Beruflich Dokumente
Kultur Dokumente
Fortaleza-CE
2016
KENARD SILVA BRITO
Fortaleza-CE
2016
KENARD SILVA BRITO
Aprovada em ____/_____/_____
BANCA EXAMINADORA
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Orientador
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minha me Regina Celi Silva Brito e ao meu pai Francisco Das Chagas Brito por
me ensinarem a ser forte e no baixar a cabea, exemplos de humildade!
Gadolinium is a chemical element with symbol Gd and number atomic 64. Gadolinium
contrast medium contains complex molecules, that is, an arrangement of atoms.This
improves the diagnostic accuracy of the MRI scan. it increases the visibility of
inflammation, a tumour or growth, blood vessels and assesses the blood flow to organs
such as the brain and heart. Gadolinium contrast medium is generally very safe. Side
effects or reactions are uncommon but may occur. Gadolinium contrast medium should
be avoided in patients with reduced kidney function or kidney failure (either chronic or
acute), and hepatorenal syndrome. Nephrogenic systemic fibrosis (NSF), a debilitating
disease resulting in skin contractures (or localised skin thickening and tightening) and
internal organ damage has occurred with some gadolinium based contrast agents in a
minority of patients who had pre-existing severe kidney function abnormalities
A dose usual para estudos no vasculares de 0,1 mmol/kg, sendo mais elevada
para estudos de angioressonncia. Em indivduos com funo renal normal, o gadolnio
se equilibra rapidamente entre o plasma e o interstcio, com meia-vida de 2 horas e
eliminado atravs da filtrao glomerular, sem contribuio da secreo tubular, com
clearance renal variando de 1,1 a 1,6 ml/kg/min. Mais de 95% da dose injetada
eliminada em 24hs e menos de 3% eliminada nas fezes. Em pacientes com insuficincia
renal avanada (estgio 5) a farmacocintica dos complexos com gadolnio est
alterada. Devido ao relativo baixo peso molecular (500 Da), pequeno volume de
distribuio (0,28 l/kg) e pouca ligao protica, estes so facilmente removveis com
hemodilise, mas no pela dilise peritoneal(7). Em um estudo, a meia-vida do gadolnio
em paciente com doena renal crnica foi de 34,3 horas e diminuiu para 2,6 horas nos
que receberam hemodilise, enquanto que nos pacientes mantidos em dilise peritoneal
permaneceu por 52,7 horas(9).
2.0 Complicaes dos meios de contraste base de Gd
Epidemiologia
Etiologia
Achados Clnicos
Manifestaes cutneas
Manifestaes sistmicas
Tratamento
1 Evitar o uso em pacientes com insuficincia renal, pelo menos at que seja
esclarecida qual a real participao destes agentes no desenvolvimento da FNS. Para
isso, necessrio identificar quais os pacientes de risco para a FNS, de acordo com a
recomendao da FDA: a) insuficincia renal grave aguda ou crnica (taxa de filtrao
glomerular < 30 ml/min/1,73 m); b) disfuno renal aguda relacionada sndrome
hepatorrenal ou no perodo periope ratrio de transplante heptico. Os meios de
contraste a serem evitados so: Omniscan, Magnevist e OptiMARK. Todavia,
prudente considerar todos os agentes base de Gd at que novas evidncias apaream.
Caso seja necessria a realizao de RM com injeo de contraste nesses pacientes,
deve-se considerar que seja utilizado o menor volume possvel e que eles sejam
submetidos a hemodilise logo aps o procedimento (o ideal seriam trs sees de
hemodilise em dias seguidos).
medida que novas fontes fisiolgicas de ons de cobre e zinco vazam para o
espao intravascular, na tentativa de restabelecer o equilbrio de sua concentrao, elas
tambm deslocam mais Gd do que quelato. Este ciclo continua at que todo o Gd
quelado eliminado do corpo pelos rins, pela filtrao glomerular. Por esta razo, h
uma preocupao potencial quanto ao nvel do on Gd livre em casos de insuficincia
renal, assim como em pacientes com menor taxa de depurao renal de todas essas
substncias do corpo. No est muito bem estabelecida a segurana da administrao de
meios de contraste base de Gd em pacientes com distrbios da funo renal ou
insuficincia renal franca. Alguns estudos sugerem que eles so bem tolerados.
O Magnevist pode ser dialisado, com mais de 95% da dose administrada sendo
removida ao terceiro tratamento de dilise (41).
Caractersticas fsico-qumicas dos contrastes para RM disponveis comercialmente.
Meios de Nomes Gd-DTPA Gd-DOTA Gd-HP-DO3A Gd-DTPA-BMA Gd-BOPTA Gd-DO3A-butrol Gd-DTPA-
BMEA
contraste genricos gadopentetate gadoterate gadoteridol gadobenate
gadodiamide gadobutrol gadoversetamide
dimeglumine meglumine (0,5 mol/l) dimeglumine
(0,5 mol/l) (1.0 mol/l) (0,5 mol/l)
(0,5 mol/l) (0,5 mol/l) (0,5 mol/l)
Viewgam
de estabilidade
termodinmica
(log Keq)
de estabilidade
condicional
em pH 7,4
(osm/kg)
(mPa.s a 37 C)
(l/mmol/s) 0,47
T,
plasma
(mg/ml)
de quelante
(mg/ml)
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