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Iodine-based contrast media, multiple myeloma and monoclonal gammopathies: literature review and ESUR Contrast Media
Fulvio Stacul1, Michele Bertolotto2, Henrik S Thomsen3
1S.C. Radiologia Ospedale Maggiore, Piazza Ospitale 1, IT-34129, Trieste, Italy.
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.
Insights
Multiple myeloma and monoclonal gammopathies do not increase the risk of post-contrast acute kidney injury (PC-AKI) in patients with normal renal function. However, dehydration and hypercalcemia in these patients can elevate PC-AKI risk.
Area of Science:
- Nephrology
- Radiology
- Oncology
Background:
- Multiple myeloma (MM) and monoclonal gammopathies (MG) are often considered contraindications for iodine-based contrast media due to perceived risks of kidney injury.
- Radiologists and clinicians frequently avoid contrast media in these patient populations.
Purpose of the Study:
- To systematically review the incidence of post-contrast acute kidney injury (PC-AKI) in patients with MM or MG.
- To evaluate the actual risk of PC-AKI associated with iodine-based contrast media in these specific patient groups.
Main Methods:
- A systematic literature search was conducted in Medline and Scopus databases.
- Included studies were cohort and case-control studies reporting renal function changes after contrast administration, adhering to PRISMA guidelines.
- Data collection and analysis followed pre-specified eligibility criteria.
Main Results:
- Thirteen studies involving 824 contrast administrations in 642 patients with MM or MG were analyzed.
- A low incidence of PC-AKI was observed, with only 12 unconfounded cases (1.6%).
- Most administrations involved intravenous urography with high-osmolality contrast media in dehydrated patients.
Conclusions:
- MM and MG alone are not independent risk factors for PC-AKI.
- Dehydrated patients with impaired renal function and hypercalcemia face an increased risk of PC-AKI.
- Correction of hypercalcemia is recommended prior to contrast administration; Bence-Jones proteinuria assessment is unnecessary.
