Editorial by Sharon Williams
November 12, 2025

In early 2015, I opened a post with the following question: Why does a Gadolinium Toxicity diagnosis have to be full-blown NSF (Nephrogenic Systemic Fibrosis) or nothing at all? I went on to say that we believe Gadolinium Toxicity is a “disease of degrees”, which can manifest itself in many ways depending on how much gadolinium someone retains. And it can occur in patients with normal renal function.

Here we are ten years later, in 2025, and our belief about retained gadolinium causing a disease with varying degrees of severity is stronger than ever. That belief is based on the results of the Patient Survey that Hubbs Grimm and I conducted last year along with patient advocates Sarah Ratnam and Catriona Walsh. We recently released our first paper that focuses on the symptoms reported by 316 survey participants after MRIs with a gadolinium-based contrast agent (GBCA). The patients had normal and near normal renal function at the time of their MRIs. 185 of the participants have one or more test results that confirm they retained gadolinium for more than 30 days and for as long as 22 years after contrast administration, including 14 years in pelvic bone, and 13 years in sigmoid colon tissue.

The similarities between the symptom reporting patterns of the survey participants closely mirror those published about the clinical presentation of early-phase NSF as described by Marckmann & Skov (2009). Based on what Marckmann wrote about NSF, it seems that NSF itself had varying degrees of severity. Marckmann (2009 & 2011) wrote that there were significant individual differences in the clinical course of NSF, even in end-stage renal disease (ESRD) patients, which seems to indicate that retained gadolinium could trigger a range of symptoms, with a varied clinical outcome in all patient populations.

The variability of the symptoms shows that even in severely renally impaired patients, gadolinium-induced NSF did not cause the exact same set of symptoms or level of severity.

Is NSF itself the “disease of degrees”? Do all patients affected by gadolinium manifest NSF to varying extents, but without the “N” or nephrogenic component? The many similarities between the early clinical picture of NSF and the symptoms reported by participants in our Patient Survey suggest that they do.

Rather than a new or separate disease entity for patients with normal renal function, such as Gadolinium Deposition Disease (GDD) as described by Semelka & Ramalho (2023), our survey findings suggest that GDD and NSF may reflect different points along a continuum of gadolinium-induced toxicity. In other words, what we are observing may be one gadolinium-induced disease process manifesting with varying degrees of severity, which is how Marckmann described NSF in his Severity Grading in 2009.

Gadolinium has the Potential to Harm All Patients

We cite many published works in our paper that connect what is known about gadolinium’s toxic effects to various symptoms, particularly neuropathic and calcium signaling-related manifestations.

Due to having a similar ionic radius, the gadolinium (Gd³⁺) ion can compete with calcium (Ca²⁺) in all biological systems that require calcium for proper function (Sherry et al., 2009). Gadolinium’s interference with calcium channels could cause body systems to dysfunction, which suggests potential mechanisms of harm that extend beyond what is visible to the naked eye or seen under a microscope.

During our research, we discovered an important 2007 FDA Memorandum to the File; Appendix 4 in our paper is the first page of the memorandum. Item ‘b’ in the Summary states the following:
“Unchelated gadolinium is a very toxic compound, particularly to the liver and to calcium channels.”

We believe gadolinium’s recognized toxic effect on calcium channels is how gadolinium can cause harm – a fact the FDA failed to recognize in its 2007 memorandum. Gadolinium’s adverse effects on the function of cells, particularly nerve cells that require calcium for proper function, provide evidence of how some and perhaps all patients can be harmed by retained gadolinium. It could well explain many of the otherwise ‘unexplained’ symptoms experienced by survey participants and other patients after their MRIs with a GBCA.

Causation has not been established…yet.

We recognize that the findings of our Patient Survey do not establish causation. However, the consistency of the reported symptom patterns that mirror those described for the early phase of NSF represent an emerging safety signal that warrants careful attention. The one common denominator between all survey participants and patients diagnosed with NSF is the fact that each person received a gadolinium-based contrast agent prior to the onset of their new, unexplained symptoms.

Our Patient Survey provides novel data on the potential long-term adverse effects of gadolinium retention in all patient populations, underscoring the need for systematic investigation by unbiased, independent researchers.

Besides prospective research studies, we believe there is a need for retrospective research to try to determine how retained gadolinium has adversely affected patients with normal renal function. Subjects for a retrospective, case-control study could be found from the participants in our Patient Survey, many of whom have confirmation of long-term gadolinium retention. The time to learn from those patients is now, while they are still alive and can share details of their symptoms and health issues both before and after their exposure to gadolinium-based contrast agents.

