Nephrogenic Systemic Fibrosis

Abstract

Summary For more than 10 years it has been believed that gadolinium‐based contrast agents in doses used for magnetic resonance imaging (MRI) are relatively safe with regard to acute non‐renal and renal adverse reactions and delayed reactions. However, recent observations have shown that it may not be the case in patients with reduced renal function as gadolinium‐based contrast agents may trigger the development of fibrosis in all parts of the body so‐called nephrogenic systemic fibrosis (NSF). Its primary predilection is the skin. Unrelated to the development of NSF, contrast‐induced nephropathy may occur after administration of gadolinium‐based contrast agents. The current review updates the recent developments regarding the severe delayed reaction. However, the fear of NSF should not lead to a denial of a well‐indicated enhanced MRI examination.

Risk of contrast-medium-induced nephropathy in high-risk patients undergoing MDCT – A pooled analysis of two randomized trials

“…Therefore, the results of this analysis cannot be used to compare the risk-benefit ratio of contrast-enhanced MRI and contrast-enhanced MDCT, since the majority of biopsy-proven NSF cases has indeed been observed among patients with stage 5 CKD [14][15][16][17].…”

“…The more severe the degree of renal impairment, the greater is the risk of developing CIN, so that the risk is highest in patients with stage 4 or 5 chronic kidney disease (CKD), i.e., in patients with GFR below 30 ml/min/1.73 m 2 [4,6]. This patient group is not only at high risk of CIN, but also of nephrogenic systemic fibrosis (NSF), a scleroderma-like, systemic fibrosing disorder that may lead to serious physical disability and has been associated with the intravenous (IV) administration of gadolinium-containing contrast agents, particularly those of low stability, used in magnetic resonance imaging (MRI) [7][8][9][10][11][12][13][14][15][16][17]. It would be important to compare the risk-benefit ratio of contrast-enhanced MRI and contrast-enhanced multidetector computed tomography (MDCT) in patients with advanced renal failure that need cross-sectional imaging for diagnostic or prognostic purposes [18].…”