Nephrogenic Systemic Fibrosis Manifesting a Decade After Exposure to Gadolinium

Abstract

The clinical history and histopathological features of this case support the diagnosis of NSF 10 years after exposure to gadolinium. Although the use of gadolinium contrast agents in patients with kidney failure has markedly decreased, patients with exposure to gadolinium years to decades previously may manifest the disease.

Safety and technique of ferumoxytol administration for MRI

“…However, the risks associated with iodinated and gadolinium‐based agents in patients with severe renal disease (iodinated contrast‐induced nephrotoxicity and NSF) are even higher and can be fatal . Gadolinium deposits in deep nuclei of the brain and delayed cases of NSF have been reported up to a decade after exposure , although the clinical significance of gadolinium deposition in the brain is unknown at this time.…”

A unique case of nephrogenic systemic fibrosis from gadolinium exposure in a patient with normal eGFR

“…Symptoms most commonly manifest within weeks to months after receiving gadolinium 6. However, this period may be longer as suggested by one case report of NSF developing 10 years after gadolinium exposure 11. Our patient presented 3 months after gadolinium exposure.…”

T1hyperintensity on brain imaging subsequent to gadolinium-based contrast agent administration: what do we know about intracranial gadolinium deposition?

“…These studies also have implications for design of animal studies which need to reflect the clinical reality of the patients exposed to GBCAs, as has already been highlighted by Pietsch et al 21,22 Alternatively, it is possible that if Gd accumulates in brain tissue, it does so after release from a reservoir such as bone given that there is evidence for Gd being present in small amounts in the skin and bone after exposure to GBCAs, including macrocyclic agents, even when renal function is normal. 23 This means that there is a potential for effects long after Gd exposure, for example, Thomson et al reported the development of NSF in a patient for more than 6 years following gadodiamide exposure, whereas Larson et al 24 reported NSF 10 years after Gd 3 exposure-the specific GBCA used was not stated in this report but highly likely to have been a high-risk GBCA given the period and geographical location in question. Thomson et al 3 have also reported delayed presentations of NSF from prior exposure to high-risk agents.…”