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The Theory Behind How Gadolinium Based Contrast Agents Cause Nephrogenic Systemic Fibrosis

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In 2006, reports began to emerging linking the usage of Gadolinium based contrast agents to the development of a rare condition called Nephrogenic Systemic Fibrosis. The condition was first noted in patients undergoing dialysis who had recently received an injection of a contrast agent containing Gadolinium prior to an MRI or MRA procedure. While the cause of this association is not yet understood, researchers believe that in some way, the injection of a Gadolinium based contrast agent into a patient with impaired renal function or renal failure can cause the development of Nephrogenic Systemic Fibrosis.

One theory behind the reason for the development of Nephrogenic Systemic Fibrosis following an injection with a Gadolinium based contrast agent is that the Gadolinium ion may become separated from the contrast agent, allowing it to move freely throughout the body. This freed Gadolinium is a toxic agent that causes Nephrogenic Systemic Fibrosis as it travels throughout the body. Biopsies of the tissue affected by the condition have resulted in the discovery of Gadolinium ions in the cells of the affected tissue. This is the most direct evidence available that Gadolinium based contrast agents can cause Nephrogenic Systemic Fibrosis.

According to this theory, the impaired renal function of patients on dialysis increases risk of the patient developing the disorder because the Gadolinium is not removed from the body by the kidneys as it is in patient with normal renal function. Because of the patient’s impaired renal function, the Gadolinium remains in the body for an extended period of time which increases the risk that some of the Gadolinium ions will break free of the contrast agent solution. Although there is no hard evidence to support this theory, many researchers find it plausible.

The individuals most susceptible to developing Nephrogenic Systemic Fibrosis are patients undergoing dialysis for renal failure. As the renal function gets worse, the risk for developing the condition increases. The FDA has issued a public health alert warning medical professionals to exercise caution with using Gadolinium based contrast agents with patients with moderately to severely impaired renal function and renal failure. The risk of developing the disease should be carefully weighed and alternative treatments discussed before making a final decision.

Based on current information, approximately 3% to 5% of patients with impaired renal function or renal failure will develop Nephrogenic Systemic Fibrosis after receiving a Gadolinium based contrast agent injection prior to an MRI procedure. In some cases, the benefit of obtaining detailed images from the MRI will outweigh the small risk of developing Nephrogenic Systemic Fibrosis, but in other cases, other treatment options may be the better choice. Each decision should be made on a case by case basis and should be based on the current stage of the patient’s renal function.

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