On May 27, 2015, JAMA Dermatology published a Case Report by Larson et al that described a biopsy-confirmed case of “Nephrogenic Systemic Fibrosis Manifesting a Decade after Exposure to Gadolinium”. According to the report, a long-term hemodialysis patient was exposed to a gadolinium-based contrast agent several times between 1998 and 2004 during magnetic resonance angiography (MRA) of his abdominal vessels and arteriovenous fistula. Ten years later, in 2014, he developed new dermal papules and plaques. The diagnosis of NSF was made based on the findings of a biopsy of affected skin which showed thickening of collagen, CD34+ spindle cells, and increased mucin in the dermis. (Information about the agent(s) and dosages are not provided).
Prior to this case, the authors noted that the longest documented time after exposure to gadolinium to NSF manifestation was 3 ½ years.
This case shows that even in patients with severe renal disease retained gadolinium can take many years before causing “visible” evidence of a problem. The authors concluded that, “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”.
Larson and her colleagues said, “All patients with symptoms of a fibrosing dermatopathy and history of kidney failure should undergo testing for NSF regardless of the number of years since last gadolinium exposure”.
Based on recent findings of residual gadolinium in brain tissues of patients with normal renal function, I believe that all patients exposed to gadolinium-based contrast agents should have any unexplained symptoms investigated to determine if they might also be the result of their previous gadolinium exposures.
At this time, we do not know if patients with normal renal function will manifest with biopsy findings like those seen in patients with NSF. I believe that is why it is important to remember that NSF is not just a skin disease or dermopathy – it is a systemic disease that can affect all body systems and the damage being done can be inside the body.
See Background on NSF for more details about Nephrogenic Systemic Fibrosis. Information on recent studies that report findings consistent with gadolinium retention in patients with normal renal function can be found in the News section of our website.
Larson, K. N., Gagnon, A. L., Darling, M. D., Patterson, J. W., & Cropley, T. G. (2015). Nephrogenic Systemic Fibrosis Manifesting a Decade After Exposure to Gadolinium. JAMA Dermatology. http://doi.org/10.1001/jamadermatol.2015.0976
Cowper, S. E. (n.d.). Nephrogenic Systemic Fibrosis: History, Diagnosis and the Registry. Retrieved October 5, 2012, from http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/CardiovascularandRenalDrugsAdvisoryCommittee/UCM196233.pdf