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Nephrogenic Systemic Fibrosis Associated with Agents Containing Gadolinium

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Nephrogenic Systemic Fibrosis is a condition that causes the skin on the extremities to become thick and harden, causing debilitation, severe pain, and disfiguring the person that it affects. The condition only occurs in patients with advanced kidney disease or kidney failure and then, only after they have been exposed to a Gadolinium based contrast agent during an MRI or MRA procedure. The condition is considered a rare one, with less that 300 confirmed cases occurring worldwide.

In 2006, a hospital in St. Louis, Missouri informed the CDC that they had found that a number of patients in their dialysis unit had developed cases of Nephrogenic Systemic Fibrosis. In all, 33 patients were confirmed as having the condition. All of the patients had received an injection of a Gadolinium based contrast agent prior to an MRI in the months before the onset of the condition. An investigation was conducted and it concluded that the Gadolinium based contrast agent received prior to the MRI was the most likely cause for the development of Nephrogenic Systemic Fibrosis.

The cases were confirmed by the use of a skin biopsy of the affected areas of the body along with visual confirmation of the condition. The investigation was quickly widened to include all of the St. Louis area, with researchers contacting many hospitals and radiology clinics to see if they had experienced any thing similar. Information was collected from the patient’s medical histories and complied into a general report. No connection was found between the ages of the patients, the sex of the patients, amount of time since dialysis treatment begun, type of dialysis received, or inpatient status at the hospital. The most common thread between all of the affected patients was exposure to a Gadolinium based contrast agent in the months preceding the onset of the condition.

Nephrogenic Systemic Fibrosis was identified as a skin disorder occurring in patients with impaired renal function in 1997. Also known as Nephrogenic Fibrosing Dermopathy, there is very little information available about the progression of the condition or its causes. The cases discovered in St. Louis represent the largest geographic cluster of cases of Nephrogenic Systemic Fibrosis in the world and give researcher some definitive evidence that Gadolinium based contrast agents may be responsible for the development of the condition. While the association cannot be completely confirmed, the evidence is enough to warrant caution in the use of Gadolinium based contrast agents in patients with advanced kidney disease or kidney failure.

Nephrogenic Systemic Fibrosis is a rare condition, occurring in less than 5% of patients with impaired renal function who use a Gadolinium based contrast agent to enhance their MRI images. Experts recommend that patients with impaired renal function should avoid exposure to Gadolinium based contrast agents until more is understood about Nephrogenic Systemic Fibrosis and the role that Gadolinium based contrast agents play in the development of the condition. In this case, it is better to be safe than sorry.

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