Published in:
Open Access 01-02-2018 | Contrast Media
Iodine-based contrast media, multiple myeloma and monoclonal gammopathies: literature review and ESUR Contrast Media Safety Committee guidelines
Published in: European Radiology | Issue 2/2018
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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.