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”. (more…)
A novel approach to diagnosing Nephrogenic Systemic Fibrosis, better known as NSF, was recently published by Birka et al in Analytical Chemistry. Birka and his colleagues used the combination of inductively coupled plasma mass spectrometry (ICP-MS), laser ablation (LA) ICP-MS for elemental bioimaging, and hydrophilic interaction liquid chromatography (HILIC) ICP-MS for speciation analysis, which allowed them to diagnose a case of NSF. While the article, Diagnosis of Nephrogenic Systemic Fibrosis by means of Elemental Bioimaging and Speciation Analysis, is very scientific in its details, there are facts to be learned by patients as well.
Skin biopsy specimens of NSF patients that were investigated by various techniques, found the presence of gadolinium deposits were mainly in the deeper regions of the subcutis (fat and connective tissue). A correlation of gadolinium with calcium, sodium, and phosphorous was observed in all cases.
The case report in this study involved a young woman who exhibited characteristic symptoms of NSF that began in 2011. Her clinical history included renal failure and kidney transplants from living donors in 2004 and 2006; the authors noted that she still has dialysis-dependent kidney insufficiency. The patient had an MRI in 2002 with Magnevist (Gd-DTPA) and in 2005 with ProHance (Gd-HP-DO3A). (more…)
As you read more of the published articles about NSF, GBCAs and gadolinium, you will find a lot of confusing and at times conflicting information. One thing I realized while doing my research is that it is important to consider when the article was published. It wasn’t until 2006 that the connection was made between NSF and GBCAs, and as time has gone on some of what was said in the earlier articles has been further evaluated which resulted in new facts emerging.