Tuesday, November 3, 2015

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.


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.

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