rentradВестник рентгенологии и радиологииJournal of radiology and nuclear medicine0042-46762619-0478Limited Liability Company "LUCHEVAYA DIAGNOSTIKA", Russian Association of Radiologists10.20862/0042-4676-2019-100-1-58-66rentrad-416Research ArticleОБЗОРЫREVIEWSМРТ с контрастированием у пациента с хронической болезнью почек: контрастировать нельзя отказать. Где поставить запятую?MRI with Contrast Enhancement in a Patient with Chronic Kidney Disease: to Contrast Have Not Be Denied. Where Should We Put the Comma?https://orcid.org/0000-0002-1823-0125КамышоваЕ. С.KamyshovaE. S.

Камышова Елена Сергеевна - кандидат медицинских наук, ассистент кафедры внутренних, профессиональных болезней и ревматологии Медико-профилактического факультета.

Ул. Трубецкая, 8, стр. 2, Москва, 119991

Elena S. Kamyshova - PhD, Assistant Professor of department of preventive medicine.

Ul. Trubetskaya, 8/2, Moscow, 119991

https://orcid.org/0000-0001-8887-4420ШимановскийН. Л.ShimanovskiiN. L.

Шимановский Николай Львович - доктор медицинских наук, профессор, член-корреспондент РАН, заведующий кафедрой молекулярной фармакологии и радиобиологии им. академика П.В. Сергеева.

Ул. Островитянова, 1, Москва, 117997

Nikolay L. Shimanovskii - MD, Head of the Department of molecular pharmacology and radiobiology. Professor, member-correspondent of RAS.

shimannn@yandex.ruФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава РоссииРоссияI.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian FederationRussian FederationФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава РоссииРоссияPirogov Russian National Research Medical University (RNRMU), Ministry of Health of the Russian FederationRussian Federation20191403201910015866Copyright © Камышова Е.С., Шимановский Н.Л., 20192019Камышова Е.С., Шимановский Н.Л.Kamyshova E.S., Shimanovskii N.L.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.russianradiology.ru/jour/article/view/416

В данном обзоре обсуждается вопрос использования гадолинийсодержащих контрастных средств (ГСКС) у пациентов с нарушением функции почек, в частности при хронической болезни почек (ХБП). Актуальность данной проблемы обусловлена высокой распространенностью ХБП в популяции: по разным оценкам, признаки повреждения почек и/или снижение скорости клубочковой фильтрации (СКФ) выявляют в среднем у каждого десятого жителя в различных странах.

Перед МР-исследованием с контрастированием крайне важно выявлять таких пациентов, поскольку несоблюдение международных рекомендаций по безопасному применению контрастных средств может привести к развитию серьезного осложнения - нефрогенного системного фиброза (НСФ). Также в обзоре обсуждаются новые данные о применении ГСКС у пациентов с нарушенной функцией почек. Результаты недавно проведенного исследования GRIP свидетельствуют о благоприятном профиле безопасности контрастного средства Гадовист® у пациентов с умеренно выраженным и тяжелым нарушением функции почек.

Таким образом, с учетом имеющихся данных по безопасности и современных рекомендаций по безопасному применению контрастных средств (ESUR 10.0) у пациентов с тяжелым нарушением функции почек (рСКФ < 30 мл/мин/1,73 м2) рекомендуется использовать только ГСКС низкого риска развития НСФ, в частности контрастного средства Гадовист®.

This paper provides information on the prevalence of chronic kidney disease (CKD) in the population. In General, according to various studies, signs of kidney disease and/or reduced glomerular filtration rate (GFR) are detected on average in every tenth resident in different countries. It is extremely important to identify such patients before MRI with contrast enhancement, otherwise non-compliance with international manuals on contrast agents could lead to nephrogenic systemic fibrosis (NSF). The data of the study of Gadobutrol in Renally Impaired Patients (GRIP) indicate a favorable safety profile of Gadovist® in patients with moderate and severe renal impairment. Taking into account the available safety data and current manuals on contrast agents, only NSF low risk gadolinium-based contrast agents can be used in patients with severe renal impairment.

