[Nephrogenic systemic fibrosis possibly caused by gadolinium-containing contrast agent]

Area of Science:

• Nephrology
• Dermatology
• Radiology

Background:

• Nephrogenic systemic fibrosis (NSF) is a recently identified disorder affecting patients with renal insufficiency.
• The condition is characterized by progressive fibrosis of the skin and other organs.

Observation:

• A 34-year-old woman with end-stage renal disease presented with severe skin thickening, hardening, and joint contractures.
• Skin biopsy revealed marked dermal and subcutaneous fibrosis with CD34-positive fibrocytes.
• Autoimmune markers were negative, except for antinuclear antibodies.

Findings:

• The patient's clinical presentation and biopsy findings were consistent with nephrogenic systemic fibrosis (NSF).
• While the exact cause remains unknown, gadolinium-based contrast agents are implicated in NSF pathogenesis.
• Histopathology demonstrated significant fibrotic changes characteristic of NSF.

Implications:

• The Dutch Medicines Evaluation Board restricted the use of specific gadolinium contrast agents (gadodiamide, gadopentetate dimeglumine) in patients with severe renal failure or post-liver transplantation.
• Caution is advised for other gadolinium agents in patients with moderate renal insufficiency to prevent NSF.
• These findings underscore the importance of evaluating contrast agent safety in patients with impaired kidney function.