Ten-Year Experience With Nephrogenic Systemic Fibrosis

Bahrami, Simin; Raman, Steven S.; Sauk, Steven; Salehmoghaddam, Saleh; Villablanca, J. Pablo; Finn, J. Paul; Lu, David

doi:10.1097/rct.0b013e31819d68ed

Cited by 11 publications

(10 citation statements)

References 25 publications

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“…They are not iodinated compounds; hence no risk for nephropathy is expected [232]. It has been reported, however, that the use of gadolinium-based contrast agents may be associated with acute renal failure or nephrogenic systemic fibrosis (rare pathology that causes fibrosis of the skin and connective tissues throughout the body involving several organs, with kidney included) particularly in patients with preexisting renal failure [233, 234]. …”

Section: Contrast-induced Nephropathymentioning

confidence: 99%

Side Effects of Radiographic Contrast Media: Pathogenesis, Risk Factors, and Prevention

Andreucci

Solomon

Tasanarong

2014

BioMed Research International

204

212

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Radiocontrast media (RCM) are medical drugs used to improve the visibility of internal organs and structures in X-ray based imaging techniques. They may have side effects ranging from itching to a life-threatening emergency, known as contrast-induced nephropathy (CIN). We define CIN as acute renal failure occurring within 24–72 hrs of exposure to RCM that cannot be attributed to other causes. It usually occurs in patients with preexisting renal impairment and diabetes. The mechanisms underlying CIN include reduction in medullary blood flow leading to hypoxia and direct tubule cell damage and the formation of reactive oxygen species. Identification of patients at high risk for CIN is important. We have reviewed the risk factors and procedures for prevention, providing a long list of references enabling readers a deep evaluation of them both. The first rule to follow in patients at risk of CIN undergoing radiographic procedure is monitoring renal function by measuring serum creatinine and calculating the eGFR before and once daily for 5 days after the procedure. It is advised to discontinue potentially nephrotoxic medications, to choose radiocontrast media at lowest dosage, and to encourage oral or intravenous hydration. In high-risk patients N-acetylcysteine may also be given.

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Section: Contrast-induced Nephropathymentioning

confidence: 99%

Side Effects of Radiographic Contrast Media: Pathogenesis, Risk Factors, and Prevention

Andreucci

Solomon

Tasanarong

2014

BioMed Research International

204

212

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“…Erythropoietin use was seen in up to 80 %, although this may simply have reflected erythropoietin resistance relating to chronic inflammation [23]. Other risk factors, including liver disease [24], immunosuppression [25], hyperphosphatemia [26], and acidosis [2], were reported but not consistently reproduced. At this stage, it appeared that NSF involved a process of sensitizing events (renal disease and some proinflammatory condition) and an unidentified trigger (e.g., allergen deposition) [27].…”

Section: Evidence For a Link With Gadolinium-based Contrast Agentsmentioning

confidence: 99%

“…In reality, there is inadequate data to evaluate whether the risk of NSF varies significantly between different contrast agents due to: (1) the small total number of cases of NSF; (2) uncertainty of the specific agent used; (3) the large proportion of market share possessed by gadopentetate dimeglumine and gadodiamide in the relevant time period. Interaction between chelate stability, prolonged contrast-agent circulation, and [25] 209 dialysis 4 1.9 % CKD chronic kidney disease; AKI acute kidney injury; HD hemodialysis; PD peritoneal dialysis, CI confidence interval tissue pH leading to Gd release therefore remains incompletely understood, as is the role of Gd in the uncontrolled proliferation of fibrocytes in NSF.…”

Section: Role Of Different Gadolinium-based Contrast Agentsmentioning

confidence: 99%

Gadolinium and nephrogenic systemic fibrosis: an update

2013

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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.

