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Gadolinium and nephrogenic systemic fibrosis: an update
Alex Weller1, Joy L Barber, Oystein E Olsen
1Department of Radiology, St George's Hospital NHS Trust, Blackshaw Road, London, SW17 0QT, UK, alweller@gmail.com.
Pediatric Nephrology (Berlin, Germany)
|October 23, 2013
Summary
Nephrogenic systemic fibrosis (NSF), a severe condition linked to gadolinium contrast agents in MRI, has significantly decreased in patients with kidney issues following guideline changes. Vigilance and safer contrast agents are recommended.
Area of Science:
- Nephrology
- Radiology
- Toxicology
Background:
- Nephrogenic systemic fibrosis (NSF) is a debilitating, potentially fatal multisystem disease exclusively affecting patients with renal impairment.
- A strong association exists between NSF and the use of gadolinium-based contrast agents (GBCAs) during magnetic resonance imaging (MRI).
- Risk factors for NSF include pre-existing renal impairment and acute proinflammatory conditions such as major surgery or vascular events.
Purpose of the Study:
- To review the incidence, risk factors, and management of Nephrogenic systemic fibrosis (NSF).
- To assess the impact of GBCAs on patients with kidney disease.
- To evaluate the effectiveness of new guidelines in reducing NSF cases, particularly in pediatric populations.
Main Methods:
- Review of existing literature and case reports on Nephrogenic systemic fibrosis (NSF).
- Analysis of the association between gadolinium-based contrast agents (GBCAs) and NSF development.
- Evaluation of the impact of implemented guidelines on NSF incidence.
Main Results:
- Implementation of guidelines restricting GBCAs in at-risk patients led to a sharp reduction in new NSF cases.
- No new cases of NSF have been reported in children after guideline implementation.
- Restoration of renal function, via recovery or transplantation, offers the most successful outcomes for NSF patients.
Conclusions:
- Guidelines restricting GBCAs in patients with renal impairment have been effective in reducing NSF.
- Continued vigilance, including screening for renal impairment and using safer GBCAs, is crucial.
- Consideration of alternative imaging modalities or non-contrast-enhanced MRI is recommended for at-risk patients.
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