American Board of Internal Medicine (ABIM) Certification Practice Exam

In patients with an estimated glomerular filtration rate of less than what value is gadolinium use in MRI studies contraindicated?

1. 20 mL/min/1.73 m2

2. 40 mL/min/1.73 m2

3. 30 mL/min/1.73 m2

4. 10 mL/min/1.73 m2

The correct answer is: 30 mL/min/1.73 m2

The use of gadolinium in MRI studies is contraindicated in patients with an estimated glomerular filtration rate (eGFR) less than 30 mL/min/1.73 m² due to the risk of nephrogenic systemic fibrosis (NSF). NSF is a serious and potentially life-threatening condition that can occur in patients with kidney impairment following exposure to gadolinium-based contrast agents. Maintaining a threshold of 30 mL/min/1.73 m² helps to ensure that the renal function is sufficient to eliminate the contrast agent. In patients with eGFR below this level, the likelihood of gadolinium accumulation increases, raising the risk for adverse effects like NSF. While patients with eGFR values below 30 might still undergo an MRI with gadolinium under certain conditions or protocols, guidelines generally recommend avoiding the use of gadolinium altogether in this population to safeguard against those risks. This threshold is grounded in clinical practice and safety guidelines established by nephrology and radiology associations.