Nephrogenic systemic fibrosis associated with gadolinium based contrast agents: A summary of the medical literature reporting

110

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.

Section: Cyclic Chelatesmentioning

confidence: 99%

Risk factors for NSF: A literature review

Prince

Zhang

Roditi

et al. 2009

110

“…The current understanding of NSF is that almost all cases have been attributed to exposure to gadodiamide, with the remainder of NSF cases associated with gadoversetamide (Optimark) or gadopentetate dimeglumine (Magnevist) exposure. Of all biopsy-proven NSF cases reported in the peer-reviewed literature, as of February 1, 2008, 157 cases have been associated with gadodiamide (34). This represents 96% of the 163 unconfounded cases where documentation showed that a single type of gadolinium-chelate was given to the patient before the onset of NSF; excluding cases where the type of agent was unknown, multiple types of agents were given, or there was no documentation of gadolinium-chelate administration.…”

Section: Gadolinium Agent Utilization and Safetymentioning

confidence: 99%

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

Kalb

Martín

Salman

et al. 2008

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.

“…Several clinical studies have described the following characteristics of NSF lesions: cutaneous thickening of the skin with or without pigment alterations, swelling (mostly of the lower extremities), progressive skin indurations comparable with ''peau d'orange,'' redness, pruritus, and burning sensations (4). The associated skin thickening may also result in joint contractures.…”

mentioning

confidence: 99%

Gadolinium‐based contrast agents and NSF: Evidence from animal experience

Sieber

Steger‐Hartmann

Lengsfeld

et al. 2009

Nephrogenic systemic fibrosis (NSF) is a potentially severe systemic disease typically characterized by fibrosis of the skin and connective tissues. The etiology of NSF is still unknown but is likely to be multifactorial. Specific triggers under scientific evaluation have included surgery and/or the occurrence of thrombosis or other vascular injury, proinflammatory state, the administration of high doses of erythropoietin, and more recently the use of gadolinium-based contrast agents (GBCAs). The aim of this review is to summarize knowledge regarding the pathogenesis of NSF and the potential role of GBCAs in its pathology, with a focus on animal experiments. The potential role of complex stability of GCBAs will be highlighted by results from several in vitro and in vivo experiments in rodent models of NSF.