Gadolinium and nephrogenic systemic fibrosis: an update

Abstract

Nephrogenic systemic fibrosis (NSF) is a multisystem disease seen exclusively in patients with renal impairment. It can be severely debilitating and sometimes fatal. There is a strong association with gadolinium-based contrast agents used in magnetic resonance imaging (MRI). Risk factors include renal impairment and proinflammatory conditions, e.g. major surgery and vascular events. Although there is no single effective treatment for NSF, the most successful outcomes are seen following restoration of renal function, either following recovery from acute kidney injury or following renal transplantation. There have been ten biopsy-proved pediatric cases of NSF, with no convincing evidence that children have a significantly altered risk compared with the adult population. After implementation of guidelines restricting the use of gadolinium-based contrast agents in at-risk patients, there has been a sharp reduction in new cases and no new reports in children. Continued vigilance is recommended: screening for renal impairment, use of more stable gadolinium chelates, consideration of non-contrast-enhanced MRI or alternative imaging modalities where appropriate.

Progressing Toward a Cohesive Pediatric 18F-FDG PET/MR Protocol: Is Administration of Gadolinium Chelates Necessary?

“…Considering the risk of nephrogenic sclerosis (24, 25) and recently reported gadolinium chelate deposition in the brain (26, 27), in addition to costs and added examination time for contrast-enhanced sequences, there would be a major benefit from eliminating gadolinium-chelate administration and streamlining of pediatric PET/MR studies. Growing cancers are characterized by angiogenesis (28) and glucose metabolism (29).…”

Robust kidney perfusion mapping in pediatric chronic kidney disease using single‐shot 3D‐GRASE ASL with optimized retrospective motion correction

“…Renal ASL holds great potential, given that it provides quantification of a crucial pathophysiological parameter of kidney disease: renal blood flow (RBF). Furthermore, it achieves this without requiring injection of MR contrast agents, which are typically contraindicated for patients with impaired renal function . RBF differences in chronic kidney disease (CKD) and acute kidney injury patients have been demonstrated with ASL when compared to healthy volunteers, as well as age‐related variations in kidney perfusion .…”

Imaging patients with renal impairment

“…Progressive disease can be fatal and there is no known proven curative treatment [2,85]. No race or gender predilection has been recognized, and cases have been reported in patients up to 87 years old, with a peak incidence from 51 to 60 years of age [86]. There have been no reported cases of NSF in children under the age of 6 years [2,87] …”