магнитно-резонансная томографияхроническая болезнь почекгадолинийсодержащие контрастные средствагадобутролрекомендации по безопасному применениюконтрастных средствобзорmagnetic resonance imagingchronic kidney diseasegadolinium-based contrast agentsgadobutrolmanuals on contrast agentsreviewКомпания «Байер», техническая поддержка и обеспечение взаимодействия между авторами настоящего обзораCompany “Bayer”, technical support and interaction between the authors of this reviewReferencesRunge V.M. Commentary on T1-weighted hypersignal in the deep cerebellar nuclei after repeated administrations of Gadolinium-based contrast agents in healthy rats. Invest Radiol. 2015; 50: 481-2.Runge V.M. Commentary on T1-weighted hypersignal in the deep cerebellar nuclei after repeated administrations of Gadolinium-based contrast agents in healthy rats. Invest Radiol. 2015; 50: 481-2.Prince M.R., Zhang H., Zou Z., Staron R.B., Brill P.W. Incidence of immediate gadolinium contrast media reactions. Am J Roentgenol. 2011; 196(2): W138-43.Prince M.R., Zhang H., Zou Z., Staron R.B., Brill P.W. Incidence of immediate gadolinium contrast media reactions. Am. J. Roentgenol. 2011; 196 (2): W138-43.Bruder O., Schneider S., Pilz G., van Rossum A.C., Schwitter J., Nothnagel D. et al. 2015 Update on Acute Adverse Reactions to Gadolinium based Contrast Agents in Cardiovascular MR. Large Multi-National and Multi-Ethnical Population Experience With 37788 Patients From the EuroCMR Registry. J Cardiovasc Magn Reson. 2015; 17(1). DOI: 10.1186/s12968-015-0168-3Bruder O., Schneider S., Pilz G., van Rossum A.C., Schwitter J., Nothnagel D. et al. 2015 Update on Acute Adverse Reactions to Gadolinium based Contrast Agents in Cardiovascular MR. Large Multi-National and Multi-Ethnical Population Experience With 37788 Patients From the EuroCMR Registry. J Cardiovasc Magn Reson. 2015; 17(1). DOI: 10.1186/s12968-015-0168-3Grobner T. Gadolinium-a specific trigger for the development of nephrogenic fibrosing dermopathy and nephrogenic systemic fibrosis? Nephrol Dial Transplant. 2006; 21: 1104-8.Grobner T. Gadolinium-a specific trigger for the development of nephrogenic fibrosing dermopathy and nephrogenic systemic fibrosis? Nephrol Dial Transplant. 2006; 21: 1104-8.Marckmann P, Skov L., Rossen K., Dupont A., Damholt M.B., Heaf J.G. et al. Nephrogenic systemic fibrosis: suspected causative role of gadodiamide used for contrast-enhanced magnetic resonance imaging. J Am Soc Nephrol. 2006; 17: 2359-62. DOI: 10.1681/ASN.2006060601Marckmann P., Skov L., Rossen K., Dupont A., Damholt M.B., Heaf J.G. et al. Nephrogenic systemic fibrosis: suspected causative role of gadodiamide used for contrast-enhanced magnetic resonance imaging. J Am Soc Nephrol. 2006; 17: 2359-62. DOI: 10.1681/ASN.2006060601Cowper S.E., Robin H.S., Steinberg S.M., Su L.D., Gupta S., LeBoit P.E. Scleromyxedema-like cutaneous diseases in renal-dialysis patients. Lancet. 2000; 356: 1000-1.Cowper S.E., Robin H.S., Steinberg S.M., Su L.D., Gupta S., LeBoit P.E. Scleromyxedema-like cutaneous diseases in renal-dialysis patients. Lancet. 2000; 356: 1000-1.Morcos S.K., Haylor J. Pathophysiology of nephrogenic systemic fibrosis: a review of experimental data. World J Radiol. 2010; 2(11): 427-33.Morcos S.K., Haylor J. Pathophysiology of nephrogenic systemic fibrosis: a review of experimental data. World J Radiol. 2010; 2(11): 427-33.Idee J.M., Port M., Dencausse A., Lancalot E., Corot C. Involvement of Gadolinium chelates in the mechanism of nephrogenic systemic fibrosis: an update. Radiol Clin North Am. 2009; 47: 855-69.Idee J.M., Port M., Dencausse A., Lancalot E., Corot C. Involvement of Gadolinium chelates in the mechanism of nephrogenic systemic fibrosis: an update. Radiol Clin North Am. 2009; 47: 855-69.Idee J.M., Fretellier N., Robic C., Corot C. The role of Gadolinium chelates in the mechanism of nephrogenic systemic fibrosis: a critical update. Crit Rev Toxicol. 2014; 44: 895-913.Idee J.M., Fretellier N., Robic C., Corot C. The role of Gadolinium chelates in the mechanism of nephrogenic systemic fibrosis: a critical update. Crit Rev Toxicol. 