Time‐dependent decrement of dermal gadolinium deposits and significant improvement of skin symptoms in a patient with nephrogenic systemic fibrosis after temporary renal failure

Schäd, Susanne G.; Heitland, Peter; Kühn‐Velten, W. Nikolaus; Gross, Gerd; Jonas, Ludwig

doi:10.1111/cup.12214

Cited by 15 publications

(6 citation statements)

References 28 publications

(28 reference statements)

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“…In patients with normal renal function, Gd has been found deposited in the brain 1 , bone 2 and skin 3,4 and to be present in urine collections years after the GBCA should have been completely cleared, sometimes associated with painful and disorienting symptoms 5,6 . Similar skin retention has been observed in patients with severely reduced renal function, but to a greater extent and strongly associated with nephrogenic systemic fibrosis 7,8 . Retention and its outcomes in all patients is independently associated with the thermodynamic and kinetic stability of GBCAs 9,10,11 , resulting in a common hypothesis that the outcomes are associated with the release of Gd10 10 .…”

Section: Introductionsupporting

confidence: 66%

The Impact of Excess Ligand on the Retention of Nonionic, Linear Gadolinium-Based Contrast Agents in Patients With Various Levels of Renal Dysfunction: A Review and Simulation Analysis

Prybylski

Jay

2017

Advances in Chronic Kidney Disease

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The role of gadolinium (Gd)-based contrast agents (GBCAs) in the pathophysiology of nephrogenic systemic fibrosis (NSF) is now uncontested. While the definitive mechanism has not been established, the association with weaker GBCA ligands and with reduced renal clearance supports a hypothesis that Gd release from the GBCAs is a key process in precipitating the disease. Prevention strategies often include the use of more stable GBCA ligands in patients with reduced kidney function, but animal models and some clinical data suggest better patient outcomes can be achieved when excess ligand is administered with weaker GBCAs; this is particularly significant for OptiMARK®, which contains a nonionic, linear ligand similar to gadodiamide, the active ingredient in Omniscan®, but contains twice the amount of excess ligand. Here we review evidence regarding the use of OptiMARK® over Omniscan® for prevention of NSF, and perform a pharmacokinetic-based simulation to determine if the presented evidence is consistent with the established kinetics of GBCAs and Gd.

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Section: Introductionsupporting

confidence: 66%

The Impact of Excess Ligand on the Retention of Nonionic, Linear Gadolinium-Based Contrast Agents in Patients With Various Levels of Renal Dysfunction: A Review and Simulation Analysis

Prybylski

Jay

2017

Advances in Chronic Kidney Disease

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“…A combination of AAS/ICP-MS and X-ray microanalysis would be optimal. In preceding papers we published different examples for the validity of electron microscopy in combination with elemental analysis by EDX or EELS [13][14][15][16][17][18][19][20].…”

Section: Discussionmentioning

confidence: 99%

Detection of Mercury in the 411-year-old Beard Hairs of the Astronomer Tycho Brahe by Elemental Analysis in Electron Microscopy

Jonas

Jaksch

Zellmann

et al. 2012

Ultrastructural Pathology

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Hairs more than 400 years old of the famous astronomer Tycho Brahe were studied by electron microscopy to evaluate the hypothesis that Johannes Kepler murdered his teacher Brahe by mercury intoxication. The beard hairs showed a well-preserved ultrastructure with typical hair scales and melanosomes. The authors detected an accumulation of electron-dense granules of about 10 nm inside the outer hair scales, but not in the hair shaft and roots. At the places of these heavy-metal-containing granules they detected mercury besides other elements by energy dispersive X-ray analysis (EDX, Oxford, UK) in a field cathode scanning electron microscope (SEM, Gemini, Zeiss). The mercury-containing granules were found over the whole length of hairs, but only in the outer hair scales. Nevertheless, surface coatings of hairs were free of mercury. This distribution of mercury does not support the murder hypothesis, but could be related to precipitation of mercury dust from the air during long-term alchemistic activities.

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“…This is supported by data on NSF patients who recovered from acute renal failure or underwent kidney transplantation [33] and subsequently demonstrated a clinical improvement. Therapies resulting in the elimination of free gadolinium ions is another potential option, as a decrease of dermal gadolinium deposition has been correlated with an improvement of clinical symptoms [34]. Different therapeutic approaches such as extracorporeal photopheresis or apheresis seem to be feasible [35].…”

Section: Guidelinesmentioning

confidence: 99%

MR Contrast Agent Safety in the Age of Nephrogenic Systemic Fibrosis: Update 2014

et al. 2014

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Nephrogenic systemic fibrosis (NFS) is a potentially fatal disease that is linked to the administration of gadolinium based contrast agents (GBCA). As the associated risk factors have been identified and countermeasures taken, NSF has become a rarity. However, there is ongoing research to better understand its pathogenesis and studies on the safety of different GBCA in the context of NSF are carried on. This article aims to provide a brief review of the topic of NSF and to summarize recent developments and literature publications within the last year.

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Time‐dependent decrement of dermal gadolinium deposits and significant improvement of skin symptoms in a patient with nephrogenic systemic fibrosis after temporary renal failure

Cited by 15 publications

References 28 publications

The Impact of Excess Ligand on the Retention of Nonionic, Linear Gadolinium-Based Contrast Agents in Patients With Various Levels of Renal Dysfunction: A Review and Simulation Analysis

The Impact of Excess Ligand on the Retention of Nonionic, Linear Gadolinium-Based Contrast Agents in Patients With Various Levels of Renal Dysfunction: A Review and Simulation Analysis

Detection of Mercury in the 411-year-old Beard Hairs of the Astronomer Tycho Brahe by Elemental Analysis in Electron Microscopy

MR Contrast Agent Safety in the Age of Nephrogenic Systemic Fibrosis: Update 2014

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