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Iodine-based contrast media, multiple myeloma and monoclonal gammopathies: literature review and ESUR Contrast Media Safety Committee guidelines.
Eur Radiol 2018; 28(2):683-691ER

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.

Authors+Show Affiliations

S.C. Radiologia Ospedale Maggiore, Piazza Ospitale 1, IT-34129, Trieste, Italy.Department of Radiology, University of Trieste, Strada di Fiume 447, IT-34149, Trieste, Italy.Department of Diagnostic Radiology 54E2, Copenhagen University Hospital Herlev, Herlev Ringvej 75, DK-2730, Herlev, Denmark. Henrik.Thomsen@regionh.dk.Department of Medical and Surgical Sciences, University of Trieste, Piazza Ospitale 1, IT-34129, Trieste, Italy.Department of Internal Medicine, University of Genoa, Genoa, Italy. Unit of Clinical Epidemiology, IRCCS, Azienda Ospedaliera Universitaria San Martino-IST-Istituto Nazionale per la Ricerca sul Cancro, Largo Rosanna Benzi 10, IT-16132, Genoa, Italy.Service Central de Radiologie Hôpital Paul Brousse 14, av. P.-V.-Couturier, F-94807, Villejuif, France.Department of Diagnostic Radiology, University Hospitals of Basel, Petersgaben 4, CH-4033, Basel, Switzerland.Department of Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 20, rue Leblanc, Paris Cedex 15, F-71015, Paris, France.Department of Radiology, Zentralinstitut für medizinische Radiologie, Diagnostik und Intervention, Landesklinikum St. Pölten, Propst Führer-Straβe 4, St. Pölten, AT-3100, St. Pölten, Austria.Department of Radiology, C2-S, Leiden University Medical Center, NL-2300 RC, Leiden, The Netherlands.Radiology, Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Molkestreet 90, D-76133, Karlsruhe, Germany.Department of Radiology, St. Bartholomew's Hospital, University of London, West Smithfield, London, EC1A 7BE, UK.No affiliation info available

Pub Type(s)

Journal Article
Review
Systematic Review

Language

eng

PubMed ID

28856420

Citation

Stacul, Fulvio, et al. "Iodine-based Contrast Media, Multiple Myeloma and Monoclonal Gammopathies: Literature Review and ESUR Contrast Media Safety Committee Guidelines." European Radiology, vol. 28, no. 2, 2018, pp. 683-691.
Stacul F, Bertolotto M, Thomsen HS, et al. Iodine-based contrast media, multiple myeloma and monoclonal gammopathies: literature review and ESUR Contrast Media Safety Committee guidelines. Eur Radiol. 2018;28(2):683-691.
Stacul, F., Bertolotto, M., Thomsen, H. S., Pozzato, G., Ugolini, D., Bellin, M. F., ... Webb, J. A. W. (2018). Iodine-based contrast media, multiple myeloma and monoclonal gammopathies: literature review and ESUR Contrast Media Safety Committee guidelines. European Radiology, 28(2), pp. 683-691. doi:10.1007/s00330-017-5023-5.
Stacul F, et al. Iodine-based Contrast Media, Multiple Myeloma and Monoclonal Gammopathies: Literature Review and ESUR Contrast Media Safety Committee Guidelines. Eur Radiol. 2018;28(2):683-691. PubMed PMID: 28856420.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Iodine-based contrast media, multiple myeloma and monoclonal gammopathies: literature review and ESUR Contrast Media Safety Committee guidelines. AU - Stacul,Fulvio, AU - Bertolotto,Michele, AU - Thomsen,Henrik S, AU - Pozzato,Gabriele, AU - Ugolini,Donatella, AU - Bellin,Marie-France, AU - Bongartz,Georg, AU - Clement,Olivier, AU - Heinz-Peer,Gertraud, AU - van der Molen,Aart, AU - Reimer,Peter, AU - Webb,Judith A W, AU - ,, Y1 - 2017/08/30/ PY - 2017/04/11/received PY - 2017/08/04/accepted PY - 2017/08/03/revised PY - 2017/9/1/pubmed PY - 2018/7/17/medline PY - 2017/9/1/entrez KW - Acute kidney injury KW - Contrast media KW - Monoclonal gammopathies KW - Multiple myeloma KW - Renal failure SP - 683 EP - 691 JF - European radiology JO - Eur Radiol VL - 28 IS - 2 N2 - 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. SN - 1432-1084 UR - https://www.unboundmedicine.com/medline/citation/28856420/Iodine-based_contrast_media,_multiple_myeloma_and_monoclonal_gammopathies:_literature_review_and_ESUR_Contrast_Media_Safety_Committee_guidelines L2 - https://dx.doi.org/10.1007/s00330-017-5023-5 DB - PRIME DP - Unbound Medicine ER -