If no risk factors for reduced renal function were identified at screening, new laboratory testing for
eGFR does not need to be done.
Identifying At-Risk Inpatients
For all inpatients, eGFR level should be obtained within two days prior to any GBCA administration.
In addition, the ordering health professional should assess inpatients for the possibility of AKI, as eGFR
calculation alone has limited sensitivity for the detection of AKI.
General Recommendations for Imaging Patients at Risk for NSF
Once a patient at risk for NSF is identified, alternative diagnostic examinations that do not employ
a GBCA should be considered. In nonemergent or nonurgent cases if the potential benefits of a GBCAenhanced
MRI are felt to outweigh the risk of NSF in an individual patient and there is no suitable
alternative, the referring physician and patient should be informed of the risks of GBCA administration, and
both should agree with the decision to proceed. In emergent or urgent cases it may not always be possible
to inform the patient or referring physician prior to GBCA administration.
If the decision is made to administer a GBCA to a patient at increased risk for developing NSF, the
supervising radiologist (including the name) should document the reason for the examination and the
rationale for use of intravenous GBCA.
Group I agents (see table at end of chapter), the GBCAs that have been most often associated with NSF,
have been contraindicated by the FDA in these patients [24]. Alternative agents should be used.
The lowest possible dose of GBCA required to obtain the needed clinical information should be used,
and it should generally not exceed the recommended single dose