Q: 52 year old male with history of hypertension and Chronic Kidney Disease with last known Glomerular Filtration Rate(GFR) 25mL/min (but not on hemodialysis) presented with acute chest pain radiating to back with high suspicion of Aortic dissection. ER resident obtained Gadolinium based magnetic resonance imaging(MRI/MRA) for better images. Now you are worried about Nephrogenic Systemic Fibrosis. What would be your next step?



Answer: Perform Hemodialysis (HD)

Hemodialysis immediately after gadolinium removes most of the contrast agent, followed by second session next day.



References:

1. Saitoh T, Hayasaka K, Tanaka Y, et al. Dialyzability of gadodiamide in hemodialysis patients. Radiat Med 2006; 24:445. 

2. Okada S, Katagiri K, Kumazaki T, Yokoyama H. Safety of gadolinium contrast agent in hemodialysis patients. Acta Radiol 2001; 42:339.