2014; 44: 895-913.Frenzel T., Lengsfeld P., Schirmer H., Hutter J., Wein-mann H.J. Stability of gadolinium-based magnetic resonance imaging contrast agents in human serum at 37 °C. Invest. Radiol. 2008; 43(12): 817-28.Frenzel T., Lengsfeld P., Schirmer H., Hutter J., Wein-mann H.J. Stability of gadolinium-based magnetic resonance imaging contrast agents in human serum at 37 °C. Invest. Radiol. 2008; 43(12): 817-28.ESUR 10.0. European Society of Urogenital Radiology Guidelines on contrast agents version 10.0. 2018. European Society of Urogenital Radiology website; 2018. Available at: http://www.esur-cm.org/index.php/en/ (accessed 01 February 2019).ESUR 10.0. European Society of Urogenital Radiology Guidelines on contrast agents version 10.0. 2018. European Society of Urogenital Radiology website; 2018. Available at: http://www.esur-cm.org/index.php/en/ (accessed 01 February 2019).Смирнов А.В., Шилов Е.М., Добронравов В.А., Каюков И.Г., Бобкова И.Н., Швецов М.Ю. и др. Хроническая болезнь почек: основные принципы скрининга, диагностики, профилактики и подходы к лечению. Нефрология. 2012; 16(1): 85-115.Smirnov A.V., Shilov E.M., Dobronravov V.A., Kayukov I. G., Bobkova I.N., Shvetsov M.Y. et al. Chronic kidney disease: basic principles of screening, diagnosis, prevention and treatment approaches. Nephrology. 2012; 16(1): 85-115 (in Russ.).National Kidney Foundation. K/DOOI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification and Stratification. Am J Kidney Dis. 2002; 39 (Suppl 1): S1-S266.National Kidney Foundation. K/DOOI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification and Stratification. Am J Kidney Dis. 2002; 39 (suppl 1): S1-S266.European Best Practice Guidelines, Expert Group on Hemodialysis, European Renal Association. Section I. Measurement of renal function, when to refer and when to start dialysis. Nephrol Dial Transplant. 2002; 17 [suppl 7]: 7-15.European Best Practice Guidelines, Expert Group on Hemodialysis, European Renal Association. Section I. Measurement of renal function, when to refer and when to start dialysis. Nephrol Dial Transplant. 2002; 17 [suppl 7]: 7-15.Levey A.S., Eckardt K.U., Tsukamoto Y., Levin A., Coresh J., Rossert J. et al. Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2005; 67(6): 2089-100.Levey A.S., Eckardt K.U., Tsukamoto Y., Levin A., Coresh J. , Rossert J. et al. Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2005; 67(6): 2089-100.Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Inter. 2013; 3 (Supple): 1-150.Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Inter. 2013; 3 (Supple): 1-150.Walser M. Assess infernal function from creatinine measurement in adults with chronic renal failure. An J Kidney Dis 1998; 32(1): 23-31.Walser M. Assess infernal function from creatinine measurement in adults with chronic renal failure. An J Kidney Dis 1998; 32(1): 23-31.Levey A.S., Stevens L.A., Schmid C.H., Zhang Y.L., Castro A.F. 3rd, Feldman H.I. et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009; 150: 604-12.Levey A.S., Stevens L.A., Schmid C.H., Zhang Y.L., Castro A.F. 3rd, Feldman H.I. et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009; 150: 604-12.Шалягин Ю.Д., Нагайцева С.С., Швецов М.Ю. и др. Снижение скорости клубочковой фильтрации как маркер хронической болезни почек: частота встречаемости и клинические ассоциации (по данным обследования пациентов терапевтического профиля, госпитализированных в Коломенскую ЦРБ). VII Съезд Научного Общества Нефрологов России, сборник тезисов. Москва; октябрь 2010. С. 140-1.Shalyagin Y.D., Nagaytseva S.S., Shevtsov M.Y. et al. Reduced glomerular filtration rate as a marker of chronic kidney disease: incidence and clinical associations (according to the survey of therapeutic patients hospitalized in Kolomenskaya CCH). VII Congress of the scientific society of Nephrologists of Russia, collection of abstracts. Moscow; October 2010. P. 140-1 (in Russ.).Нагайцева С.С., Швецов М.Ю., Лукшина Л.П., Бур-ба С.В., Гарпищенко А.Г., Герасимов А.Н. и др. Впервые выявленная хроническая болезнь почек среди пациентов терапевтического стационара: роль расчета скорости клубочковой фильтрации по методу CKD-EPI. Клиническая медицина. 