Gadolinium-induced NSF…not fully understood but recognized.

We do not know why some patients with normal renal function who received an MRI with a GBCA report the onset of new symptoms after their MRIs while others do not. However, something similar occurred with NSF, when not all patients with end-stage renal disease developed NSF-like symptoms after their MRIs with a linear GBCA. While the explanation remains unknown, the finding nevertheless occurred, and it was recognized by the FDA and other governing bodies around the world.

We believe a similar recognition for patients with normal renal function is long overdue.

A Disease of Degrees: Gadolinium Toxicity, NSF or Something Else?

In 2009, Marckmann wrote, “It may be time to consider renaming NSF to what it really seems to be, which is Gd-induced systemic fibrosis”. Wagner (2016) and Kay (2008) suggested that the term “nephrogenic systemic fibrosis” should be changed to reflect the fact that gadolinium can cause systemic fibrosis even in the absence of severe renal impairment.

We have no way to know if retained gadolinium causes fibrosis in all patients. However, we believe “NSF” does not reflect the broader range of gadolinium-associated findings now being reported…findings in patients with normal renal function and with laboratory tests confirming gadolinium retention in urine, blood, stool, hair, nails, teeth, and connective and glandular tissues, including in prostate tissue 22 years after contrast administration.

We believe the time has come to rename NSF once and for all, to reflect the fact that governing authorities have recognized that patients with normal renal function also retain gadolinium in their brain, bones, skin, and other tissue for months to years after contrast administration (FDA, 2017).

The results of our Patient Survey indicate retained gadolinium is not clinically benign in patients with normal renal function; it induces symptoms with varying degrees of severity and for varying lengths of time, just as occurred in some patients with severe renal disease.

The “Disease of Degrees” needs a name that reflects the fact that retained gadolinium has the potential to adversely affect all patients, regardless of their level of renal function at the time of GBCA administration.

Patients, Doctors, Researchers…Please read our report to learn more.

Signs & Symptoms after Gadolinium Administration: A Patient Survey
Report 1: Symptoms Paralleling Early-Phase NSF, can be downloaded here:
https://gadoliniumtoxicity.com/research/ourresearch/contrast-mri-2025-patient-survey-report-1/

Sharon Williams
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References:
Kay, J. (2008). Gadolinium and Nephrogenic Systemic Fibrosis: The evidence of things not seen. (editorial). Cleveland Clinic Journal of Medicine, 75(2), 112–117. http://www.ccjm.org/content/75/2/112.full.pdf

Marckmann, P., & Skov, L. (2009). Nephrogenic Systemic Fibrosis: Clinical Picture and Treatment. Radiologic Clinics, 47(5), 833–840. https://doi.org/10.1016/j.rcl.2009.05.004

Marckmann, P. (2011). Gadolinium-based Magnetic Resonance Contrast Agents and Nephrogenic Systemic Fibrosis. US Nephrology, 6(1), 40–44. http://www.touchnephrology.com/articles/gadolinium-based-magnetic-resonance-contrast-agents-and-nephrogenic-systemic-fibrosis?page=0,4

Semelka, R. C., & Ramalho, M. (2023). Gadolinium Deposition Disease: Current Knowledge and Expert Opinion. Investigative Radiology, 58(8), 523–529. https://doi.org/10.1097/RLI.0000000000000977

Sherry, A. D., Caravan, P., & Lenkinski, R. E. (2009). Primer on gadolinium chemistry. Journal of Magnetic Resonance Imaging : JMRI, 30(6), 1240–1248. https://doi.org/10.1002/jmri.21966

U.S. Food & Drug Administration, & Blank, M. (2007). Division of Medical Imaging and Hematology Products, Memorandum to the File, Gadolinium-Based Contrast Agents (GBCAs) and Nephrogenic Systemic Fibrosis (NSF). http://s3.amazonaws.com/propublica/assets/omniscan/blank-melanie-review-omniscan2.pdf

U.S. Food & Drug Administration. (2017). FDA Drug Safety Communication, December 19, 2017. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-warns-gadolinium-based-contrast-agents-gbcas-are-retained-body

Wagner, B., Drel, V., & Gorin, Y. (2016). Pathophysiology of gadolinium-associated systemic fibrosis. American Journal of Physiology – Renal Physiology, 311(1). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4967166/

Williams, S., Grimm, H., Ratnam, S., Walsh, C. (2025). Signs & Symptoms after Gadolinium Administration: A Patient Survey. Report 1: Symptoms Paralleling Early-Phase NSF.
[Online] https://gadoliniumtoxicity.com/research/ourresearch/contrast-mri-2025-patient-survey-report-1/