Tuesday July 10, 2007
Gadolinium based contrast agent (GBCA) and renal insufficiency

During MRI and MRA scans, a Gadolinium based contrast agent (GBCA) is used for more refined films. New evidences suggest that Gadolinium based contrast agents are associated with Nephrogenic Systemic Fibrosis (NSF) or Nephrogenic Fibrosing Dermopathy (NFD). Interestingly, the effect may be delayed upto 18 months after exposure !!

NSF may result in fatal or debilitating systemic fibrosis affecting the skin, muscle, and internal organs. Patients with renal dysfunction are at very high risk for NSF. In dialysis dependent patients, it is recommended to consider prompt hemodialysis following GBCA administration and upto 3 frequent sessions of dialysis. (Does it work ?). NSF is well documented following exposure to a GBCA in patients with

• acute or chronic severe renal insufficiency (GFR less than 30) *
• patients with acute renal insufficiency of any severity due to the hepato-renal syndrome or
• in the peri-operative liver transplantation period

*To date, there has not been a report of NSF in a patient with normal renal function or mild to moderate renal insufficiency following GBCA exposure

Among the factors that may increase the risk for NSF are repeated or higher than recommended doses of a GBCA. The dose of gadolinium-based contrast agent given to patients undergoing an MRA is often higher and have higher risk of developing the condition.

The signs and symptoms of NSF includes itching, reddened or darkened patches on skin; and/or skin swelling, hardening and/or tightening. Yellow raised spots on the whites of the eyes. Joint stiffness and/or muscle weakness. In addition, patients may develop widespread fibrosis of other organs. A skin biopsy is necessary to confirm the diagnosis.

There is no treatment for NSF.

FDA has recently advised detailed box warning which can be read here.