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Nephrotoxicity of Iopamidol in Pediatric, Adolescent, and Young Adult Patients Who Have Undergone Allogeneic Bone Marrow Transplantation¹

¹ From the Departments of Hematology-Oncology (A.E.H., L.C.B.), Diagnostic Imaging (S.C.K.), and Biostatistics and Epidemiology (O.G.G., X.P.X.), St Jude Children’s Research Hospital, 332 N Lauderdale, Memphis, TN 38105-2794; and Department of Radiology, University of Tennessee, Memphis (S.C.K.). Received September 4, 2001; revision requested October 29; final revision received May 24, 2002; accepted June 24. Supported in part by grant P01 CA-20180, Cancer Center Support (CORE) grant P30 CA-21765 from the National Cancer Institute, and the American Lebanese Syrian Associated Charities. Address correspondence to S.C.K. (e-mail: sue.kaste@stjude.org).

PURPOSE: To assess the effects of the low-osmolar contrast agent iopamidol and antimicrobial drugs on renal function in pediatric, adolescent, and young adult patients who have undergone bone marrow transplantation (BMT).

MATERIALS AND METHODS: A retrospective review of records of 120 consecutive pediatric patients who underwent allogeneic BMT in 1997 or 1998 was performed. Eighty-nine patients (median age, 8.1 years) fulfilled study eligibility criteria. Cumulative doses of nephrotoxic antimicrobial drugs were recorded, as well as serum creatinine and blood urea nitrogen concentrations from 24 hours before to 72 hours after each administration of iopamidol during a computed tomographic examination performed within 100 days after BMT. Random coefficient models were used to estimate nephrotoxic effects.

RESULTS: Mean baseline glomerular filtration rate was 130.2 mL/min/1.73 m², and mean baseline creatinine concentration was 0.51 mg/dL (45 µmol/L). Older age at BMT (P < .001), use of foscarnet (P = .003), and receipt of iopamidol (P = .073) each prompted a rise in serum creatinine concentration. The antiviral drug foscarnet was associated with the largest increase in the creatinine level; the use of iopamidol effected a relatively small rise in creatinine level.

CONCLUSION: Iopamidol nephrotoxicity was negligible in this cohort of pediatric patients who had undergone allogeneic BMT, even in the presence of elevated renal function levels.

© RSNA, 2003

Index terms: Abdomen, CT, 70.12112, 80.12112 • Bone marrow, transplantation • Contrast media, effects • Contrast media, toxicity • Kidney, effects of drugs on, 81.64 • Thorax, CT, 50.12112, 60.12112