People who underwent MRIs and MRA scans and were injected with a gadolinium based contrast agent may be at risk for developing a rare disease called Nephrogenic Systemic Fibrosis. People with compromised kidney and liver function are at a particularly higher risk. One interesting study that examines this disease is called, “Nephrogenic systemic fibrosis” by Diego R. Martin – Pediatric Radiology – Volume 38, Supplement 1 – January, 2008. Here is an excerpt: “Abstract – Nephrogenic systemic fibrosis (NSF) is a dermatological fibrosing disease with potential systemic manifestations resulting in mild to severe symptoms including joint contractures. NSF can be lethal in a subset of cases. It has been recently observed that almost all patients with NSF have had severe renal insufficiency and have received prior administrations of gadolinium-based contrast agents (GBCA). This review will focus on the specific evidence from a retrospective study performed at our center in combination with the general experience available. Conclusions summarize our current understanding of NSF. Recommendations are provided for use of GBCA in clinical MRI practice. Conclusions and recommendations include that the risk of inducing NSF is related to higher-dose administrations of GBCA and that there are differences in risk related to differences in gadolinium-chelate formulation, with the highest relative risk associated with gadodiamide (Omniscan, Nycomed Amersham, GE Healthcare, Piscataway, N.J.).”
Another interesting study is called, “Nephrogenic systemic fibrosis” by Samtleben W. – Radiologe. 2007 Sep;47(9):778-84. Here is an excerpt: “A scleromyxedema-like disease was recognized in 1997. In 2000 this disorder was first published and termed nephrogenic fibrosing dermopathy because all patients had advanced renal failure. In 2006 it was discovered that the patients had a history of a preceding contrast-enhanced magnetic resonance imaging (MRI). All patients had acute or chronic severe renal insufficiency with a glomerular filtration rate (GFR) <30 ml/min per 1.73 m(2). So far a total of about 215 patients with this new skin disorder have been reported to international registries. The skin thickening has a typical histology and begins in the peripheral extremities and progresses proximally, including also the abdominal wall and the head in some patients. NSF involves not only the skin, but also the muscles and other organs (e.g., lungs, heart, eyes) in some patients. Therefore the term nephrogenic systemic fibrosis (NSF) was introduced. Skin fibrosis and sclerosis are usually progressive with disabling contractures of involved joints (knees, hands, feet). NSF may be lethal in up to 28% of patients. Spontaneous remissions are rare. No generally accepted treatment is available. So far, the pathogenesis is not well understood. One hypothesis supposes a role of gadolinium liberated from the contrast agents. As patients with acute or chronic advanced renal failure (GFR <30 ml/min per 1.73 m(2)) including those with hepatorenal dysfunctions are at high risk to develop NSF after exposure to gadolinium-based contrast agents, contrast-enhanced MRI should be avoided in this group and alternative diagnostic procedures should be used whenever possible.”
Another interesting study is called, “Nephrogenic systemic fibrosis” by Pintér I, Vágási K, Wittmann I, and Nagy J – Orv Hetil. 2007 Sep 23;148(38):1801-4. Here is an excerpt:
“The nephrogenic systemic fibrosis – referred to in the literature earlier as nephrogenic fibrotizing dermopathy – is a rare clinical entity that develops in patients with renal disease. Its development has been described mainly after the usage of a gadolinium-based MRI contrast medium in patients with impaired renal function, mainly in dialysed patients. The nephrogenic systemic fibrosis is characterized by fibrosis evolving in the distal part of the extremities, and in more severe cases involving the lung, the liver, heart and skeletal muscles. The disease may have a fast progression and fatal outcome if it involves multiple organ systems, in approximately 5% of the cases. Until now, no evidence-based therapy of nephrogenic systemic fibrosis is known, however, in single cases an amelioration has been described after renal transplantation and plasmapheresis, and remission has been described after extracorporal photopheresis.”
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