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Risk for Nephrogenic Systemic Fibrosis in Patients with Advanced Kidney Disease

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A study was recently conducted to determine the risk of developing Nephrogenic Systemic Fibrosis (NSF) in patients with advanced kidney disease who had undergone an MRI using a Gadolinium based contrast agent. The study determined that for each MRI procedure using a Gadolinium based contrast agent that the patient undergoes, the risk of developing a case of Nephrogenic Systemic Fibrosis increases by 2.4%. NSF is a potentially fatal disease with no known cure or effective treatment. Based on this study, researchers have determined that patients with advance kidney disease should avoid exposure to agents containing Gadolinium. If the Gadolinium containing agents cannot be avoided, the risks and benefits should be carefully assessed before treatment begins.

Nephrogenic Systemic Fibrosis is considered a systemic disorder characterized by the tightening and thickening of the skin on the extremities. Over time, the surface of the skin begins to resemble the peel of an orange and the soft tissue begins to harden and calcify. The condition can result in extreme discomfort and many patients experience a severe burning sensation in the areas of the skin that are affected. The condition is progressive and the more advanced stages of NSF can affect the internal organs, causing them to scar and thicken as well. The first cases of Nephrogenic Systemic Fibrosis were discovered in 1997 and the first medical references were written in 2000.

Because Nephrogenic Systemic Fibrosis was discovered so recently, not much is known about the condition. There seems to be a positive correlation between NSF and Gadolinium exposure in patients with advanced kidney disease. In 2006, the US Food and Drug Administration issued a public health alert warning of the increased risk of developing NSF when patients with advanced kidney disease use a Gadolinium based contrast agent before undergoing an MRI. Nephrogenic Systemic Fibrosis tends to occur only in patients with advanced kidney disease or kidney failure and then only if the patient has received an injection of a Gadolinium based contrast agent within recent months. Not all patients with advanced kidney disease develop the condition, regardless of whether or not they have received an injection of a Gadolinium based contrast agent.

After compiling the information gained by the studies researching the correlation between kidney disease, Gadolinium based contrast agents, and the development of Nephrogenic Systemic Fibrosis, researchers have come to the conclusion that only individuals with advanced kidney disease or kidney failure are at risk to develop NSF. All of the recorded cases of NSF seemed to have appeared within several weeks to several months after patients had received an injection of a Gadolinium based contrast agent. Because Gadolinium is removed from the body by the kidneys, experts believe that NSF may be caused by Gadolinium remaining in the body for an extended period of time because the kidneys cannot effectively remove it from the body. More research will be needed to determine the exact cause of the development of Nephrogenic Systemic Fibrosis, but in the meantime all patients with advanced kidney disease are advised to avoid exposure to Gadolinium and Gadolinium based contrast agents.

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