Imaging in the time of NFD/NSF: do we have to change our routines concerning renal insufficiency?

Abstract

To date there are potential chronology-based but not conclusive reasons to believe that at least some of the gadolinium complexes play a causative role in the pathophysiology of nephrogenic systemic fibrosis (NSF) or nephrogenic fibrosing dermopathy (NFD). Still, the exact pathogenesis and the risk for patients is unclear beside the obvious connection to moderate to severe renal insufficiency. So far, MR imaging with Gd-enhancement was regarded as the safest imaging modality in these patients-the recent development creates tremendous uncertainty in the MR-community. Nevertheless, one should remember that, despite the over 200 cases of NSF and about 100 with proven involvement of Gd 3+ , the vast majority of over 200 million patients exposed to gadolinium since the 1980s have tolerated these agents well. Importantly, NSF is a rare disease and does not appear to occur in patients without renal impairment. Many patients and researchers have undergone MR investigations with Gd exposure in the past. For those, it is essential to know about the safety of the agents at normal renal function. We can hope that pharmacoepidemiological and preclinical studies will allow us to better understand the pathophysiology and role of the various MR contrast agents in the near future.

Nephrogene systemische Fibrose

“…Durch diese um bis zu 20-fach verlängerte Halbwertszeit sind die winzigen Mengen freien Gadoliniums vermehrt den biologischen Reaktionen zugänglich. Außerdem kann weiteres elementares Gadolinium aus seiner Chelatbindung herausgelöst werden [4]. …”

Gadolinium and lanthanum: A iatrogenic transmetallation?

“…Consequently a Gd dechelation may easily occur with the release of Gd ions, thus explaining its toxicity, namely in renal failure patients [25,26]. Also the altered metabolic profile found in renal insufficiency can further promote transmetallation and shift the equilibrium towards the dissociation of Gd ions [27].…”

Development of the application of speciation in chemistry

“…Magnevist ([Gd(DTPA)]), and only a few cases have been observed after the use of macrocyclic agents [191,198,[201][202][203][204][205]. …”