CLINICAL NEPHROLOGY: Edited by David S. GoldfarbGadolinium-based contrast agents why nephrologists need to be concernedLeyba, Katarinad; Wagner, Brenta,b,cAuthor Information aKidney Institute of New Mexico bNew Mexico Veterans Administration Health Care System cDepartment of Medicine, University of New Mexico Health Care System dUniversity of New Mexico School of Medicine, Albuquerque, New Mexico, USA Correspondence to Brent Wagner, Director of the Kidney Institute of New Mexico, Renal Section Chief, New Mexico Veterans Administration Health Care System (501/111c), 1501 San Pedro Drive SE, Albuquerque, NM 87108, USA. Tel: +505 925 1065; e-mail: BrWagner@salud.unm.edu Current Opinion in Nephrology and Hypertension: March 2019 - Volume 28 - Issue 2 - p 154-162 doi: 10.1097/MNH.0000000000000475 Buy Metrics Abstract Purpose of review The hegemony of gadolinium-based contrast agent-induced adverse events stretches beyond those who have renal impairment. ‘Nephrogenic’ systemic fibrosis is a misnomer: gadolinium-based contrast agents are the known trigger for the disease; kidney impairment is a risk factor. Impaired (true) glomerular filtration may be one catalyst for gadolinium-based contrast agent-induced adverse events, but it is increasingly evident that the same cluster of symptoms occurs in patients with normal renal function. Recent findings It has been known for nearly 30 years that gadolinium-based contrast agents distribute and are cleared according to a three compartment model. Single doses of gadolinium-based contrast agents can trigger ‘nephrogenic’ systemic fibrosis in nondialysis dependent patients. Manifestations have occurred years after exposure. Renal insufficiency alone is not an adequate explanation for ‘nephrogenic’ systemic fibrosis, and the continuum of its symptoms with the adverse events reported by patients with normal renal function clearly indicate that the physiologic reactions are largely undefined. Summary Gadolinium-based contrast agents should be used with extreme caution. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.