2015; (93)7: 56-61.Nagaitseva S.S., Shvetsov M.Y., Lukshina L.P., Burba S.V., Garpishchnko A.G., Gerasimov A.N. et al. Newly-diagnosed chronic kidney disease in patients of a therapeutic clinic: the role of GFR calculation by the CKD-EPI formula. Klin Med (in Russ). 2015; (93)7: 56-61.American College of Radiology. Manual on contrast media version 10.3. 2018. American College of Radiology website; 2018. Available at: https://www.acr.org/yme-dia/ACR/Files/Clinical-Resources/Contrast_Media.pdf (accessed 01 February 2019).American College of Radiology. Manual on contrast media version 10.3. 2018. American College of Radiology website; 2018. Available at: https://www.acr.org/7me-dia/ACR/Files/Clinical-Resources/Contrast_Media.pdf (accessed 01 February 2019).Tombach B., Bremer C., Reimer P., Kisters K., Scae-fer R.M., Geens V. et al. Renal tolerance of a neutral gadolinium chelate (gadobutrol) in patients with chronic renal failure: results of a randomized study. Radiology. 2001; 218: 651-7.Tombach B., Bremer C., Reimer P., Kisters K., Scae-fer R.M., Geens V. et al. Renal tolerance of a neutral gadolinium chelate (gadobutrol) in patients with chronic renal failure: results of a randomized study. Radiology. 2001; 218: 651-7.Willson J., Gleghorn K., Seigel O., Kelly B. Nephrogenic systemic fibrosis: A 15-year retrospective study at a single tertiary care center. J Am Acad Dermatol. 2017. Aug; 77(2): 235-40.Willson J., Gleghorn K., Seigel O., Kelly B. Nephrogenic systemic fibrosis: A 15-year retrospective study at a single tertiary care center. J Am Acad Dermatol. 2017. Aug; 77(2): 235-40.ESUR 8.1. European Society of Urogenital Radiology Guidelines on contrast agents. Version 8.1. 2012. European Society of Urogenital Radiology website; 2012. Available at: http://www.esur.org/guidelines/ (accessed 01 February 2019).ESUR 8.1. European Society of Urogenital Radiology Guidelines on contrast agents. Version 8.1. 2012. European Society of Urogenital Radiology website; 2012. Available at: http://www.esur.org/guidelines/ (accessed 01 February 2019).Soulez G., Bloomgarden D.C., Rofsky N.M., Smith M.P., Abujudeh H.H. et al. Prospective cohort study of nephrogenic systemic fibrosis in patients with Stage 3-5 chronic kidney disease undergoing MRI with injected Gadobenate dimeglumine or Gadoteridol. Am J Roentgenol. 2015; 205:469-78.Soulez G., Bloomgarden D.C., Rofsky N.M., Smith M.P., Abujudeh H.H. et al. Prospective cohort study of nephrogenic systemic fibrosis in patients with Stage 3-5 chronic kidney disease undergoing MRI with injected Gadobenate dimeglumine or Gadoteridol. Am J Roentgenol. 2015; 205:469-78.Young L.K., Matthew S.Z., Houston J.G. Absence of potential gadolinium toxicity symptoms following 22,897 gadoteric acid (Dotarem®) examinations, including 3,209 performed on renally insufficient individuals. Eur Radiology. 2018; Oct 1. DOI: 10.1007/s00330-018-5737-zYoung L.K., Matthew S.Z., Houston J.G. Absence of potential gadolinium toxicity symptoms following 22,897 gadoteric acid (Dotarem®) examinations, including 3,209 performed on renally insufficient individuals. Eur Radiology. 2018; Oct 1. DOI: 10.1007/s00330-018-5737-zMichaely H.J., Aschauer M., Deutschmann H., Bongartz G., Gutberlet M., Woiter R. et al. Gadobutrol in renally impaired patients: results of the GRIP study. Invest Radiol. 2017 Jan; 52(1): 55-60.Michaely H.J., Aschauer M., Deutschmann H., Bongartz G., Gutberlet M., Woiter R. et al. Gadobutrol in renally impaired patients: results of the GRIP study. Invest Radiol. 2017 Jan; 52(1): 55-60.Girardi M., Kay J., Elston D.M., Leboit P.E., Abu-Alfa A., Cowper S.E. Nephrogenic systemic fibrosis: clinicopath-ological definition and workup recommendations. J Am Acad Dermatol. 2011; 65: 1095.e7-1106.e7.Girardi M., Kay J., Elston D.M., Leboit P.E., Abu-Alfa A., Cowper S.E. Nephrogenic systemic fibrosis: clinicopath-ological definition and workup recommendations. J Am Acad Dermatol. 2011; 65: 1095.e7-1106.e7.

The authors declare that there are no conflicts of interest present.