Go to PubMed...
    12. Marckmann P, Skov L, Rossen K, et al. Nephrogenic systemic fibrosis: suspected causative role of gadodiamide used for contrast-enhanced magnetic resonance imaging. J Am Soc Nephrol 2006; 17: 2359-2362. Go to original source... Go to PubMed...
    13. Morcos SK. Nephrogenic systemic fibrosis following the administration of extracellular gadolinium based contrast agents: is the stability of the contrast agent molecule an important factor in the pathogenesis of this condition? Br J Radiol 2007; 80: 73-76. Go to original source... Go to PubMed...
    14. Obermoser G, Emberger M, Wieser M, Zelger B. Nephrogenic fibrosing dermopathy in two patients with systemic lupus erythematosus. Lupus 2004; 13: 609-612. Go to original source... Go to PubMed...
    15. Perazella MA, Rodby RA. Gadolinium use in patients with kidney disease: a cause for concern. Semin Dial 2007; 20: 179-185. Go to original source... Go to PubMed...
    16. Perazella MA, Rodby RA. Gadolinium-induced nephrogenic systemic fibrosis in patients with kidney disease. Am J Med 2007; 120: 561-562. Go to original source... Go to PubMed...
    17. Satellite symposium of the International Society for Magnetic Resonance in Medicine. Berlin, Germany 2007.
    18. Thomsen HS, Morcos SK, Dawson P. Is there a causal relation between the administration of gadolinium based contrast media and the development of nephrogenic systemic fibrosis (NSF)? Clin Radiol 2006; 61: 905-906. Go to original source... Go to PubMed...
    19. Thomsen HS. Nephrogenic systemic fibrosis: A serious late adverse reaction to gadodiamide. Eur Radiol 2006; 16: 2619-2621. Go to original source... Go to PubMed...
    20. Vymazal J, Bulte JW, Frank JA, Di Chiro G, Brooks RA. Frequency dependence of MR relaxation times. I. Paramagnetic ions. J Magn Reson Imaging 1993; 3: 637-640. Go to original source... Go to PubMed...

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