Urinary gadolinium (Gd) provides an indication of recent or ongoing exposure to the metal, and endogenous detoxification to a lesser extent. Urinary Gd would be expected to be variably high if urine was collected within a week of medicinal Gd administration for imaging purposes.
Gd is found in the environment in geographically variable amounts, and usually at very low levels. It is widely used in industrial and household applications such as radar technologies, compact discs, and microwaves; direct exposure from such sources is not a concern. However disposal of Gd-containing devices contributes to greater potential for human exposure. The single greatest direct source of exposure to Gd is Gd-based contrast agents (GBCAs) that are widely used with magnetic resonance imaging (MRI).
Concern has been raised regarding the use of unstable linear GBCAs, especially for patients with mild to severe kidney dysfunction. Urinary Gd levels vary with the time after administration, and the dose of the specific GBCA. There is much controversy regarding the safety of certain unstable GBCAs; Gd doesn’t have physiological functions in the body.
Urinary levels of Gd normally decrease rapidly after administration for patients who have good kidney function (glomerular filtration rate; GFR). However, the rate of Gd clearance may be markedly slowed with compromised GFR. While the Gd levels normally decrease rather rapidly in urine and feces, it is clear that some Gd is retained in the body for a long time. Of greatest potential concern is Gd deposition in the brain, which is correlated with the number of GBCA-enhanced MRI procedures.
Gadolinium deposition disease has recently been described and may be associated with central and peripheral pain, headache, bone pain, skin thickening, muscle weakness, arthralgia, and persistent clouded mentation and headache. If such new symptoms appear 2-8 weeks after Gd-enhanced MRI, it is recommended to assess the level of Gd in urine (1st AM void or 24 hour collection).
Elemental analysis of hair or nails may be used to assess exposure to Gd over a longer period of time, but reference values are not available for nails. Chelation may acutely increase urinary excretion of Gd.
Gadolinium
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