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MRI Contrast in Patients with Kidney Disease

todd121's picture
todd121
Posts: 1258
Joined: Dec 2012

I had quite a shock today. I visited my nephrologist for my checkup and I mentioned to her about the two oncologists having a disagreement over the CT contrast. One oncologist will not give me contrast if my creatinine is over 1.5. Because of this, I've had no contrast CTs in the past 2 1/2 years. The other oncologist said he'd give me the contrast but hydrate me well. My creatinine is 1.6-1.7.

I asked the nephrologist what she thought. She agreed with the second oncologist that the risk was fairly low and that if it was helpful to have the contrast she'd so it's ok. However, she advised against have the MRI contrast. I said WHAT? The oncologist that wouldn't give me the CT contrast, gave me MRI contrast 2 weeks ago. My nephrologist said the gadolinium in the MRI contrast can cause a very serious skin condition that is incurable in renal impaired patients. It's not advised for patients with eGFR < 60.

She said that if I need this contrast in the future, it would be best to have my oncologist/radiologist talk to her first before deciding whether to use the MRI contrast or not. There might be ways around (use less, hydrate well, etc.).

I poked around, and, sure enough, I found info on this. Have any of you heard of this?

If your kidney function is low, you might just want to be aware of this issue if you're getting MRI's with contrast. I had read on this board before that MRI contrast had no danger to the kidneys. Well, it's not the kidneys that it damages, but for some reason it can cause a condition called Nephrogenic Fibrosing Dermopathy (NFD) also called Nephrogenic Systemic Fibrosis (NFS).

There is a dosing recomendation for those of us with eGFR < 60.

Todd

hydrangea's picture
hydrangea
Posts: 31
Joined: Oct 2012

Todd,

Many thanks for sharing this information you newly acquired.  This definitely applies to my situation and I plan to discuss w/ my oncologist.  My history since 2012 has been CT scans w/ and without contrast of chest/abdomen and pelvis.  After my 3rd set of scans I developed an allergic reaction (very severe) and when it came time for the next set of scans my urologist ordered MRI w/ contrast.  When my oncologist received the scans he said he didn't like using MRI for kidney cancer and said he would pre medicate me prior to CT scans w/ contrast and without.  So I have had 4 more CT scans w/ contrast w/ the 4th one most recently on 3/31.  Hospital called me 3/30 said my GFR was 51 and I needed to have IV hydration prior to the scans w/ contrast plus continue taking the pre meds as instructed.  After the scan I stayed for another iv hydration and for hospital personnel to observe me.  Needless to say, I once again developed a severe reaction.  Now the hospital has said they will never administer another CT w/ contrast to me.  When my oncologist heard this he told me we would discuss further at my next appointment but he would probably recommend an MRI w/ contrast. So what do you do if you shouldn't have either???

I am thinking that if my GFR would happen to go up to 60 or above, the concern for the MRI w/ contrast would lessen.  Also frightens me that 2 years ago my oncologist said he preferred CTs w/ contrast not MRIs & now I would be required to have an MRI.  What a dilemna! 

Again, many thanks for sharing this important information.

Diane

 

todd121's picture
todd121
Posts: 1258
Joined: Dec 2012

My nephrologist said she'd like to be consulted. She said the answer isn't completely no on the contrast, but that it needs to be weighed. I found a website that suggested a maximum dosage of gadinilium for patients with eGFR between 15 and 60. I don't remember what it is exactly, but perhaps a discussion with a nephrologist about the different options of both contrasts might be worthwhile?

It sounds like you'rehaving an allergic reaction to the contrast? It's not causing your kidneys a problem?

Good luck. Keep us updated.

Todd

Srashedb
Posts: 454
Joined: Dec 2013

as I have mentioned, I asked (and asked and asked again!) about the contrast and the nurse practitioner kept repeating that contrast was fine. When I asked about MRIs, she ordered them (after repeated demands) WITH gaudalimn which I had read about and discovered what you mentioned. It can cause kidney failure in a patient without kidney cancer.

her response was less than helpful and the MRI was scheduled with the gaudalimn until I cancelled it. 

As we have recently discovered, the MRI can be done without the gaudalimn or any other contrast. His radiation/oncologist wanted precision and the CT scans were not clear. she was able to see the areas clearly as was his surgeon.

areas that are now being seen on a CT scan were seen in the first MRIs; now, the question is about it being progression or untreated. She was exasperated and said she didn't want him having anymore scans.

it isn't the oncologist's fault but the one who orders and schedules the tests; to describe me as crazed and furious I am is an understatement! 

And, it was the same person who told me two weeks ago that my husband had to get to the office immediately so she could start him on Votrient when the oncologist was out of town. Thankfully, he contacted us when he returned and read my email; he would like to try Xgeva but it can wait until his radiation and follow-up are completed.

Sarah

todd121's picture
todd121
Posts: 1258
Joined: Dec 2012

I saw that a reduced/max dosage was recommended for patients with reduced kidney function. Perhaps getting a nephrologist involved if constrast is needed might be worthwhile? They seem to really know about this topic.

Todd

Jojo61's picture
Jojo61
Posts: 1276
Joined: Oct 2013

Todd....that is valuable information. I am always amazed at how each doctor ignores requests, and seem to be oblivious of effects on some substances on our one and only precious kidney!

And Sarah - thank goodness you are on the ball with all of this stuff! I need a clone of you up here with me! Smile

 

Srashedb
Posts: 454
Joined: Dec 2013

it is exhausting and frustrating but we do need to stay on the docs; this nurse practitioner took offense at being challenged but she is not my concern.

I would gladly advocate for you

Sarah

Srashedb
Posts: 454
Joined: Dec 2013

we have a nephrologist now; he runs labwork every 3 months and there are 3 pp of test results.

it is reassuring

Sarah

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