Iodine-based contrast media, multiple myeloma and monoclonal gammopathies: literature review and ESUR Contrast Media Safety Committee guidelines

On behalf of the ESUR Contrast Media Safety Committee, Gertraud Heinz-Peer

Research output: Journal article (peer-reviewed)Review article

24 Citations (Scopus)

Abstract

Objectives: Many radiologists and clinicians still consider multiple myeloma (MM) and monoclonal gammopathies (MG) a contraindication for using iodine-based contrast media. The ESUR Contrast Media Safety Committee performed a systematic review of the incidence of post-contrast acute kidney injury (PC-AKI) in these patients. Methods: A systematic search in Medline and Scopus databases was performed for renal function deterioration studies in patients with MM or MG following administration of iodine-based contrast media. Data collection and analysis were performed according to the PRISMA statement 2009. Eligibility criteria and methods of analysis were specified in advance. Cohort and case-control studies reporting changes in renal function were included. Results: Thirteen studies were selected that reported 824 iodine-based contrast medium administrations in 642 patients with MM or MG, in which 12 unconfounded cases of PC-AKI were found (1.6 %). The majority of patients had intravenous urography with high osmolality ionic contrast media after preparatory dehydration and purgation. Conclusions: MM and MG alone are not risk factors for PC-AKI. However, the risk of PC-AKI may become significant in dehydrated patients with impaired renal function. Hypercalcaemia may increase the risk of kidney damage, and should be corrected before contrast medium administration. Assessment for Bence-Jones proteinuria is not necessary. Key Points: • Monoclonal gammopathies including multiple myeloma are a large spectrum of disorders. • In monoclonal gammopathy with normal renal function, PC-AKI risk is not increased. • Renal function is often reduced in myeloma, increasing the risk of PC-AKI. • Correction of hypercalcaemia is necessary in myeloma before iodine-based contrast medium administration. • Bence-Jones proteinuria assessment in myeloma is unnecessary before iodine-based contrast medium administration.

Original languageEnglish
Pages (from-to)683-691
Number of pages9
JournalEuropean Radiology
Volume28
Issue number2
DOIs
Publication statusPublished - 1 Feb 2018

Keywords

  • Acute kidney injury
  • Contrast media
  • Monoclonal gammopathies
  • Multiple myeloma
  • Renal failure
  • Contrast Media/adverse effects
  • Acute Kidney Injury/chemically induced
  • Europe
  • Humans
  • Risk Factors
  • Paraproteinemias/diagnosis
  • Multiple Myeloma/diagnosis
  • Incidence
  • Iodine/adverse effects
  • Societies, Medical
  • Radiology

ASJC Scopus subject areas

  • Radiology, Nuclear Medicine and Imaging

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