Gadodiamide-Associated Nephrogenic Systemic Fibrosis: Why Radiologists Should Be Concerned

Broome, Dale R.; Girguis, Mark S.; Baron, Pedro; Cottrell, Alfred; Kjellin, Ingrid; Kirk, Gerald A.

doi:10.2214/ajr.06.1094

Cited by 553 publications

(419 citation statements)

References 21 publications

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“…This suggests that NSF risk can be substantially reduced in acute renal failure patients by either dialyzing shortly after GBCA injection or by delaying the MRI until after the serum creatinine has peaked and the renal failure is beginning to resolve. Another article, however, reported failure of low-intensity dialysis to prevent NSF (11,83), indicating the importance of ensuring that a full, comprehensive dialysis is performed shortly following GBCA administration.…”

Section: Acute Vs Chronic Renal Failurementioning

confidence: 99%

Risk factors for NSF: A literature review

Prince

Zhang

Roditi

et al. 2009

Magnetic Resonance Imaging

110

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Emerging evidence linking gadolinium-based contrast agents (GBCAs) to nephrogenic systemic fibrosis (NSF) has changed medical practice patterns toward forgoing GBCA-enhanced magnetic resonance imaging (MRI) or substituting other imaging methods, which are potentially less accurate and often radiation-based. This shift has been based on reports of high NSF incidence at sites where a confluence of risk factors occurred in patients with severe renal dysfunction. This review article explores the factors that affect NSF risk, compares risks of alternative imaging procedures, and demonstrates how risk can be managed by careful selection of GBCA dose, timing of injection with respect to dialysis, and other factors. Nearly half of NSF cases are a milder form that does not cause contractures or reduce mobility. It appears that eliminating even a single risk factor can reduce NSF incidence/risk at least 10-fold. Elimination of multiple risk factors by using single-dose GBCA, dialyzing dialysis patients quickly following GBCA administration, avoiding GBCA in acute renal failure while serum creatinine is rising, and avoiding nonionic linear GBCA in renal failure patients may reduce NSF risk more than a thousand-fold, thereby allowing safe GBCA-enhanced MRI in virtually all patients.

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Section: Acute Vs Chronic Renal Failurementioning

confidence: 99%

Risk factors for NSF: A literature review

Prince

Zhang

Roditi

et al. 2009

Magnetic Resonance Imaging

110

View full text Add to dashboard Cite

show abstract

“…It is believed that prolonged exposure to this agent occurs in the setting of reduced renal clearance and that Gd dissociated from its ligand will deposit in tissues, including skin, and lead to activation of the fibrotic process associated with NSF (33,(37)(38)(39). NSF is primarily a disease affecting patients with severely impaired renal function, usually less than 15 mL/min (40) and mostly affecting patients on dial-ysis Furthermore, NSF risk and severity appears to correlate with dose; a higher single dose, but also cumulative total gadodiamide dose (41,42). It has been found, for example, that dialysis patients who developed NSF had been given a cumulative average dose of 0.35 mmol/kg of gadodiamide (29).…”

Section: Gadolinium Agent Utilization and Safetymentioning

confidence: 99%

Kidney transplantation: Structural and functional evaluation using MR Nephro‐Urography

Kalb

Martín

Salman

et al. 2008

Magnetic Resonance Imaging

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End-stage-renal disease (ESRD) is a major health issue in the United States, and the Medicare costs of ESRD totaled nearly $21 billion in 2005. Renal transplantation has emerged as the treatment of choice in this patient population, providing improved quality of life and lower healthcare costs compared with other treatment options. Imaging evaluation of a graft kidney plays a critical role in the postoperative care of the renal transplant patient. In the past, diagnostic evaluation of the transplant kidney has depended upon a combination of ultrasonography, computed tomography, MRI, and biopsy, used in conjunction with the patient's clinical presentation. However, new and developing advances in MR technology has lead to the development of MR Nephro-Urography (MRNU), which provides both anatomic and functional evaluation of the kidney in a single examination. It is expected that the increasing use of MRNU will have a significant impact on the management of renal transplant patients. This review describes MRNU methodology, examines known posttransplant complications, and highlights the utility of MRNU as a comprehensive imaging examination to diagnose both surgical and medical complications of the transplant kidney.

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“…No gadolinium was identified in a tissue sample from any patient without NSF. Other metals found in the tissues of NSF patients included large deposits of iron, copper, and zinc (23,25,52), and this in itself may betoken transmetallation. Of particular interest is their determination that in all four cases the gadolinium was intracellular.…”

Section: Stability In Practicementioning

confidence: 99%

“…In addition to the phenomenon of CIN with the Gd chelates, we have seen the emergence of a new condition, nephrogenic systemic fibrosis (NSF), which is associated with, if as yet not definitively proven to be caused by, Gd chelate administration to patients with end-stage renal failure (ESRF) and perhaps other serious medical conditions (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26).…”

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confidence: 99%

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Nephrogenic systemic fibrosis: Possible mechanisms and imaging management strategies

Dawson

2008

Magnetic Resonance Imaging

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Gadodiamide-Associated Nephrogenic Systemic Fibrosis: Why Radiologists Should Be Concerned

Abstract: Development of NSF was strongly associated with gadodiamide administration in the setting of either acute hepatorenal syndrome or dialysis-dependent chronic renal insufficiency.

Cited by 553 publications

References 21 publications

Risk factors for NSF: A literature review

Risk factors for NSF: A literature review

Kidney transplantation: Structural and functional evaluation using MR Nephro‐Urography

Nephrogenic systemic fibrosis: Possible mechanisms and imaging management strategies

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