Hair and fingernail gadolinium ICP-MS contents in an overdose case associated with nephrogenic systemic fibrosis

Nephrogenic systemic fibrosis (NSF) is a rare acquired disorder affecting renal insufficiency patients. There is a growing recognition of the association between the rapid rise in the use of gadolinium (Gd)-containing contrast agents for magnetic resonance imaging (MRI), and the occurrence of acute nephrogenic systemic fibrosis. This case report concerns a 62-year-old woman with chronic renal insufficiency who underwent numerous MRI examinations using Gd-based contrast agents. For the first time, to our knowledge, Gd was performed in the NSF patient's blood, as well as in hair and in fingernails by inductively plasma coupled mass spectrometry. Gd contents in blood, hair and in fingernails were initially 300 to 1000 times higher compared to controls. These results are a new illustration of the strong association between the frequent use of Gd-based contrast media and NSF in patients with kidney diseases. Gd quantitative determination could be of major interest for patients with renal failure who are required to undergo repeated gadolinium-enhanced MRI examinations.