Nephrogenic Systemic Fibrosis: A Review of History, Pathophysiology, and Current Guidelines

Hazelton, Julian M.; Chiu, Michael K.; Abujudeh, Hani H.

doi:10.1007/s40134-019-0312-1

Cited by 14 publications

(13 citation statements)

References 69 publications

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“…While the pathophysiology of NSF remains unclear, it is believed that renal insufficiency prolongs the physiologic half-life of GBCAs and increases the high circulating concentrations of the endogenous metals iron, copper, and zinc. Both actions promote the dissociation of Gd +3 from their chelating ligands (8,32). Once displaced, free Gd +3 combines with endogenous ions such as phosphate to form complexes that can precipitate in tissues and elicit a fibrotic response (8).…”

Section: Association With Gbca Groupmentioning

confidence: 99%

Gadolinium Deposition and Nephrogenic Systemic Fibrosis: A Radiologist’s Primer

2020

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Gadolinium-based contrast agents (GBCAs) have an excellent safety profile. However, over the last 2 decades, two specific concerns have surfaced. GBCAs are associated with nephrogenic systemic fibrosis (NSF) and tissue retention of gadolinium. NSF is a rare fibrosing disorder with a poor prognosis, which is characterized by skin and subcutaneous thickening as well as systemic manifestations. The disease has been reported exclusively in patients with advanced renal disease, and it is associated with higher doses and specific types of GBCAs. The number of new cases of NSF has fallen over the past decade, presumably because of adherence by health care providers to regulatory guidelines, which continue to evolve. While gadolinium retention has been known to occur in the liver and bones, the relatively recent findings of deposition and retention in the brain have reignited the debate concerning the safety profile of GBCAs. Despite these concerns, there have been no proven health effects related to gadolinium deposition and retention other than NSF. The authors review the different categories of GBCAs available for commercial use, discuss NSF and gadolinium retention in the brain, and provide updates on the latest U.S. and European regulatory guidelines regarding use of these agents. Given the frequency with which GBCAs are used in clinical practice, it is imperative for all radiologists to learn the current guidelines to provide the safest and highest quality of patient care. ©

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Section: Association With Gbca Groupmentioning

confidence: 99%

Gadolinium Deposition and Nephrogenic Systemic Fibrosis: A Radiologist’s Primer

2020

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“…22 Unchelated Gd 3+ ions form salts with endogenous anions, such as phosphate or carbonate, which then enter tissues, stimulating an inflammatory response and resulting in scarring of the tissue. 23 Due to greater understanding of these effects and the implementation of regulatory guidance, gadolinium-related NSF is now uncommon. 24 The high affinity of gold for polarisable, 'soft' donor atoms, explains the extensive use of sulfur-based linkers for attaching gadolinium chelates to the surface of gold nanoparticles.…”

Section: James D E T Wilton-elymentioning

confidence: 99%

Gold nanomaterials functionalised with gadolinium chelates and their application in multimodal imaging and therapy

2020

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“…Most cases of NFS are reported in patients with severe chronic kidney disease (CKD4, eGFR 15-29 ml/min/1.73 m 2 ) and end-stage CKD (CKD5, eGFR <15 ml/min/1.73 m 2 ). Risk factors for developing NSF, include renal failure (acute or chronic), the pre-existing pro-inflammatory state of these patients, and type, dosage, and frequency of GCBA administration [41,42]. The higher the dose of GBCA, either administered in a single dose or cumulative dose of multiple administrations, the higher is the risk of NFS [41].…”

Section: Adverse Events Related To Gadolinium-based Contrast Agents (mentioning

confidence: 99%

“…Therefore, low-risk GBCA and the lowest possible dose should be used in patients with renal insufficiency to prevent the development of NFS. For dialysis-dependent patients, a full 4-h dialysis session should be considered [35,41,42].…”

Section: Adverse Events Related To Gadolinium-based Contrast Agents (mentioning

confidence: 99%

Patient Safety in Radiology

Montazeran

Caramella

Fatehi³

2020

Textbook of Patient Safety and Clinical Risk Management

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Medical imaging (in short radiology) includes diagnostic and interventional procedures and has an essential role in the diagnosis and treatment of diseases. The objective in this field of medicine is focused on providing diagnostic and therapeutic benefit to the patients along with protecting them from the possible hazards associated with the procedures. By continuously upgrading imaging technologies and improving imaging modalities, such as ultrasound imaging, X-ray-based imaging (radiography, fluoroscopy, and computed tomography), magnetic resonance imaging (MRI), and interventional radiology, safety has become more and more crucial. The potential hazards in radiology for the patients and the staff are multidimensional and will be discussed in the chapter.

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Nephrogenic Systemic Fibrosis: A Review of History, Pathophysiology, and Current Guidelines

Cited by 14 publications

References 69 publications

Gadolinium Deposition and Nephrogenic Systemic Fibrosis: A Radiologist’s Primer

Gadolinium Deposition and Nephrogenic Systemic Fibrosis: A Radiologist’s Primer

Gold nanomaterials functionalised with gadolinium chelates and their application in multimodal imaging and therapy

Patient Safety in Radiology

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