Question

According to ACR guidelines, a Group II gadolinium-based contrast agent (lowest risk of nephrogenic systemic fibrosis) can be safely administered in which of the following?

• A. A patient with GFR <50 mL/min/1.73m²
• B. A 30-year-old with no renal function test done
• C. A 60-year-old with no renal function test done
• D. A child with normal renal function

Hint:

Group II agents = macrocyclic, negligible NSF risk → usable even when renal function is poor.

Answer 1

The Correct Option is A

The question hinges on the ACR risk stratification of gadolinium-based contrast for nephrogenic systemic fibrosis (NSF). Linear agents (Group I) carry the greatest risk, macrocyclic agents (Group II) carry a negligible risk, and Group III agents have insufficient data.

The defining feature of Group II agents is that their association with NSF is so weak that the ACR does not require routine eGFR measurement before use and permits administration even in patients with impaired kidneys. So the scenario that best demonstrates safe Group II use is the patient whose renal function is known to be reduced.

Among the options, the patient with GFR $<50$ mL/min directly tests this principle — a Group II agent remains safe despite the low GFR. The two "no RFT" choices are about whether screening is needed (a separate issue), and the child with normal renal function does not showcase the renal-impairment advantage of Group II agents.

Hence the correct response is the low-GFR patient.
\[\boxed{\text{GFR }<50\text{ — Group II GBCA is safe}}\]