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“…Gadolinium is not an iodinated compound, and its use is associated with a low risk for nephropathy. Some reports, 22,23 however, indicate that use of gadolinium may result in self-limiting acute renal failure or nephrogenic systemic fibrosis, a rare abnormality that involves fibrosis of a variety of organ systems. Patients with preexisting renal failure are the most at-risk patients for nephrogenic systemic fibrosis when gadolinium is used.…”

Section: Adverse Reactionsmentioning

confidence: 99%

“…(Critical Care Nurse. 2012;32 [6]: [15][16][17][18][19][20][21][22][23][24] This article has been designated for CNE credit. A closed-book, multiple-choice examination follows this article, which tests your knowledge of the following objectives:…”

Section: Contrast-induced Nephropathy In Critical Carementioning

confidence: 99%

Contrast-Induced Nephropathy in Critical Care

Wood

2012

Critical Care Nurse

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minutes before the imaging study to protect against contrast-induced nephropathy (CIN). Because of the frequency of nausea and vomiting associated with use of N-acetylcysteine, a nurse practitioner in the department suggests that the patient be given an infusion of sodium bicarbonate 150 mEq/L at a rate of 3.5 mL/kg per hour for 1 hour before the CT scan. A hospitalist who is with another patient overhears the discussion and adds that some evidence suggests that hydration with physiological saline at 1 mL/kg per hour may suffice.What is CIN and what is the best course of action for this patient? In this article, I describe CIN; the patients at risk for this abnormality; and the etiology, pathophysiology, preventive interventions, and treatments for this iatrogenic complication of imaging with contrast material. BackgroundCIN is a disorder characterized by the onset of acute renal failure within 24 to 72 hours after the administration of iodinated contrast medium. Contrast-induced nephropathy is an iatrogenic disease caused by the administration of iodinated contrast material to certain at-risk patients. The clinical features include renal failure, with oliguria, anuria, and electrolyte derangements. Contrastinduced nephropathy can prolong hospitalization, result in greater morbidity and mortality, and increase patients' costs. A variety of preventive and treatment strategies exist, including use of alternative imaging. Critical care nurses need to understand the nephropathy and the patients at risk and to develop a familiarity with prevention, treatment, and outcome. (Critical Care Nurse. 2012;32[6]:15-24) This article has been designated for CNE credit. A closed-book, multiple-choice examination follows this article, which tests your knowledge of the following objectives:1. State the pathophysiology of contrast-induced nephropathy 2. Identify patients at risk for developing contrast-induced nephropathy 3. State preventive therapies useful in high-risk patients CNEContinuing Nursing EducationA 62-year-old woman with a history of congestive heart failure and type 2 diabetes mellitus comes to the emergency department because she has had pain in the left lower quadrant of her abdomen and fever for 3 days.by AACN on May 9, 2018 http://ccn.aacnjournals.org/ Downloaded from typically asymptomatic, although a few patients experience renal dysfunction and may require dialysis. Despite its typically mild manifestations, CIN is associated with increases in hospital stays, [4][5][6] in-hospital mortality, 7,8 and 1-year mortality. 4,5,7 Lengths of stay can be twice as long as the stays of patients without CIN, 4,6 and both inpatient and 30-day mortality can be as much as 10-fold greater. 4,6,8 Several populations of patients are at risk, including patients with preexisting renal disease, congestive heart failure, and diabetes mellitus. Several treatment regimens are available to protect the kidneys during administration of contrast material. Contrast MediaContrast media are used in a wide array of medical imaging, inclu...

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Ten-Year Experience With Nephrogenic Systemic Fibrosis

Abstract: All cases of NSF occurred in dialysis-dependent, gadolinium-exposed patients. Associations between immunosuppressive and erythropoietin therapies and NSF need further investigation.

Cited by 11 publications

References 25 publications

Side Effects of Radiographic Contrast Media: Pathogenesis, Risk Factors, and Prevention

Side Effects of Radiographic Contrast Media: Pathogenesis, Risk Factors, and Prevention

Gadolinium and nephrogenic systemic fibrosis: an update

Contrast-Induced Nephropathy in Critical Care

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