Gadolinium-Induced Nephrogenic Systemic Fibrosis
Section snippets
Pathogenesis
The association of gadolinium use in the pathogenesis of NSF in high-risk patients with a creatinine clearance less than 30 mL/min/1.73 m2, the finding of gadolinium deposition on skin biopsy, and the virtual disappearance of the disease with preventative protocols of not administering GBC in patients with creatinine clearances of less than 30 mL/min/m2 or acute renal failure, all implicate GBC as a causative agent.7, 10, 32, 33 On literature review, NSF has not been described in patients with
Treatment and Prevention of NSF
To date, treatment of NSF has been disappointing. Resolution of acute renal failure when present and renal transplantation have been associated with disease resolution.10, 28, 32, 53, 54, 55, 56, 57 Symptomatic relief, physical therapy, and pain control are paramount. Extracorporeal photopheresis and sodium thiosulfate have had anecdotal success, as has the use of rapamycin and imatinib mesylate.58, 59, 60 Therapies with limited success include glucocorticoids, pentoxifylline, cyclophosphamide,
Comments
NSF is now essentially preventable as it relates to patients who have significant CKD and dialysis-dependent AKI or end-stage renal disease. Although the pathogenesis is not entirely worked out, the important role of gadolinium exposure has been identified. Ironically, gadolinium was used as an imaging agent because of its lower nephrotoxicity relative to iodinated contrast material in patients with renal impairment. It was believed to be an inert contrast material and we failed to recognize
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2015, Colloids and Surfaces B: BiointerfacesCitation Excerpt :The most commonly used positive (T1-weighted) contrast agent in clinic is gadolinium chelates, such as the popular Gd-diethylenetriaminepentaacetate (Gd-DTPA) and Gd-tetraazacyclododecanetetraacetic acid (Gd-DOTA) [6,7]. However, the dissociated gadolinium ions from gadolinium chelates could induce the risk of nephrogenic systemic fibrosis (NSF) [8–10]. Thus, many strategies, such as the loading of macromolecules and micelles, the fabrication of nanoscaled objects, and so on, have been attempted to inhibit the toxicity and side-effect of released gadolinium ions together with retaining good contrast effect [11–13].